88-561 wHi7e - ciTr CLERK COUt1C1I /}, ��/
PINK - FINANCE G I TY �O SA I NT PA U L
CANARV - DEPARTMENT Y �//
BLUE - MAYOR File NO• �� �V -
Counci Resolution �
Presented By °L
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D. #23827) for a City of St. Paul One Day
Gambling Permit (Raffl Only) applied for by the Alliance for
the Mentally I11 at 20 4 Randolph on April 28, 1988, between
the hours of 7:30 P.M. and 8:15 P.M, be and the same is hereby
approved.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
�.ong [n Fav r
Goswitz
Rettman � B
scheibe� A gai n s Y
Sonnen
Wilson �p
AI"{� , � �� Form Appr ve� by Cit Att ey
Adopted by Council: Date �
Certified Yasse '1 Secre BY— �
By
tapprove y IVlav r., �, � � Approved by Mayor for Submission to Council
Bjr BY
Pi1BtIS�E[� A P R 3 � 1 $g
TOR o,�re .w oete oorr�,�to �f,�����
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ApQroval of a City af Satnt P� Q�e Gaomb]�.tx�.�.t�#f].eca�ly) .
Cour��il Research Cente�
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. I]A'�E: 4/6/88 LIATE: 4J19/�3 - �
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tw�tMr+a�r t�i«p.�.a:ca�i c� n�ortr: - _ ;
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aowq�low _ ieD exs aC�+oa sou+o � �' 7 t/'z� �
s►� � t�rren co�+�seion � �s�s . �oot�o.�nom* __.��o�ot�� _�*
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Noa�na �i�tmer,- on betsal.f of tt�e Atl�:at�ce ; tt� i�nt�ly �11, ;�sts 'Oo�u�c,i�. app6rdval caf
tt�eir a�plicatica� for a (3�ie �ay C3;ty af t Pau1 Gat�bling P!e�t f ILaff les c�Y) . The �f'�.e
�i17. be he� at the Col].ec,� of St. Ca , . �' 20fl4 �ar�3o2� Aven�e, ari Apri1 2�, }��f8,bei�ra�e� .
t�l�e"hours csf`7:30 p.m. az� 8s15 p.m. raff� W3.].I:�:be i�eI.d al,r�`c�oc�junei:�,�n with the�.ir
�r�aw�al fi�d rafsing ev�t. Proceeds wil be used to i�x�v�e the lives of th�� �nen�ll.y il� arid
the3s f�il.i.ps. .
- . . . r�nr. _ . ,. . ... . _ ;.
If C3otaticil a}�a��al. 3.� grantsd, the fca� the Nlenfially �ll,. wh�h has be�z it� e�cistezx�e ,
�for 13 years, wi11 be able tc� hc�ld their fle,: - `
COIMQOf�{YMet,.MRwn��nd To NAam): . , ,� .
If Co�aicil a�p�oval is n�ot grant�ed, �Ehe . lianc.�e for the Mentally Tll��1:11;;,be �nab7.e._��hio��d. ,
this raff�.
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UIVISION OF LICENSE AND PERMIT ADMINI TRATION DATE 3 a� 8�i � � ��
INTF,RDF.PARTMENTAL REVIEW CHECKLIST Appn Pro essed/Rece ved by
Lic Enf Aud
Applicant ���/N�Q J���Q(' Home Address t0 ��' ��� ��
Bus ine s s Name �. Home Phone ��j)Q �����51�Q c�{
�I't"Fa f��/.2L.[.
Business Address Type of License(s)
aQo 4 an P /'
Business Phone � . Q� ' (�,am�jl�n
� d -t�rn i.-� L /� n/ti�
Public Hearing Date t p License I.D. �6 �?Z��_-7
at 9:00 a.m. in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. 4� � ��
llate Notice Sent; aler 4E � '/q"
to Applicant ��g �y
rederal Firearms �� N I/�
Public Hearing --T
DATE INS ECTIUN
REVIEW VERFIED ( OMPUTER) CONIlrIENTS
A proved ot A roved
�
Bldg I & D ��� +
Health Divn. � �A '
�
� li
Fire Dept. i �� �
� I
Police Dept. � �� I '����
License Divn. ��/ �
i t`
i b
� �.
City Attorney �
�
Date Received:
Site Plan
To Council Research `� � ��
Lease or ett r � Date
from Landlord � �
r ����
� �. Minnesota Charitable Gambiing Contr I Board LAWFUL GAMBLING EXEMPTION
, � Room N475 Griggs-Midway Buiiding FOR BOARD USE ONLY
�:,,`;
',�;r�:� ' 1821 University Avenue
x�; - St.Paul,MN 551043383
'`�.:� ` (6 7 21 642-0555
,,__ �,....;�
,_ ,
R��� .:• �
'Yj r�.� INSTRUCTIONS: 1. Submit request#or exemption a least 30 days prio�to the occasion.
,�`'�i` 2. When completing form, do not omplete shaded areas until after the activity.
!F,,,�,,. ^ 3. Give the gold copy to the City r County. Send the remaining copies to the Board.The copies will be
�_i' ;�� : returned with an exemption nu ber added to the form. When your activity is conctuded; complete
" � PLEASE TYPE the financial information, sign a d date the form,and return to the Board within 30 days.
Or anization Name Number of Members Lice�se Number lif currentty or previously
A� liance for the Mentally I11 of N 24 board Iicensedland/orpermitnumbenOt �t'C@C�SE�
; Ad r s ' �ty State Zip County
� -2�� Fort Road St . Paul MN 55102 Ramsey
. Chief Executive Officer's Name Phone Manager's Name � Phone Number f
��,�' �., �/��' } .ti /.
Howard L . Agee �612� 781-3 84 �;.- , . _ , . ,� ,� . , y.,: . ;` �-,
Type of Organization If Other Nonprofrt Organization(Check One and attach proof of nonprofit statusl.
s��: � Fratemal ❑ Veterans C�J IRS Designation
❑ Religion L� Other Nonprofit Organization ❑ Incorporate with Secretary of State
. _ - Attach proof of three years existence. O Affiliate of Parent Nonprofit O�ganization
� ame of Premisgs Where Activity WII Occur Datelsl of Activity,drawinglsl
+ � �ast Marion Lounge, Col lege of St. Cathe in e
� ��' P is s ddres Cit State Zip County 4�����
, -
��� �an�olph Avenue S�t. Paul , M1V 55105 Ramsey
t Game Yes No ��
� y: Bingo X
�'„.
C 'y r� ' _ -
� '��, • Raffles � X -�
4°a.��-�`,.
i ��a .
��;`Paddlewheels X
g�
; :` Tipboards X
' ` Pull-Tabs X
�•
a . se of Prof'
� F� �: �enera`� operati ng of the organi zati on.
� A
E , . _
� ,
t .
. � . �
�
I affirm all information submitted to the Board is true, cor- ��.' ��i�i`"�iaC#uifti�' �ot�"'�brnittecf�4;�;�;i`B��i�
, �« ��� ��+� *�� �� ,i�, r, �
' at end cv►�plete. � �� � �'�' �'�� �
� '}`�`� � � V /��.../t�
Y �
' � � '' Chief Ezecutive'6,fficer Signature Date �lisf E�te�tlt�i4ENflC�s �,��4
..
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ACKNOWLEDGEMENT OF OTICE BY LOCAL GOVERNING BODY
• I hereby acknowledge receipt of a copy of this applicati n.By acknowledging receipt, I admit having been served with notice
� = that this application will be reviewed by the Charitable ambling Control Board and will become effective 30 days from the
� '"' - date of receipt(noted below)by the City or County, unl ss a resolution of the local governing body is passed which specifi-
' ;�;:,' - cally disallows such activity and a copy of that resolu on is received by the Charitable Gambling Control Board within 30
days of the below noted date.
, . CITY OR COUNTY TOWNSHIP
a' Local verr�ny�od�,jy4 or Co ty) , Township Neme IMust be notified when County is the approving bodyl
Xl�l.
� y r Si ne re of Rec iv' Apolicati , �,� .v Signature af Person Receiving Application
;
e��
''` T le�' �� �/�ta-R Title Date
CG-00020-01 (6/87) White—Board Canary—Board returns to Organization to complete shaded areas.
Pink—Organization Gold—City or County
_ City of Saint Paui (%/`—�6��
. Depa�tment of inance and Management Services 3���
: Lice se and Permit Division �1
' = 203 City Hall� 4`
St. Pa , Minnesota 55102-298•5056
APPLI ATION FOR LlCENSE
; CASH CHECK CLASS NO. New Renew
° a � � � � 0 3 a� � l1Sr�
Date �'
Code No. Titfe of License From °� � 1B�TS�J� � 19
c,.� i�C� - Iz Lc��`7� ( �� �
ioo /-} �� iQ i�4� #�r --�:w =`i�,,-�-a/l i ��
ApplieanUCompany Name .
100 ^• '?
�.
� � 1 �
�.����CvL. �-1 v� • �_C.. �t: i�� _�_
100 Buslnesa Name `-'
,00 a o v � ,��n�l���`
Busineas Address Phone Na
100 �
S � ' G c.��� /�'�'� -�-J /(�_
100 Mail to Addreas P�one No.
�� �..� t��:�t � S��r, �3, ? r---
ManapeHOwnsr•Nams � 'G �
,� �� � 1 �-veliF�l�u y����
100 AtanageHGwner-Home Addmss ( Phone No.
4098 Application Fee 2, 50 (�
Received the Sum of 10`0� � ( - "rG�,�� /�'� ,7 5� l iu�
' �. � J Mana yeHOwner-Cit y,Slite 3 Zip Code
100 otsl 100
� `
Ucense Ins ector v � B : ���� , ���A � �
P Y Signaturo of Applicant
Bond•
Company Name Policy No. Expiration Oate
Insurance:
Company Nams Policy No. Expiration Date
Minnesota State Identification No Social Security No.
Vehicle Information:
Serial Number lats Number
Other.
THIS IS A R CE1PT FOR APPLICATION
THIS IS NOT A LICENSE TO OPERATE.Your application for icense wiil either be granted or rejected subject to the provisions of the zoning
ordinance and completfon ot the inspeciions by the Health, Fire,Zoning and/or License Inapectors.
$15.00 CHARGE R ALL RETURNED CHECKS
� •, 1`� �, ,�
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T` � ��Y� 7� J���
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CITY F SAINT PAUL ��`S��
_ - ' " � DEPART�NT OF FIN CE AND MANAGFrKENT SERVZCES
' DIVISION OF LICENS A.\'D PERMIT ADMINISTRATION
INFORMATION RE UIRID WITH APPLICATION FO PERMIT TO CONDUCT GArIDLING SESSION IN SAINT PAUL
Four sessions are allowed per year, wit each session being a maximum of four consecutive
hours. This application aad a11 requir d attachments must be filed with the License
Inspector at Ieast thirtq days prior to the requested date of the gambling event.
1) Name of organization AllianCe for t e Mentally I11 of MN, Inc.
2) Address where� organization's regula meetings are held�76 Snellina Av. NO., St. Pdul
3) nay and time of ineetings 2nd Thurs /mo.• 7:00 .m. ; 6-7 times/ ear
College of St. Catherine, 2004 Randolph Ave.
4) Address where gambling session will be held St. Pdul . MN 55116 - St. JOSeph Hdll
5) Is applicant owner of property wher gambling session will be held? Yes XX No
6) If leased, who is the owner of prop rty where gambling session will be held?
College of St. Catherine
7) Name of officer making application oward L. Agee, President Board of Directors
8) Address of officer 1011 415t Avenue N. E. , #313--Mpls., 55421Date of birth 2/9/25
9) Name of manager who will conduct g bling session Norma Simmer �1!?�o�.S
10) Address of manager 1709 Wellesley venue, St. Paul , N6V 55105
lI) In connection with what event is th s gambling session being held?
Annual fund raiser, including ente tainment
12) What type of gambling device(s) wil be used? Paddlewheel Tipboard
__' . Ra fle XX Pulltabs Bingo
13) Specify when gambling session(s) wi 1 take place:
HOURS:
Day(s) Thursday nate(s) pril 28, 1988 From: 7:30 p. m. To: 8: 15 p. m.
(Maximum of four hours)
14) Will prizes be paid in money or mer handise? merchandise
t
15) Is the applicant association organi ed under the laws of the State of Minnesota? e� S
16) How long has the organization been n existence? 13 years
17) what is the purpose of the organiza ion? Impl"OV2 lives of inentally ill and families
18) Officers of the organization: � 1
Name-Title Address S�� Date of birth
/d - /s� If�F.�d� ;?
f
Jack G. Brown , ice President 194 Cedarhurst, Dee haven, 55391 t� i �� � �r i_�
Virginia Roach, Secretary 162 Oak Avenue, Arden Hills 55112 3�$I3�0
Jeffry Boston , Treasurer 1153 Summit Avenue, St. Paul 55105 /�f'y��S,,�,,- _
19) Give names of officers or any other person paid for services to the organization.
Name-Title Address Date of Bir.th
N/A
I�f A �
20) In whose custody will records of organization's gambling sessions be kept?
Name Alliance for the Mentally I11 of MN address 265 Fort Road, St. Paul . MN 55102
2I) Attach a cover letter defining the event for which you are requesting this license.
22) Attach a Ietter of permission to conduct the gambling session at the requested address.
23) Attach a copy of your organization's membership roster and date each member joined.
24) Attach a copy of the Department of the Treasury, Internal Revenue Service "Return of
�Organization Exempt from Incame T�", Farm 990. [Chapter 419.04 (1)j
25)�Attach a copy of Department of the Treasury, Internal Revenue Service, "Exempt Orgaai-
zation Business Income Ta.Y", Form 990T. [Chapter 419.04 (2)]
26) Attach the annual report required of charitable organizations by Minnesota Statutes,
Section 309.53. [Chapter 419.04 (3)]
27) Have you read and do you thoroughly understand the provisions of alI laws, ordinances,
and regulations governin� the operation of gambling sessions? Ves
28) Any changes desired by the applicant association ma.y be made only with the consent of
the License Committee.
29) Has any person(s) participating in the operation of any of the gambling sessions
covered by this license ever been convicted of a felony in the State of Minnesota or
in any other State or Federal Court? Yes No XXX . If answer is "yes", provide
names, addresses, and birth dates.
Organization: Alliance for the Mentally I11 of MN, Inc.
By: (Officer-Titl C � .
and •
State of Minnesota) (Manager in charge of gambl.ing session)
j ss .
County of Ramsey ) � , �
✓� G��yLC1. anl
being duly sworn say that they are the petitioners in the above application; that they have
read the foregoing petition and know the contents thereof; that the same is true of their
own knowledge.
N Anr,iv./�/�M�.1nnAi�,V�;,.�nMA/.^.A/.^.,n.�\MAM a
Subscr�'1bed and sworn before me this Qp 5 � . �•�>�ss�te t�. NE�MAN
�S dSy Of /Y)A2CN 19 O d �`�r��" NO7ARY PUBLIC-MiNNESOTA
` '�,..�:
P ��fNNfP1N COUNTY
' . � ' ._
^� A � �^ �n�J � ��y Cow�m.:spires Dec. 35,1991
�����w� �i� t`:�v��•avvvvwvva.•vvwvwvwvvwvvvWR
Notary Public, County, nnesota
My Commission Expires �. IS. �n19J
Building Department Approved Disapproned bq
Fire Department Approved Disapproved by
Police Department Approved Disapproved by �
. _ ���
k ....... _ ...:.:.<�:.. .......... . ... . . - .. . .
Alliance for the Mentally lll
of Minnesota M�..�...«
1M MN1MN�MNne�
�p ryy Y�M�1ry IN
(fameAy Menlal Hes11A Adraeates Coaldion) ��p
�S �pp� St Psul,Mlnnhoq 55102 (612)242•Z741
Marc 15, 1988
- City of St. Paul
Depa tment of Finance & Management Services
Divi ion of License and Permit Administration
Room 203, City Hall �
St. aul , MN 55102
�
- To w an it may concern:
The verrt on April _28, 1988, is our Annual Fund Raising
Eve . It will provide entertainmerrt, and a social
hour, as well as the raffle. The invitation, which
is b ing sent to' our membership, is attached for
your review. .
; I
Sin rely,
,`� lG���r/ .
t��
Deb rah L. Miller
Off'ce Manager
��-���
, _ .
� _ __ . _ -- . . _ . . ..... _ -
_ °o�ct ,
.
. Zooa r�,da+�sc ra,�nn�,nes�or� ssas ,
so.�;.�s«„� .uA�
�a� ��
March 17, 1988
Dear Ms. Sicrmer,
It has been brought to our attention that the
iance far the Mentally I11 Fund Raiser
scheduled for April 28, 1988 will include a raffle.
collec� is aware of this event and has
rov�ed tl�e raffle in conjunction with the
d Raiser.
, incerely,
/��
a F. J n
pecial-Events Coordi.nator �
���--�'
_ .�t••., CITY OF SAINT PAUL
'� ' DEPA TMENT OF FINANCE AND MANAGEMENT SERVICES
+ 'n. we .
DIVISION OF LICENSE AND PERMIT ADMINISTRATION
.��. Room 203,Ciry Hall
Saint Pauf.Minnesota 55102
George Latimer
Mayor
4/6/88
To: Virginia Baisley
From: Christine Rozek
Re: Record Check
In connection with an appl cation for a One Day City of St. Paul
Gambling Permit, Raffle On y, at 2004 Randolph Avenue, a. record check
is requested on the follow ng:
Harold L. Agee Jack G. Brown
1011 41st Avenue NE . 19405 Cedarhurst
Minneapolis Deephaven
Birthdate: 2/9/25 Birthdate: 6/27/27
Virginia Roach Jeffrey Boston
1628 Oak Avenue 1153 Summit Avenue
Arden Hills St. Paul
Birthdate: 3/8/36 Birthdate: 12/7/52
Norma SiRaner
1709 Wellesley
St. Paul
Birthdate: 3/17/25
CR/car
. . ���i
+�`�,..., ' CITY OF SAINT PAUL
DEPA TMENT OF FINANCE AND MANAGEMENT SERVICES
� i�i ;'
., „a DIVISION OF LICENSE AND PERMIT ADMINISTRATION
���� Room 203, City Hall
Saint Paul,Minnesota 55102
George Latimer
Mayor
April 6, 1988
Norma Si�er (Alliance for he Mentally I11)
1709 Wellesley
St. Paul, MN 55105
Dear Ms. Simmer:
Your application for a City Gambling Pe=mit has been =eceived in this
office.
A hearing on your applicati n for Raffle ID �(s) 23827 will be held
before the St. Paul City Co cil on April 19, 1988 at 9:00 A.M., Third
Floor of the City and Count Court House. This date may be changed
without the License & Permi Dfvision's consent and/or knowledge.
Therefore, it is suggested hat you call the Citq Clerk's Office at
298-4231 to confirm this he ring date. .
You are hereby notified tha qour atteadance is required at this
meeting. Failure to appear y result in deaial of qour application.
Ve -'trulq qours,
,��'j�7 '
� f �,
oseph . Carchedi
License Inspector
JFC/lk