88-772 WHITE - C�TV GLERK
PINK - FINANCE CO�IACIl �J
CANARV - DEPARTMENT G I TY O SA I NT PAU L /
BLUE - MAYOR File NO• `�r�
� � , Co c 'l Resolution ;�"�f,, ,
Presented By
Referred o Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D. #46258) for the renewal of a State of
Minnesota Class B Gam ling License applied for by Shop Pond
Gang, Inc. , 991 North Lexington (Gabe's by the Park) be and
the same is hereby ap oved/dw�ed.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays ,
Dimond
Lo� [n Fa or
Goswitz
Rettman
Scheibel d _ A gai n t BY
Sonnen
��i�}een
MAY � 7 � Form Ap roved by ' y Attorney
Adopted hy Council: Date • L /,(/
Certified Passe ncil Secre By— J b �S�
�y,
Appro ed avor: Date � p►pproved by Mayor for Submission to Council
By By
Pt�llSHE� (vi,�,Y ` � 1988
. ��_7��
DIVISION OF LICENSE ANI) P�RMIT ADMI ISTRATION DATE I 1 q ��/ �/a5� p �
INTERDF.PARTMFNTAL KEVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
Applicant �(��jQ�^'� �• �1 U.S� h'la i7 Home Address ��� �� ��SSC�1'Y)InQ/�3��
Rusiness Name 5 !�� Home Phone � �S " �Oµ�
Business Address `71 �� C.U(�Yl n Type of License(s) �:i,�G �..tQSS �
Business Phone 'l. �Y1�JQ$'�• �-Q.�,,,�
Public Hearing Date 5 g� License I.D. �l �(pa�
at 9:00 a.m. in the Counci Chamber ,
3rd floor City Hall and Courthouse State Tax I.D. �� IU/�'
llate Notice Se � Dealer �� �/�"
to Applicant l /y�g' �
P'ederal Firearms �� A'
Public Ne<iring -�
DATE INS ECTIUN
REVI�,W VERFIED ( OMPUTER) CUMMENTS
A roved ot A roved
�
Bldg I & D � �
�J ,L� '
Health Divn. '
; ���- �
�
Fire Dept. � �� �
i �
I S y. I
Police Dept. �I��
License Divn. ,
�
I
City Attorney �
� ��� ;
Date Received: '
Site Plan N !� � (/
To Council Research a
j,�,� or Letter Date
from Landlord � � g�
� ' , } . ~ � , i � Vr a�1 �IV
,�=��.... Charitable Gambling Control Board
� Rm N-475 Griggs-Midway Bldg. For Board Use Onry
� �� 1821 University Ave. Paid Amt:
- = St. Paul, MN 55104-3383 Check No.
:....:'� (612)642-0555 Date:
''�� . 'GAMBLING LI ENSE RENEWAL APPUCATION
:,�,
�,, LICENSE NUMBER: ''�� 1- /EFF. TE: y � /AMOUNT OF FEE: ; •W -
�� 1.Applicant-Legal Name of Organization 2.Street Address
�� SHO� �Qh'D � aM� i270 �i Laroentenr ��7
�:; �
r;i�- 3.City, State,Zip 4.County 5. Business Phone
-r 9t Pavl. �Ad 5511"s Ra�sev oiP 488-2426 .
,a
6. Name of Chief Executive Officer 7. Business Phone
"; _ RiMarO ;Soran Si2 64�-�)25? -
$ 8. Name of Treasurer or Person Who Accounts for Revenues 9. Business Phone - � •
`� Ph i l i� +�os�a:ni ic 522 488-�4?.fi
:,f
�' 10. Name of Gambling Manager 11.Bond Number 12. Business Phong ' ` '
,7r_.tr2� +!�sstern+an 65;Ic�s4962?OtQ �. ��'
13. Name of Establishment Where Gambling Will Take Place 14.County 15. No.of Active Members
;� nabes hv :_?� aarK Sk ra�i; - Rae�ev _ 17c^
16. Lessor Name 17. MonthlX Rent:
b'abes hv �he t�art� �+�
. 18. If Bingo will be conducted with this license, please specify d s and times of Bingo.
Days Times D s Times Days Times
19. Has license ever been: ❑ Revoked Date: ❑ Suspended Date: ❑ Denied Date:
i
20. Have internal controls been submitted previously? . �3.Yes ❑ No(If`No,"attach copy) •
21. Has current lease been filed with the board? �Ye3 0 No(If"No,"attach copy) � -
_ 22. Has current sketch been filed with the board? _ ;�1•Ye� ❑ No(If"No;attach copy) �
-: _ ,_..._,�.,..�._
� GAMBLI G SITE AUTHORIZATION . ^ y
By my signature below,local law enforcement officers or agents the Board are hereby authorized to enter upon the site,at any time, gambling is
, being conducted,to observe the gambling and to enbrce the law or any unauthori¢ed game or practice. ,
y BANK R CORDS AUTHORIZATION -.•-•- •-
By my signature below,the Board is hereby authorized to inspect the bank records of the General Gambling Bank Account whenever necessary to
_ fulfill requirements of current gambling rules and law. 4
OATH
i I hereby declare that: ° . >._ -. � '
1. I have read this application and all information submitted ta th Board• � � - ... %
2. All information submitted is true, accurate and complete; ,_
� 3. All other required information has been fully disclosed;
4. I am the chief executive officer of the organization;
5. I assume full responsibility for the fair and lawful operation of a I activities to be Conducted;
6. I will familiarize myself with the laws of the State of Minnesota especting gambling and rules of the board and agree,if licensed,to abide by those
Iaws and rules, including amendments thereto. -
23 Official Legal Name of Organization Signature(Ch ef Execubve Officer) Date Title
, , ,, ; ; f , �;
�. �t � � , +t ,- _ .. � ; l -t
� ,.�-rU�:; �Gs�'�..T/GU`r°'� .-�d�('i. �..�/f r' -- f,��c.r.-� `.�• t..::+t t�
� ' � ACKNOWLEDGEMENT NOTICE BY LOCAL GOVERNING BODY �y - .
I hereby acknowledge receipt of a copy of this application. By ack owledging receiprt, I admit having been served with notice that this application will
be reviewed by the Charitable Gambling Control Board and if appr ved by the Board,will become effect+ve 30 days from the date of receipt(noted
below), unless a resolution of the local governing body is passed hich speci�cally disallows such activity and a copy of that resolution is received by
the Charitable Gambling Control Board within 30 days of the belo noted date.
24.CitylCounty Name(Local Eiqverning Bqdy) Township:If site is located within a township,please complete items 24
.,�� f; ,�, �LU�I.s..� and 25:
Signature of PersoFt Receiving Application: 25.Signature of Person Receiving Application
`. ��� -
�l
U• � ,(),..�..�`�"'.,�`�Z.-v �'� �+�
�
Title� ,,Date Receive�this date b ms 30 dfiy�pe' d) Title:
L:a :.�J'-J'11.;�,�.:i-^ �J+-� �� �q 1 '�
Name of Person Delivering Application to Local Goveming Body: Township Name
_ r
CG-00022-01 (5/8� White Copy-Board Canary-Applicant Pink-Local Goveming Body
-- ._ . �r . ._ . ... . ..«...
+ . �
• ' • ,, City of Sai�t Paul Vr" 0 9 �?7
• � . Department of F nance and Management Services �!_ a���
� Licen e and Pertnit Division �p
203 City Hall
_ , St. Pau Minnesota 55102-298-5056
APPLIC TION FOR UCENSE
CASH CHECK CLASS NO. New Renew
0 0 — 0 0 Date ��' ' ' t9 ' s
Code No. T(tle of License 2.0 G� 1 -� �C,' �
From � 19`�To y � � t9 �
., `� 1� I �
T�'� .f 1 C_ fJ �`1!� �r.,��,� rt r. �^ 100 •� v ��� a rl �;� �'l� ,1 ' Yl<
� � -.� - -
� ` , A IlcanUComparryr Name
�1"', r ,�,p<. �, <'. C-»-r i r� T�:1 PP �-
� 100 (�1 1 ;
-I �'( i ��..� ,,.,1 !� � , , ,.. f.,-,,.
100 8usinsas Name ..
100 � � . l i',-�,,,,,t ,�1,� �1 _� �: ��, �
� ,
Businsas Addresa PAon�Na
100
100 Mail to Address PAone Na
10o I ' J L� T `.' ':\ J-r' �
ManapeHOwnsr-Nam�
100 � �( ,��. `�<< i �r� , .J� t i .� �
v
100 Alanager/Gwnsr•Horta Add►ess Phone No.
dpgg Applicatfon Fee 2, 50 �� I
Recefved ths Sum of . �pp �i • J'f► Gi i � �V� ,� ���,;�
%'"]'� .�•i ManagedOwna•City.Slsn 6 DP Code _ r
100 T tat 100 � ��� ������
�/ `I �' 1 '`�/ ����__� G. �1�+ A�1�h��
License Inspector BY�
�� Siynaturo OI Applitant
Bond' Expiration Oate
Company Name Policy No.
Insurance: ExpiraUon Date
Company Name Policy No.
Minnesota State identification No Social Security No
Vehicle Information: a�eNwnoar
Serfal Number
Other:
THIS IS A R CEIPT FOR APPLICATION
THIS�S NOT A LICENSE TO OPERATE.Your apptication for I cense will either be granted or reJected subject to the provisions ot the zoning
ordinanca and completlon of the inspections by the Health, ire,Zoning and/or Licensa Inspectors. .
$15.00 CHARGE F R ALL RETURNED CHECKS
11�
�,�a�� -
�' �las1 �� c,t�
� �
ea�,
� _-r.. . � . la.�lx� r�y_
• • City of Saint Paul ��(��7��
r • • Department ot Fin ce and Management Services
� .. . Dlvision of Lice se and Permit Registration
INFORMATION RE UIRED WITA APPLICATION FO PERMIT TO CONDUCT CHARITABLE GAMBLING GAME IN
�
� SAINT PAUL
1. Ful complete name of " ganizati n which is applying for license
�� �� -
2. Address here games will be he d � �� �. .�r�
Number Str c City Zip
3. Name of manager signing this applica ion who will conduct, operate and manage
Gambling Games ?�' Date of Birth � f �p0
(a) Length of time manager has been ember of applicant organization /' �
4. Address of Manager ,�f� � ,S /t/1( , r1�
Number Street City Zip
5. Day, dates, and hours this applicati n is �or �/� 70 � - �� - �00���
l
6. Is the applicant or organization org ized under the laws o= t�e State ot �`4�?
7. Date of incorporation fl l�(�E �
8. Date when registered with the State o" :Iinnesoca !�/�/�E �0
9. How long has organization been in exi tence?
10. How long has organization been in exi tence in St. Paui?
11. What is the purpose of the organizati n? �Z�� Oc9 • E�l�
�0 5 ��r�C �D�/P S o ✓-�9�� �S /� . , -G O Mo ��
�1"�D O�C��{�D � Y I�O��`I'D i=/�! � �. ,1�l�/OV G�/Vl1"t�',S 0 ' Ov'N'G OvL� ��L
12. 0 ficers of applicant organization D � - ,v '�� � ����� '""`'�� C ur3
� �. �iame .
Name ( " /,� U L 1�� a s Gi✓/
Address /0 39 C�fi���e . � J-r/D� Address ��7UIl�,/-�th'/`��'n/i"Fu/Z �c�'b�J,l/�,3
Title CS' C / DOB 6 � Titie ��'pSU��/� DOB ��(o�r9/o
Name /G�i� ,/� ,C SG� V Name ��/G/� l./�SSF_L�/U,$ l
Address � /E�c/: S%. �G, 'l :�ddress 99/ /3U���'SS, $?."�f{v� S.!^�a,�
6ENE�C�L /t<<T.
Title ��C E�R�! DOB p T�tle 7,�,;'pSuiQEP DOB .3,.5�
�— i �
13. Give names of officers, or any otaer p rsor.s ano pai� tor se^r;ces �c �ze� organi�atfon.
Name Vam,e
Address �ddre:s
Title °=�?e
(Attach sepzrata ne�_ '. . ac:__:cr.__ ....�e�. �
14. Attached hereto is a list of names and addresses of all members of the organization: •
15. In whose custody will organization's records be kept?
Name / OS�L�II Address �o�7o�n/, �¢�Q�'Fi,/'T�'U/Z ��07
�'�v � /vtN .r7��—
16. •�Persons who will be conducting, assisting in conducting, or operating the games:
Name � /Z�,� �'Rd,�/��/' Date of Birth
Address .,'!� ,,.S !N' � � U - /%? . .�� o
Name of Spouse �/�/�f�f{ J��ST',E�QMf��`l' Date oE Birth �
Dates when such person will conduct, assist, or operate (1 O '��i¢YS �/E'c'/��
�
���� S :� PM• ro 9. 0�1°�►.
Name Date of Birth
Address
Name of Spouse Date of Birth
Dates wlen such ;�erson *af?I concuct, ass:.st, or ope=ate
17. Have you read and do pou �aor,�ugnly underscand the orovisions of all laws, ordinances,
and regulations Qoverning tae operat_on ct Cnar:.tab_e Gambiia� �ames? �,$
18. Attached hereto on t`�e form °ur-:ished bv the C�tq o:: St. PaLl is a Financia? Report
which ite�izes ;il :ecei�cs, e:cpenses, a::d dis�ursements oi t?�e applicar.t organization
a; we;l as ai? azganizat'_ons vno ?�a=re rece_��e� funds :or t:�e orecediag calendar year
whicn ;�as beez s:�ze�, pre�2red, and veri�:ed by {�/L -EJ � DS�Li1/'/
`ame
��7D Il� ��f�'P�;� T-�.uR ���7 S�:' ����.MN', J�.I'"'//3 �
�aaress
who is the �(�60 9��LL�/`�,� �j��j¢s'(J�E�_ of the applicant Organization.
`ame o= O��:ce
I9. Ope:ator of premises wne-e �Zames ��1� be heid: �
� Name c��s��e �� �/{�f�.�
,
B�rsiness Address �.�X//V6'TO/1/� Sly' , p, S'7'-�ffr�L, /1 , �'��j�
Home Address �"r��o �. �f�...�'�11�OG/'f�_.__ .J7�JPffuG; /%1/1�. .�.1�/O�
20. Amount of rent oaid by apo�:cant Orguni�ac�or ror re.^.c oL the ha1Z; specify amount
l�!o�v�r7°f +'
paid per �en � ,330�
C��' )
r
� � : � � � . � - � �-7��-
2'I. The proceeds oi the games will be isbursed after deducting prize layout costs and
' ' o ating expenses fo the followi g purposes and uses:
:
. �,�'�'D�vLt �
� b�' �L
G ,�,�� o,����� � -
22. Has the premises where the games ar to e held been certified for occupanc3 by the
City of Saint Pau1?
23. Eias your orgar.izat�on riled sed � ior� 990-T? It answer is yes, please attacn
a copy wlth this applicacion. . a swer is no, ecplain why:
Any changes desired bv tae a�plicaac �ss ciac'_on ma� be �ade onl;� w�ch t:;e consent oz the
City Council.
Orga:�'_za t'
Date By: �.��3Sj�v1/�
( Kaaagz: ;n charge or game
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. ..� v • u�parte:en: cf F:r.a�te and Nanaseme�• :_-..•-.� �
, , Division o License �nd Perslt Adm:nla;racion
UNIFOItM C I7A�LE C1IMDLING FINANCIAL REPORT
. o.�� � 8'�
, 1. Nase of Or��nis�tion /
� 2. Addres• vAere C1�aritabls Ga�b n� is eo�ducted � _ D�,�
� ��S
�. Report for p�riod eoverin� � -�
19� thtoush ��, 19�
4. Total nwber of daya played
S. Cross rseeiPta tor •bov� p�ri = �`
���/��
6. Cross prise payouta tor �sove eriod
_ —_ 'f'I/. ���7 J�D
�. Net r�eeipts - 1lne S •inu• li e 6
8. Expenaes lneu�reJ ln conductin and o er�tin : �? � ��r��
A. C�osa vs •a p 6 Sase:
B p�id. Attach orker list vith
na�es, address •nd �ro�� v g��, �
s _ �ao 00
B. R�nc for � vtek�
_ � � �'o D O
�• Lleen�e fe�.
; �� 4� �
�. Insuranes
i
E. lo�d
i
T. Dishonored ch�eka noc rseov red
: �D.UO
C. Eaployers P.I.C.A.
i
N• S�lea Tax •
_ - a�� /, o
I. Mlnn. U.C. Tax .
. _
J. Fed�ral U.C. Tax
i
K• Hiscellaneous F�cpsnses. Id� tify the a�ount
and co vhom paid.
G�'�N �l�R R �israrB�r�ir6
�. �c.t_rp�P�Rc1fl�5 Es = _�,�p!g�
2.Off'fcE E>CPEKsE ; / � �
/
3. ;
6. � ;
9• Tocal Yxpens�s
ToT�1. i O D- �
10. Nec Incooe - line 7 �inus line 9
_ ���,! � r�
11. C��ckbook balance beginnina of pe !od
_ ._....�,1,?�0.�O
12. Total of lina 10 and 11
s — /tf:a Q�,,,kXr .
13. ?oc�2 coatribuclons fros line 17 — n�Q�,r��
f 1 � T
14. Cheekbook balance end ot reportin period -
line 12 leaa 11ne I3 n`/
f 2� b
15. Speeify uaa �ade of awoynt on lin 13: '
� i�b�"Gt�-/
� �`' �' ' �' C���,�U�
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�MPLrr rut KE eR�aE
�y,aok��
, ' • :• • : . _. �e-e- .s�::_ -- .'�- _ _ .. i^��/7 _�/,�rp�?7
��"' �i
,;1 . Name � "__ " `-'v"I/7T
. , N�mt � r���7�
!f d �
Addreai b � , Address �i .�,��
Oat• llae'd '�y 'D�t• Rac'd '�
PYLpOe• ' � � � --
$liBatYT! i� �Oi� ����
of Recipi�nc Si�natur�
ot R�eipient
A�ounc A�ounc � � ,�
N�st ' N� �
: u � L�
AddT��s,� . Addreu
Daca Rec'd //`� Dat� Ree'd O -�� �'
Purpose „ . � '
Signaturs �; ' '�'G� Purposs ��, A
of Reeipient Signatur�
of R�cipient
ount Mount 00,0.0�'J
N�m� � �• � Q..���'�, � / .
� Nase � a�, ,l.t�,yh.,,;
r
Addr�ss
LQ_-- 4 w Addr�s•
Dace R�e'd . /s� Date R�e' ��
Purpoaa ` ��t1 � �
� � ���
S1�nature P�rpose ��
ot R�eipient S!`n�ture
of Recipieat
Asounc �?i �
� � �f / �Mount Q��d0
Nase ` y�� ���
c
Nam� (��
Address '' — �
Addrtss -
Date R�c'd '� Date Rec'd � �
� Purpo�e �'.� n �i ..
Signacure � ��� Purpoae 'G[- °� �t,.�`�����
of Recipienc Signature
of Retlplenc
Asount �(J„ ,7.00
A�eunc
17. Tocal Disbursemencs
?NIS REPOR2 M1ST BE FILLID•IN COI�LET Y Tp QOAI.I�Y AppLICATION FOR C}iARI?ADLE GAI�LINC
LICEIiSE.
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THIS ItEPOR2 MJS? EE FILLED•IN C01�LET Y TO QUALI1rY APpLICATION FOR CliARITAELE GAlBLING
LZCENSE.
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THIS REpORT MUST HE FILLED•IN COl�LET 7 TO QUALI1rY AFlLIG►?ION FOR CHARIrAELE GAI{BLINC
LICENSE.
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�-F:'� ����i �HEE� No. 0 U17 09
�� �� �����
c�ristine Razeic — .��� 3�«.�
oErr. No.
� FoR 2 Caurica.l �eaearc:h
_Finar�ce & r�t. �s8-5a56 � 1 �+� �
Applicatian far rc�ewal o£ a,State C s B Gan� L�vense. :
r7ar�c�cc� n�: s/4/ss �: /i�/ss
IIE��IIIEla11710Nl1:.(AOPnaro(p a Reject(R)) COUNCIL RE701!!:
�� ����E��� - �� � � Q � �Y P y;�-�
�� ���.�
�,� ��� � �� ,��.�. . ,���� � �
_�no��o. _�os�ac n�o*
o�enucr oa�+cw •ocwrw�
euwoms Mn�couNCk ae�cm�
C�i�i114�i ��5�'dfCN Certter `
MAY 08
�+m+�.�a.no.�.�,c�o�m�rr r�.w�,�.w�,�,,,�..w�►:
Ro�ert E. Kust�ennan, on beh�lf af Shap Gaz�g, � ., xecNests C�ur�ca,1 a�ravaZ c,� their
ren�aal.:of a State Class B �1,ing ' (pull & t�,pboaz�) �t 99]. Npa�th-Le�iriq�i
tt'�abe's). Proceeds frcxn pul3:tab sales • u�ed to t� ar�d �pv�pa�� y�c�,tth a�t�at�xr �ort�
. au�d'athletic �a.rogra�tis in the C�ocro Park anid `Pla�gzrn.�u�d.
: ���re.�.w.,�.a�,n.>: . . ._ - "
All fees ar�d appLicati:ons hav�e been 'ttsd.
_-�(whM.when.ara 7o Wpom): < , , ,: .
� If Cb�il �gp�ro�al is granted, the Shap Gazig, whi.ch has been in exist�o� fcarar 41 yea�s, ' ,
will be at�l.e to oontinue �in9 � I�u]-ltab at Gabe's. If Qour�il �ppro�val is
not gi�ant�:d; S�oP Por�d will dis�o�tinue • p!ul;l sales at G�e's. ' �
_
�sea�mr�s: w�os : coMs
wsrortrm�cr�rrta:
���s: