Loading...
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 v v _ � � z! I :�n' _ — ^• -� '- � c� cn :� m �D �< � �`� _ ,. ' ; o rr rt n rD �� : a :7 r — C G tD fD � n .T ' � � Jf rr ^ ^� 7 � r — n � •-, � � y -� -� �c r. cc _ 3 • r �7 � �O <<; n .'3D A C; ' `r :o � n rr ro F• � � n' , ^ r M I v Jf � ^ �G .� � 3 ^ +� /��—" '�7 1"� rt � y . � � � �7 � � � fT 'D 01 \' 07 � ' 'T • � I � _7 I R O fn fs I r V �� �� r't � (D fn � � '� %� D� � fi :17 G !+ " `G G r� � � �>C �_ � rT 7C 'D � ` �j �t� � ��• � � ' �A r9 � < ! S 'vi � � � 9� ` � E I `t �..i v O W r� ^.j� � ��� ... C , �1 N pl r n -. G � � � = i A � A � , � N r T I CA I� I` y •'� .... � � (D C': � : T� 1 � � � � I �� I\ � � C7 r. � I t, r � f > � '� �-t rt Ct � R " �y :0, ' y' : n V ' .� � v �R "'' � ' I.i7 , I 'fl E r- r. " \ I� � i I � :A � ^ fp y�j �0� ,•� i � � i9 G I\ , � I•• y� I 1 A £ "S �1 � W � ' • �4 ro :� . � '� \ � C ;o .-+ I � � � � :O •• � � 7 , . � ' � . . �.. n! r.l 1 t7I (�9•I: �J . ' ` ��_77�r . ..� 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� , � , � � aw� � , . � � ` �- � � � � '"� '�'�G .�.� H� ,/ � ° �� . �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. N .. .. c «a c� �n y �e -i "� +� '� S � A ..� A N H � r ,.,� A � y ; �o n S O a r tn = , • I ^ �* ►� eq e � � n Z �-1 7 O t~n '4 • o '+ �* �1 t� n �e I': � n p � O .t 4 ,.,� ,,, � w a � '� t e o •�,� �„� y . n � �+ ��,,, � H •t O .� p p '� = O ! { � S � 2 A • ' S 7 "' "�� � c� a� ' ►r � °� �n = ..� � ,,^� ►� os � i � � � a�n d 2 � Z J K � 1 0 �+ PI N v [�1 � :-''Q{� � : o � I � S • = � 6 : � y � >Z ` - o�n � � •� C ►a► ►Q+ � ,^� > ` �-i O = �_ cr�r u • � � a n ..v.r N � t~i .�w� � s +pi O y'± ''i 'e r � n v..... a f1 c -_ "'� � `�C n p � w a 7 n A � � ^ � = 1� rw 'O N .,�� � v "� � t+f �•1�� �w ^ M �w r ►b � i A !V O' ': . s O Y w r '� � � • �'� �.':.� 6 r � Q � ^ o n � n e- z � o � N � , � � �r ��1AIVVMi�r t e�+ � _ � � e+r .A. �.�., � r �• �,_,, • > � o n• � � r � a W � X� w a a n d • � a o a � � w � � ,� . � � N.m�_. ��-�-:�:- _:'-_ . .. _-. :.. � ��'��3 .�� , , � N�me Lt�/ Addreis Addres ��`� v Dac� �ae'd 7� Date It�e'd /� S � , o �J NufO ,(� / .r� "C lurpose /='A� C� _E ouRiY�iy�urpose !K O/' Si�nacure . Si�na w r� o! Reeipi�nt ot Reeipiant � A�ount 11�ount � ..� Nase N� . ��t� Addr�ss ` Adds�a• l� � Daca Rec'd _ Dace R�e'd � QQ' Purpos• . � Si�natur ,._ purpo�a �,(�• ��"� ���/�� Slgnacure � � � of Reelpient / of R�cipient • Nount /�� -— ounc p ,4� . � Naoe . �G •' � Nawe Addresr "� �� (� ^ Addrep �g( � �.�Q., D�ce Rec'd `7��7�� Q''> Date Rec'd . .�l.att:,�, Purpoie � ' °��n ' g' Si�nacur• �" Purposs - ,�,� .,�, of Reelplent Siir�tur� oE Reeipi nt � Aaount � � � � ^ Amount Nq �L'�-t� Na� �-p Addres � 3 ' �2. Addres� - 3�y� Date Ree'd .�.trci Date Rec'd �'� f � Purpose ' ,cJ Purpose Gl.� ,,Q.�t.� SSgnature . 'CC.m' of Recipienc Signature of Rtcipient � C A�ount 70 .�O Mcunt � � r Ut� 17. Tocal Diaburse�ents THIS ItEPOR2 MJS? EE FILLED•IN C01�LET Y TO QUALI1rY APpLICATION FOR CliARITAELE GAlBLING LZCENSE. N .. Q s �o w° � o r �o e' � o a r �e -�! r ■ �w w � en — � o °� ` n .w � O � � ►1 M n'�l �1 1� p y ? � f� i - 7 � q A r0y "'� p a rl `w ^' f�f ,i � O � •� O= � a a �l � O ! �• �. n ° _ ' < a 7C � ►S• w � � o •°i r o'o � i en c � ° ��n • y o y � • _ � q Y q � ' ' � � �1 • ' ` g 0 "� s A iZ �. r'tX$�a � n ^ � � ^ > w M � w ' � ^ > 2 H O �D r � ^ •w 6 A vvv 7 f~f n� _� i ` `_ � A iQ N 1 H 9 � � A � a � vvv p� 'OA _Z� � � ^ i rw 7 � � � � �7 � nl ��}� �z � w o � r � , A .� ,�'„I'� �� ^ � ^ r O n O O � � 7C �-1 � a w = � �w � � � � �yr7� r � � � � r r = . � � r, , � N � PpI > .. � � • O Ir p � O A a•.:r.n.NVVW O = � s e�..� � t w a p 9„J � '- w t" � w w r' � � o0 � 4 6 A d 4 6 r' � .��'3�3 ,,� , ��:�,� �� '� ��', �i � ` � • . . . �'(1'� N.m� .,/ , , � Addre�� Addsess � N/��v� j �" V/ D�tt Rec'd � � —^ / D�t• lt�c'd -�/ Puroost � hrpos• ° � Si`nature si=na�uT� of R�eipi�nc ot R�cipieat A�ount � A�ount �OrO Nasa Nre � ' 7 Addr�u % Q 3 � � � , Addr�a• , Date Rec'd '"�O D�te Ree'd 7' n 1t���'�' .r Purpose ?�� Purpo�a � � �� SSQeacure ! Si�nature of Recipienc "� � - * � of Reciplen[ �� • unt (O ��0 � � ,n � � ' Mount � , CtitR�+�.��7�� Nae� �K/ l.LC�G�d Nawe Addre � � Addr�s• Dace R�e'd � 7' / Dat• Rec'd S o Purpoa• � � a Si=n�tur ��0�� oE Rseip! ne Si�nature oE Reeipltnt Asounc lJ Amount Nas� � p� Addres �� Addr�ss • Date R�c'd �� Date flec'd Purpose , , ' Q . Signacure ;/ Purpoae of Recipienc � � Signature of Beeipienc Aaount �_ ,QQ Aacunt 17• ?ocal Disbursements � � � THIS REpORT MUST HE FILLED•IN COl�LET 7 TO QUALI1rY AFlLIG►?ION FOR CHARIrAELE GAI{BLINC LICENSE. •� .. r `� M � o ry. o e � o a r �s y � � � � � . . Q � C > W '�C .� �I M I � � � .� d . � A O .0 � d � y / � ■ e p ^� p "'� y I_ � Q � p � _ � w as � � O > n �e ,� r. �+ �t O .� p = . i � ►S�. o�i rs ^ • � o �° z = '� � �"' • v, N a .� . � 0° y = e� c o s 'A 2 9 .�t � 1+ NI N m � � �� � � .�. • C i � � e° s o� � e .°� � � w °r r � o I� C > � �-�1 dT' �D�n " � � n � O c� -+ao r ►e a n .... ^� f 'e r � A {� n v..... a�i � p �� � < � � e' � � q w • i � • � • � � � 9 n p i M . R �-l� � � n A2 � � � Mo 'w � O � O \ � O r 7C "'� ?��— C � 7 A « D ` A • �� N (/7� . O � � o � n A r � > '�' S o' n SQ 2 � ;� O N > > � � r p p �n S � n . �• � M t ' t �� ■�/VNNW�U � a � a ; � , ^ n r � n a � � n n � � a °' d a � - i �.�► . _ . . _ o„� o,,,� � ���"� �y �-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: