88-707 WHIYE - C�TV CLERK
PINK - FINANCE GITY F SAINT PAUL Council /�
CANARY - DEPARTMENT � �(
BLUE - MAVOR File NO• `J _���
Coun il Resolution ;�;�, ;.
Presented By
�'�� ��
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D. #22665) for a City of St. Paul One Day Gambling
Permit (Raffle Only) a plied for by the Baptist Hospital Fund, Inc.
at 642 E. 7th Street f r May 25, 1988, between the hours of 2:30 P.M.
and 4:�0 P.M. , be and he same is hereby approved.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimund
�� [n Fa or
Gosw;tz
Rettman
Sc6eibel � _ A gai n t By
Sonnen
� MAY ► 0198 Form Ap rov�d by Cit Attorney
Adopted by Council: Date ' / � ' �
/�
Certified Pass b ounci Secr r By
gy.
n
Appro by 1Aavor: t MAY � � � Approved by Mayor for Submission to Council
By BY
Pll�lISHED t��r:'7' � 1 198
. , . � �` 7 �`�
� UIVISION OF LICENSE AND P�:RMIT ADMIN STRATION DATE `�/ oZ0 �b/ � � �
INTERDF.PARTMF.NTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
Applicant � �1 Z,4 b�•h $-�'t , M�I� 40 3 / {4
�eA+e Address r�ct, J�S�O�/
Bus ine s s Name �. w„� K d, Home Phone
Business Address (/ �}�1 . Type of License(s) � � j}�r � �N I
Business Phone .. ��f'� ���� �Q�"t'�'� � �Q��'►'1�'� F��
Public Hearing Date �Q 1� � �� License I.D. 4l �.o1�.(p���
at 9:00 a.m, in the Council hambers,
3rd floor City Hall and Courthou e� State Tax I.D. �� N '�}
Tu ice Se ``!�'�+ Dealer 4� � �
llate A t A �
to Applicant � � N �
I'ederal Firearms 4�
Public Hearing � ---r
DATE INS ECTIUN
REVIEW VERFIED (COMPUTER) CUMMENTS
A proved ot A roved
�
Bldg I & D +
_ N�Q
Health Divn. '
�
N�� �
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Fire Dept. i �� �
i N I
! S�. I
Police Dept. �/L��
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License Divn. 0 K �
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�flco�
City Attorney �I�i���
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Date Received:
Site Plan � c.(�a��p�
To Council Research �
Lease or j�etter / Date
from Landlord �/�OJg�
:�wt
����_
' ��" Minnesota Charitable Gambling C 1 Board LAWFUL GAMBLING EXEMPTION
, ,:�
'�,��``� .� •�, Room N475 Griggs-Midway Building
�t 1821 University Avenue FOR aoaR�usE oN�v
� �. :
� �;Y.� - St.Paul,MN 55104-3383
j ,: �....�� (6121642-0555
[ ��
� ';
' :s- INSTRUCTIONS: 1: Submit request for exemption t least 30 days prior to the occasion.
�' �'''`' 2. When completing form,do not complete shaded areas until after the activity.
'�•""'-� 3. Give the gold copy to the City r County. Send the remaining copies to the Board.The copies will be
,.�".•
,`��_ returned with an exemption n mber added to the form. When your activity is concluded; complete
� PLEASE TYPE the financial information, sign nd date the form, and return to the Board within 30 days.
Organization Name Number of Members License Number lif currently or previously
, . Brlpti3C Rospita2 Fund� Z�C. �� licensedland/orpermitnumber. *!.�.Y l��pri„ntl
I:'�.r '
Addr s Cicy State Zip County
j•`'::'.: ^ G�, n,� � tnT r + p� (,
�6�+.: E. 7th Street �. . u�. .�,:� �5-.�?6 ,r?�e•�
�. : -
�= Chief Executive Officer's Name Phone Manager's Name Phone Number
�
Jah� i�eilir.g � 6I� '-^— 5�0 �?'.{..�uer'z Sti_.r:� ��=��.?�%'�'-5�"0
i'' Type of Organization N Other Nonprofit Organization ICheck One and attach proof of nonprofit statusl.
' ❑ Fraternal I� Veterans E� IRS Designation
'i ' O Religion ❑ Other Nonprofit Organization ❑ Incorporate with Secretary of State
Attach proof of three years existence. ❑ Affiliate of Parent Nonprofit Organization
', Name of Premises Where Activity Will Occur Datelsl of Activity,drawingls)
�iealthF.ast Corpo��te O:fice
. , _ .
Premises Address City State Zip County
6�ic �.. 7til .StT@E:t St. :��L2_ "'i ,`��:�(,. v<:....�e'.
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� .;: -.� � � �. u, -:� ;.:� ..,��,
.- Game Yes No . . ,- � � �� � � . �:� .�� � � .
Bingo v
.�
',�;V.
Raffles h
''"'�s;,: Paddlewheels �
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�:� Tipboards Y
k�.
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Pull-Tabs ;� �;
k
Use of Profit
t.TSBC�. t0 ptircl�.se prize£ iOr I'����.a.'. 3�1 Ln t^,��' �n7' C.^,:^_^_t!2'.'_�" 12PS�.rt! i?LLI(:^G;fr -�rnr.r,^?""TM,�,
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s� � ��'� ti 4 �� � �
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I affirm all information submitted to the Board is true,accor- a ,��
ate, and complete. ,�� E� .
� , .
�' . .�';.-:�^j. .'��.*„_;;a.'y^--!� r'-_�%�'-,� L
ChietExecutive Officer Signeture Date � �t�''��h''"��� „a�.•., ���`���`�v„
- ACKNOWLEDGEMENT O NOTICE BY LOCAL GOVERNING BODY
�. : I hereby acknowledge receipt of a copy of this applica ion.By acknowledging receipt,I admit having been served with notice
_� that this application will be reviewed by the Charitabl Gambling Control Board and will become effective 30 days from the
date of receipt(noted below)by the City or County,u less a resolution of the local governing body is passed which specifi-
cally disallows such activity and a copy of that resol tion is received by the Charitable Gambling Control Board within 30
days of the below noted date.
CITY OR COUNTY TOWNSHIP
Name of.local Goveming Body(City or County) Township Name IMust be notified when County is the approving body)
-.. ., .,_5 • j ,�"� ;�.�_i.� ��
:-w-.:'. Signature of Person Receiving Applicatio Signature of Person�teceiving Application
,'�x: ` .<<,, .� � c:�-v (�.; ��:/
Title Date eceiv,sd Title Oate
_ ! _ .. - 1 .
CG-WJ020-01 (6/87) White—Board Canary—Board returns to Organization to complete shaded areas.
Pink—Organizatio� Gold—City or County
' �.uy or�ain� raw -
Department of inance and Management Services
� • � . . �ic nse and Permit Division � a(Q (Q�
i , 203 City Hall
St. P ul, Minnesota 55102-298-5058
i � APPLI ATION FOR UCENSE
CASH CHECK CLASS NO. New Renew
� o a a o ��>
� oate � �.0 is , a
i Code No. Titie of Ucense
G
� From A � a��p��T�� 19
� .'?r�l.±' � I �rnv �G3 -l� •�DO '°�� 1
' t00 � G��,�;f ��r't� t �v n�,.�, t L
i ApplicanUCompany Name
� 100
� �y� � 7.�t� 5-�-�e c E'
100 Businsss Name
I
�oo J ( • �Q ���, �Ll�) 5� �O�o
� Busineu Address Phons Na
i , 100
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� 100 �� Ma71 to Addreas Phont No.
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' 100 � I I 2!r ��f`�►'1 �'�-t,��S
� ManapsHOwner•Name '
� �� - 7�a '
; �./:� 3 ��l�r vt �, '�-� ��,�o
� 100 AtanagsrlGw�sr-Flome Addmss Phons No.
; 4098 Applicatlon Fee 2 g�
f Fieceived the Sum of 1pp �j. �Ct��� J /r� �5/C�;
I �
^ .� ManaqerlOwner•Clty,Slate 3 Zip Code
I 10o Total 100 ,�Jo,i �ic�, ;f
( ' ad tdr e{I ze($SsL,✓
i (� / (/�
� llCense InSpeCtOr v By: ` �� Stgnature o(Applieant
�
i
�
� Bond•
Company Name PoNCy No. Expiratlon Date
j Insurance•
� Company Name Policy No. Expiration Date
Minnesota State Identification No. Social Security No.
� Yehicie Info�mation:
, Serial Number ate Numbsr
; Other. �
THIS IS A R CEIPT FOR APPLICATION
' THIS IS NOT A LICENSE TO OPEAATE.Your applicatio� for Iicense will either be granted or rejected subiect to the provisions ot the zoning
iordlnanca and completion of the inspections by the Health Fire,2oning and/or License Inspscto�a.
; �L•(�✓ ,
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,,��-'� '. $15.00 CHARGE OR ALL RETURNED CHECKS
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CITY F SAINT PAUL
� - � '� DEPARTMENT OF FIN CE AND MANAGEI�NT SERVICES
� DIVISION OF LICENS A1�'D PERMIT ADMINISTRATION
�
INPORMATION RE UIRED WITH APPLICATION FO PERMIT TO CONDUCT GAMBLING SESSION IN SAINT PAUL
Four sessions are allowed per qear, wit each session being a maximum of four consecutine
hours. This application and all requir d attachments must be filed with the License
Inspector at least thirty days prior to the requested date of the gambling event.
1) Name of organization {'jCl, � `i"� 0`� � 1
2) Address where• organization's regula meetings are held (.C��'Z �. ���' �f ��j Pu�
�cc�P
3) Day and ti.me of ineetings
4) Address where gambling session will be held G,GI,�/y�Q�
5) Is applicant owner of property wher gambling session will be held? � Yes No
6) If Ieased, who is the owaer of prop rty where gambli�g sessior. will be �.eld?
7) Name of officer making application � � e S ___.__
�w�rk-) �- .
8) Address of offfcer (��j S (p �,Date of birth \ ]o /i
�-_..�
9) Name of manager who will conduct g bling session J0�1 {n (2�.( �t V\.G� � Jo�3n ����
� wo�w�
LO) Address of manager 'f'� S e. S�L c�(i �
11) In connection with what event is th s gambling session being held?
vr. e� {�l i GC _ a�v�c.�a.,r � � l � �S$
12) What type of gambling device(s) wil be use � Paddlewheel Tipboard
Ra fIe �_ Pulltabs Bingo
13) Specify when gambling session(s) wi I take place:
HOURS:
Day(s) Date(s) aS 1 From: �� 30 To: �� �3_c�L�-
(Max of four hou�`s)
14) Will prizes be paid in money or mer andise? ��r G(�Q,v� � S�
r
15) Is the applicant association organized under the Iaws of the State of Minnesota? ��
16) How long has the organization been i existence? ,,,,�Q�, � y.���
, �
�' 17)��"What is the purpose of the organizat on? �� �k�'.�. C�@�_ !O C'�l'It�m(rr r T,
18 Officers of the organization: j
Name-Title Address Date of birth
� c��c�� 61 ..,
�,.(j .l/
�f f r=•r iRr,/J
V/
^,',
�-'�
/ 19)' Give names of officers or any other person paid for services to the organization.
� Naae-Title Address Date'of n,�,�t:: ,
.
Jo �� - ��� -1- (o�-a �. ���?'�a-�- 10 - 3� -�.'g
�c►� /V��.� - P��,�+ �'���-��. s'���'�.,h,�:r �.P�s1 � - 3 -�y 3�
20) In whose custodq will records of organization's gambling sessions be kept?
Name M.�� ��{�i�r Address ���,���.� �� ��'.
21) Attach a cover Ietter defining the event for which you are requesting this license.
� Attach a letter 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 fxom Income Tax", Form 990. [Chapter 419.04 (1) J
/ 25). -' Attach a copy of Depsrtment of the Treasury, Internal Revenue Service, "Exempt Organi-
`-� zation Business Income Ta::", 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 all Iaws, ordinances,
and regulations governing the operation of gambling sessions? �
28) Any changes desired by the applicant association may be ma.de 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 �. If answer is "yes", provide
names, addresses, and birth dates.
Organization: "�'"l� l Vl
• By: (Officer-Title) '" //�,c
and CJ � VvV1 �Q/i
State of Minnesota) (;lanagez in charge of ambling session)
) ss
County of Ramsey )
�
and
being duly swom 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.
Subscribed and sworn before me this �
day of 19 �c� ����aNM�^�/�M�`i+e�nr.�rw.n�+nner
. � :rr,,�1�i�,��f�': I'11,T��r��: � l.4'��' .:� �
� Y� iJ , 'i: ::r:i�1� 'S
.}.� , � � .. ,;';.i'Y.
i1i 1� .�y���� JV.,� 1[
� • �'�,
. Notary Public, County, Minnesota ���'�""` ,,,i eun��,,. �.a��s��i• t, ?s� 3
My Commission Expires wv��'�"^'v •
Building Department Approved Disapproved by
Fire Department Approved Disapproved by
Police Department Approved Disapproved by
i�?�Y AZ'LJOOD l��OZ�- �U Harold'B aman, M.D. �Z ��✓'� '
90 67es�t Poir�t Av�nue •���St Paul Medical CC�nnter �
�l'o;�lca Bay, r�v 55331 2579 Se th Avenue East
� � North St Paul, N�1 55109 `
�ia �ii� L1-3-193`-f E. r�it � �f_ 1� - � � �-33
559 Capitol 31vd 8716 Ir wood 'I'�ail North Sister Karen ICennel.ly
St. Paul, MN 551�3 �e , � 55042 1gggJ�RandolpAhmAvenuet�
St. Paul, NIlV 55105
John �eiling/D-30-�{q �yle Ha lin� - U�L' p Joseph O'Neill 1 �-��- J ,
H e a l t h F'a s t 14805 L1 ds Drive 0 Neil l, B u r k e & O'N e i l l
642 E 7th �e N�T 55345 800 Norwest Center
St. Paul, N�I 55106 ' • 55 E Fifth
' � St. Paul, N�V 55101
Tom Eecken�- 15-3 �o Rev ess�'a��
` � � ._;
11860 21st Street No 1400 S�ou R bert JO� M��tirel � -�O�
Lake Elmo, NIl�T 55042 West St. aul, N�T 55118 �'oridolet C.�m�nity Hospitals
2414 South 7th
Minneapolis, NIl�T 55454
A. Kent Shamblin � - ��- r 9 35 Robert Be k, M.D. �-S` �3 Timothy Hanson ��'-O� �O � / �p
St.- Paul Companies Co�no Park Physicians, P.A. HealthF'rast
385 Was�hington 801 �ont Street 642 E 7th
St. Paul, NIl�1 55102 St. Paul, NIl�1 55103 St. Paul, N�1 55106
� ����g i�-�o-aq S'fAFF
400 DCA Center �9� J on, M.D. �-a�3�, FYederick Putzier ��-3-?,(�
13100 Wayzata Blvd 570 Docto s Professional Bldg HealthEast
Minn�tonka, i�'E� 55343 1690 [Tniv sity 642 E 7th
St. Paul, 55104 St. Paul, D�1 55106
Carlos Luis 3�J q- i9/�' John Sarg t, M.D. Z�S"�� Chris Quinlan �a-3 � - L-��
Hubbard Broadcasting Rice Stree Clinic HealtlzEast
3415 University AVenue � 1006 North Rice Street 642 E 7th
St. Paul, NIl�I 55114 St. Paul, 55117 St. Paul, N�T 55106
Dianne Arnold �� ,y �'� -� -
John Ga er M.D. �-ag'`�� Vinc2 Ei.lers �I.D.�� ���y
First Bank National Assn �� �j, Clinic `� St. Anthony Ort�opaedic Clinic
332 Minnesota Street 651 Arcade Street 1661 St. Anthony
St. Paul, NIl�1 55101 St. Paul, 55106 St. Paul, NIl�1 55104
Roger Foussard �I- I�j-a$ `3-{O �--'�
Q�rist Fole M.D. � Ma�'kwardt
Foussard Nlanagement °� y' i �� 100 West ial Drive
American Nat'1 Bank #1520 17 �t Ex ge #804 ^.� �P�'�
St. Paul, NIlV 55101
St. Paul, 55102 5-g�� West St. Paul, N�1 55118
i93�,
Jerzy Robertson, PhD ��-Z S' Ronald Piz' ger, M.D. ��-�Z��
Life Sciences Sector 3M 280 North 'th #855 �
Buildi.ng 220 3M Center St. Paul, 55102 BI�' BQARD OF DIRDCT()RS
St. Paul, NIlV 55144 ORIGIl�,TED 9/1/87
Frederick Washburn, M.D. 7 .
Aspen Clinic �
1020 Bandana Blvd W •
St. Paul, NID1 55108
r. � ' . 'f
_ ' + � #$�Z/
February 16, 1988
James Harris, Auditor
MINNESOTA CHARITABLE GAMBL NG CONTROL BOARD
475 Griggs-Midway Buildin� Room N
1821 University Avenue
Saint Paul, MN 55104-3383
RE: Lawful Gambling Exemp ion Request/Baptist Hospital
Fund, Incorporated
Dear Mr. Harris:
This is in follow-up o a couple of conversations we've had
with you relative to a raf le ori�inally scheduled for January 9,
1988.
I am enclosing the fo m of raffle ticket that was used in
respect to the HealthEast asino Night program. The program was
intended only for employee , physicians and officers and
directors of HealthEast an its subsidiaries. The raffle tickets
were sold only to persons 'n those cate�ories.
The Board of Director memb rship of Baptist Hospital Fund,
Incorporated is twenty-fiv .
Since the raffle tick t did not include specified place and
time for the drawing and s nce the date it was intended for,
January 9, 1988, has long ince passed, it is proposed that upon
receipt of the exemption f om the Charitable Gambling Control
Board that a notice will � out to all participants which will
. , . . � �- �o �
r,
�, � �
. . •
Mr. James Harris �
February 16, 1988
Page Two
specify a date and place fo holding the drawing to be not less
than 15 days nor more than 0 days after receipt of the
exemption. The place for h lding the drawing will be 642 East
Seventh Street.
There are no profits r sulting from the sale of the raffle
tickets. If there were the would have been used for various
health and education pro�ra s which are sponsored by the Baptist
Hospital Fund and/or Healt ast, including no-smoking pro�rams, I
Can Cope programs, prenatal education, etc.
The total value of priz s to be awarded is $
If there' s anythin� fu her you nesd in respect to the
enclosed application please all me.
Sincerely yours,
Frederick J. Putzier
Vice President and General C unsel
plz
enclosure
54. f jp21
��'' 7��
t�1�6NNA ._ . �sMr�►reo o��co�xareo C
�� �a�'cfiedi- . C7F�E����►���� N0. ���v 9�
� � �f � . . . .. � DEPARTMENT DIRECTOR� � � AAAYOR(OR ABAIBTANT) . .
Christine Rozek , , rw�F �a��o.� 3 c�«.� .
. : �AOT Ho�m�c ��oR 2 Council Research
Finan�c�e..� Mn . t. : 29,$-5456 °no�s: 1 cm��
Application for a Qne Day City of St. Paui Gambling Permit (Raffle)
NOTIF�CATiON DaTE: April �6; 1988 HEARING DATE: � May 10, '1988
twMS:UvP�`(y«�I•�i�� cot»�. nEponT: . .
.
. .� � ..RJINIMN(i COM�8810N CNL BEAVM.E COMMN33ION � DATE M DA7E GUT � AlNLYST � . . . '.hWONE NO. . .
�� ����� L�1 L5 ��
�� - ��� � �� _�,..,�.�_ ���� �o�„�,�
—r�,�,wo�n+ro. —�oe�,c,ioo�*.
asrmcr c�ou+cti
•ocv� „
��,�� Cou:ncii Research Cent�r
: MAY 0 3 ��88
..,,�„��,�.��,,�.,�.�.�,: .
, Elizabeth Stttes, on behalf of the Ba�tist ospital Fund, Inc., requests eouncil approval
of.t�eir application for a- Ci:ty o:f St. Fau 0ne Day Gamh��:ng Permit (Ra.€f3e Unly)• Tt�e
raff�e wi�l be heZd -at 542 E. 7th Street o May 25, 19�8, bet�aeen the hours of 2:3A'p.M.
` - a�d 4:30 P.1�. Proceeds wil� be �sed for v rious health education programs.
: aa�,n�es,��; ;, , , .
A11 a�ip�i�ations and fees have been subrait ed 30 days prior to the event. A}2 requirements
of �,�gislative code 402 have been met.
-
_ C�O�;(VM�.w�w,.ana ro xn,on,): _ . . _ .
If cA�.tncil approvaZ is granted, the�Baptis Hospita� Fund, Inc. will be able to hold
their .raffle. If council approval is not iven, the raff}.e-wi21 not be held.
_
,��u►rnres: vnos . coNs
wsroRr�o�ra:
tton��ssuea: