88-774 wNITE - Cirr CLERK COI1t1C1I Q
PINK - FINANCE GITY OF SAINT PAUL �{ �7�
CANARV - DEPARTMENT
BLUE - MAVOR File NO• y
Coun il Resolution
�
,� = �����
Presented By '��✓ �
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D. #41225) for the renewal of a State Class B
Gamb�ing License by t Sylvan Booster Club, 1141 Rice Street
(Kuby's) , be and the same is hereby approved/�.le!!i�'g�i.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
i.ons [n Fa or
Goswitz
�� A ain t BY
Sc6eibel � g
Sonnen
�il�ee-
MAY 7 1 8 Form Ap ved by City At rney
Adopted by Council: Date , ' •
Certified Pass by cil Se tar BY
gl.
tapproved Mavor: Date � Approved by Mayor for Submission to Council
ti
By
� �������
DIVISION OF LICENSE AND P�:RMIT ADMI ISTRATION DATE �/°�(�O / �1� a �S
INTERDF.PARTMENTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
Applicant ,JO.S �1 Z 5�� Home Address �f 7 � J��S P�
Business Name � Va C��b Home Phone
fiusiness Address �� � � Type of License(s) C �QSS � ..{. ►11JCc$'� •
Business Phone ��� "' �QI'h �j�1 ►^!�
Public Hearing Date � �� � License I.D. 4� y� �a S
at 9:00 a.m. in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. �� ��/lA►
�
llate Notice Sen ; Dealer �i �f I/4
to Applican � � $ _� g'g
Federal Fi_rearms �� N /�
Public Hearing -�
DATE II�S ECTZUN
REVIEW VERFIED ( OMPUTER) CUMMENTS
A proved ot A roved
�
Bldg I & D � .
��� �
Health Divn. '
N�ic� ,
�
Fire Dept. j �
I � I� �
I �
Yolice Dept. �' ��`�,� r
�I p �
License Divn. . �
i
i
City Attorney � � �,�/ �
� b� ;
Date Received:
Site Plan b � � �
To Council Research
ea�e r Letter ate
from Landlord �'�' �
,,� - ' ���'77�
Charitable Gambling Control Board
�f Rm N-475 Griggs-Midway Bldg. For eoard Use Onry .
iz� 1821 University Ave. Paid Amt:
' ' ' - - - St. Paul, MN 551043383 Check No.
. •:......'�' .(612) 642-0555 Date:
;-,
GAMBLING U ENSE RENEWAL APPUCATION
` z' ' UCENSE NUMBER: g-a24gy-ppl /EFF. D TE: l�6i0I/87 /AMOUNT OF FEE: #�p,i,rp
hq.=..,',.
``� 1.Applicant-Legal Name of Organization 2. Street Address
.�,:-
��`:`' . �3SiER 1l� SYLVAN 77 N Aose �ve
" 3.Ciry, State,Zip 4.County 5. Business Phone
P � ! �a�sev b12 249-5821
6. Name of Chief Executive Officer 7. Business Phone
� .
S. Name of Treasurer or Person Who Accounts for Revenues 9. Business Phortie �•`
� -� . C � .
10. Name of ambling Manager ' 11. Bond Number 12. Business Phone ..
�r� n ''U(1 7�??f.! "
13. Name of Establishment Where Gambling Will Take Place 14.Counry 15. No.of Active Members
�Su�v's �lace g# ��ul +<axszv 3��
16. Lessor Name 17.Monthly Rent:
Fiamid �alfer;y �+�
18. If Bingo will be conducted with this license, please specify day and times of Bingo.
Days Times Da Times Days Times
19. Has license ever been: ,;,; ❑ Revoked Date: ❑ Suspended Date: ❑ Denied Date: `
�. �
20. Have internal controls been submitted previously? �Yes ❑ No(If"No,"attach copy)
21. Has current lease been filed with the board? ❑ Yes �No(If"No°attach cop�r)
- 22.Has cy�ent sketch bflen filed;,with the boarda , � _ ❑..Yes No(If"No,','attach copy).� .
� ' GAMBLIN SITE AUTHORIZATION ` - �
By my signature below, local law enforcement officers or agents of t e Board are hereby authorized to enter upon the site,at arry time,'gambling is ,
�being conducted,to observe the gambling and to enforce the law fo any unauthorized game or practice. ,
' BANK REC RDS AUTHORIZATION
By my signature below,the Board is herehy authorized to inspect th bank records of the General Gambling Bank Account whenever necessary to� ' .,
fulfill requirements of current gambling.rules and Iaw. .
OATH ' °
_ I hereby declare that: � � J;
1. 1 have read this application and all information submitted to the B ard; � �`
2. All information submitted is true,accurate and complete; . . �. '
3. All other required information has been fuily disclosed; ,
4. I am the chief executive officer of the organization; '
5. I assume full responsibility for the fair and lawful operation of all a tivities to be conducted;
6. i will familiarize myself with the laws of the State of Minnesota res ecting 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(Chief xecutive Officer) Date Title
-�,�.;.�r n U %� !��/:�.-: ��'� �s I D�L�f
� - �
ACKNOWLEDGEMENT OF TICE BY LOCAL GOVERNING BODY
1 hereby acknowledge receipt of a copy of this application. By acknow edging receipt, I admit having been served with notice that this application will
be reviewed by the Charitable Gambling Control Board and if approv by the Board,will become effective 30 days from the date of receipt(noted
j below), unless a resolution of the local governing body is passed whic specifically disallows such activiry and a copy of that resolution is received by
the Charitable Gambling Control Board within 30 days of the below no ed date.
24.Ciry/Counry Name(Local Goveming Body) Township: If site is located within a toNmship,please complete items 24
�1 r-+- ;, '-� � and 25:
Signature of Rer�n Receiving Apptication: 25.Signature of Person Receiving Application
`:• � j �� -+'{�.�
Title � Date Received(this date begins 30 day period) Title:
� � '-i '��• ��! X
Name of Person Delivering Application_to Local Governing Body: Township Name
� '�= � !�
w-y' � ,i �: ��
/CG-00022-01 (5/8� � hite Copy-Board Canary-Applicant Pink-Local Governi�g Body
v
�. . , — -� .� _. - - _ _:. . �- .
, � � � City of Saint Paul ����" '
, ' _ Department of inance and Management Services
Lic se and Permit Dtvision _ � a��
203 City Hall �
St. P I, Mi�nesota 55102•298-5056
APPLI ATION FOR LICENSE
•'. CASH CHECK CLASS NO. New Renew
an ao � ��
oats ,�..
Code No. Tttle of Licenae From � S 1�J-�=To � / � 19v �
—._
a3�3 �' ��. S �.n� �� ��.- 9..�
,� 5 u ( v G „ �a5-;��- (' l�L .�.
AppllcahUCompany Name
100
1 � r 4 � ;?,�,., ��-,��.
100 Buaineaa Name
,00 � ; . J,., �., � ��'1 ;-� .�.�:: ��
Busi�sss Addroaa Phon�No.
100
100 Maii to Address Phon�Na
--,
�oo p �,P �/ � • !' � `�. ��.��?
ManapsNOwner•Name
100 � t.��� `.'V-^+�/� ,,
� ! '�• �'�%+Z-
100 AlanspeHGwnsr•Home Addross Phont No.
4098 Applicatfon Fee � � �
Received the Sum of 100 v�' � l,,, � , f"? ,•� =����
� 'T� •�V ManagerlOwner•City,Sqte d Zip Cods
100 otal 100
� .� ' � �. - -. �-.
License Inspector B : � ��J � ��J��r
J v Y ��l� Signature ol Applieant
Bond•
Company Name Policy No. Expintion Dats
Insurance• N��
Comparryr Name Policy No. Expiration Oate
Minnesota State Identification No Social Security No
Vehicle Information:
Serial Numbsr lats Number
Other.
THIS IS A R CElPT FOR APPLlCATION
THIS IS NOT A LICENSE TO OPERATE.Your application for I cense witt either be granted or re�ected subject to the provisions of the zoning
ordtnance and eompletion of the inspections by the Health, ire,Zoning andior Ucense Inspectora.
$15.00 CHARGE F R ALL RETURNED CHECKS
`
1 � � � .
,, -�- - �IZ � ���
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14. Attached hereto is a Iist of name and addresses of all members of the organiration.
15. In whose custody will organizatio 's records be kept?
Name �.S��/� f Z sG I�oKK� Address _�7 ,�/Qe►S� /¢��
16. Persons who will be conducting, as isting in conducting, or operating the games:
Name o ,�J � �.a!� Date o f Birth �-�-�'- a �!'�
Address �f � d � �'f.Pll�� yk ,J SS�•7
Name of Spouse �C E'1q..5 � � Date of Birth
Dates when such person will condu.c , assist, or operate �V�iQ`; 6� � 0 -� 'f'MuQ j)r„Qi�:�,
-r . G�-
Name o N S Date of Birth f/ _J 9 _ � �
Address 0 6 �' /�3.1J � A�JL Y►t N SS�/ 7
Name of Spouse �C�� E,p Date of Birth
Dates when such person wi11 conduct ass�st, or ope-ate �!/�j Sq-�u�AA-y �u,�,wy
1
i���
17. Have you read and do �ou tharoughly unde:stand the provisions of alI laws, ordinances,
and regulatior,s ooveraing the opera :on ot Charitab�e Gambling games? ���
18. Atta�hed hereto on the for}: fur^ishe by the City o� St. Paul is a Financial Report
which itemizes all rece:pts, esoense , and disDUrsemencs oi the applicant organizatfon
as well as ali organizat'_ons who hav :ece�ved :unds ior the preceding calendar year
which has beea signed� prepa�ed, and c�erified by r�o����.� � � ZSc�vX�L�
Name
`I �, �o�s� �d� S�' � J C. �7 • 5�S/� 7
Address
who is the � /�- U R � oF the aoplicant Organization.
Yame oc 0 fice
19. Operator of premises where games ail� be heid:
Name /�� o L r�
/ ' .
Business Address / / 1 C r ��a . SY' �' L �J S'S//�
Home Address �7 W, D�l � lv,L /2/�� 5 f �i�V(� � yh /�J SS�// �
20. Amount of rent paid by aoplicsnc Or3a i�ation ror rezc oz the hall; specify amount
paid per 4-hour se�sion � �Q�/�'�
�a . p-o �,C
� City of Saint Paul 7'7�
„ ' Deparcment oE Finance and Management Services ��
f ', , Division of License and Yermit Registration
INFORMATION REQUIRED WITH APPLICATION FOR PERMIT TO CONDUCT CHAR.ITABLE GAMBLING GAME IN
SAINT PAUL
1. Full and complete name of organization which is applying for license
� �f G 1/J9-►1� �'o o S'�'�'I� ��U� i�IJ�I �
2. Address where games will be held /f `�1 1�' �G� S¢Pi�tJC.. s S/� �
Number Screec City Zip
3. Name of manager signing this application who wi11. conduct, operate and c�anage
Gambling Games ,�O�G � x��-►''1 L/��o�� Date of Birth � 01�-� /
(a) Length of time manager has been member o= applicant organiaation
4. Address of Manager �4 f,�1 /-� `j 7' �}�� �''f p�U L SS/� �7
Number Screet City Zip
5. Day, dates, and hours this application is for A't�� ��a,?'`�,u� ,�'�'� .- S�'
6. Is the applicant or organization organized under the laws o: the State of �"4`t? Y��
7. Date of incorporation I�PRII1 � . �9G �
.
8. Date when registered with the State of Minnesota j�v� I�Q�.If a `J, /9'G 7
9. How long has organization been in esistence? ��j� �L '�-I i��
10. How long has organization been in eYistence in St. Paul? S�rh �
11. What is the purpose of the organizatioa? �'/�o y�,�1-�C+►�t1 0� „�Kl�'�i!'�s•� t,�? ��.C+QfiB-��e�
h1lit��-�RS l.��+`i�r��,rlG ftiS�:w�Grl��Z��- �'Nr�Rv✓�'M,E,� o� S�G�q�! �l3���u�'�D �or,�,v�: ��Y
12. Officers of applicant organization
Name ��/>h.z�5 �i�t�S �� Name „�65�P� � �SG�o�C1C �
Address .��% �h;`L �� � �� Address �(7 ��vS� �����•
Title �f(�StJ:�x1�` DOB /���'�- S� Tit1e ��C�l�'sSU��,� DOB /�-��" 3�
Name ��;�'�K'�/-� �. ��5�., }�a�C,C� Name .�.� �/� RT� K P 1�f�r L �N�,�.�'
Address ���• �DS,��II� �ddress �/� Gl>, f�o y f ,¢�J`
Title �G�i.?�'�fii���� DOB f�- 1 � ''+� � Title �,<3/n .�i. h1iy�' DOB �-a 3 —�7
13. Give names of officers, or any other persons who paid for services to the organization.
Name vame
Address �.ddress
Title _itle
(Attach separace she�.� . .�_ add�=:or.�: ::aras. '.
;, _ ��-��
2�i. The proceeds of the games will be disbursed after deducting prize layout costs and
operating expenses for the follow ng purposes and uses:
o s �-� �� � ,�,�� � �N+�e F��s r��- s ;�v� � �.,oa
���E
22. Has the premises where the games a e to be held been certified for occupancy by the
City of Saint Paul? s
23. Has your orgar.ization iiled [edera form 990—T? N� If answer is yes, please attach
a copy with thfs application. Iri nswar is no, explain why:
v� E � v� m,�o,E a� �t r�o� E o�. t�s .
Any changes desired by the appl:canc �,ss ciac�on may be made only with the consent of the
City Council.
� ;� y/�� �oos�-,�� �Gv��j',�e,
Organ:zacion
Date a� gy; � '
Manager in charge game
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� • City oE Saint Paul N�-��T7�
, • • , Department f Finance and Managemeat Services ���`
•- " .. ' Division of icense and Permit Administration
UNIFORH CHAR TABLE GAMBLING FINANCIAL REPORT
Date
1. Name of Organization L ,� os jr� U
2. Addreaa vhere Charitable Gaobi ng ia conducted f��� ��C� `�'�"
3. Report for period covering o� 11 i 19� through ,(7��, �i 19 �7
4. Total number of days played
5. Crose receipts for above period ; 9 � y��� y�
6. Croes prize payouts for above p riod = �Q � �t7! y S�
7. Net receipts - line 5 oinus 1Ln 6 s a ��` L •'�,�
8. Expensea incurred in conducting and operating gama:
A. Cross vagea peid. Atcach w rker liar yith
names, address and groea va es. ; ��c-� �Q, �a
H. Rent for (, waka I'''teat S ; /d OC � O p
�. Lieense fee � y'Ih . v0
D. Insurance ; N/�
E. Bond � ��J' � �
F. Dishonored checks not recove ed ; �� ti��
G. Employers F.I.C.A. ; ��,
H. Sales Tax � � ��?� `/
I. Minn. U.C. Tax • . � ��
J. Federal U.C. Tax � ��
K. Hiscsllaneous Fxpenses. Idan ifq the amount
and to vhom paid.
�. a� ^ . : �,�..�
2. �
3. ; .
4. � S
9. Tocal Expensea TOTAL : �����, q !
10. Net Income - line 7 minus line 9 ; ��`�� ��
11. Checkbook baiance beginning of per od ; �D � < <? �
12. Total of line 10 and 11 ; /�0�� � �
13. ?ota2 contributions frou line 17 = ��� �c�a
14. Checkbook balance end of reporting eriod - '
line 12 lese line 13 ; � a �s 71,53
15. Speeify use made oF awount on line 3:
�'? � �% f ���.� r � o�,J - �� �lL �.�
_.-._.
J
COMPI.IiTP. II� IIEVERSE SThE
4n.� D�:5urse:�enCS irom acoun[ in 1 ne I2: /��- 77'�
r .
. • r1t (.
, • , � Name v � ����N
Name
Address 7 7 Lv OS�G /� � Addresa
Dace Rec'd Date Rec'd
Purpose �/�� �C v Purpose
Signacure � Signacure
of Recipienc � of Recipient
Amaunt ��� , pZ Amount
Name Nama
Address Address
Date Rec'd Date Rec'd
Purpose Purposa
Signatura Signacure
of Recipinnt of Recipienc
• Amou�t Amount
Name Name
Addresa Addrese
Dace Rec'd Date Rec'd
Purpose Purposn
Signacur� Signature
of Recipient of Recipient
Aawunt Amount
Name
Nave
Address Addresa •
Date Rec'd Date Rec'd
� Purpos• Purpoae
Sigaature Signature
of Recipient of Recipient
Amouat Ameunt
17. Total Disbursemencs '� - —
.1 e,_
TttIS REPORT MJST BE FILLED•Iti COI�L TO QUALIFY APPLICATION FOR CHARITABLE GAMBLING
LICENSE. •
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NuM9E FOR - 2 �C�.1 ��1
rr, ooNt No. � euDOEr dnECron
Finat�ve & �t. 298-5D55 � j,; cm��Y —
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sr: _ . . ; .
Appl�cation. £or re�aal of a State of ta C7.a�s .B �luag Lic��e.
_ �'ICATIC�T LaATEr 5J4/88 L�TE: 5/I7/88
_ UPWIC+�:W a R�t(Ri) COYNCIL BBPOIM�c:` .
PtANl10 OOM�II�ION qVIL,SEPVICE COMMI3810N DATE IN DATE - G AIW: . �. PFiONE Ny0. � �.
mt110 COMi8610N . I�626�BCHOOL BOARD. . � � � / t/ . � ��V� . . .
� �� $TAFF - � - qMRTEA C�A�M118810N � � � AS� . � � ADD'L INFO.ADDED* . ., .�TO COMTA�T . Ci3lL�F111JBff ' .
. .. . � . . . _ . _�OR ADDL MFO. � �R�WApC ADD�• � . .
. .pBTiMCf OQMCL - w� . . . . . � _ .
. .�.��8UrP0Ai8 MMIC1f COI1NCr.�OafECT1VE? � . . � . .. . . . � .. � . � . . � � � . �. . � � � . . -� �
COU�c�I ��a��h'C�1�t
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Mna.un,�,ovPO�ru.t,►rv�.wna.,�,w,.w�,�e.w�y1: _ .
1�. J� Zschai�e, tm beha.tf of the Sy van Boo�t� Club. re9uQStss t�.u�c�:1 approv�al of his
- �pl3cat�.on. for �i of a Class B ir� Li� :at 11�3. Rice Street �y's) . P�+ooeed�
° �n the pu33:tab sales are used for . equ.iptr�t � entry fees at �rZvari Pl,aygraand,
�c(�o.tt�iaiM..�or.naop:.a.�,�e�: - , _ .
A11 fees at�d a�aliaa.tinr� hav�e been tted. All o� the.r�u;L�a af 4Q9.21. :- 409.24
have b�ert m�t...' ,_ ::_. -
,
� .C�'lW1�R MAwR enA Ta NRiom1:
If Oau�cil app�+o�val is giv�n, the Sylvan ster Club wi.11 vontinu�e to c�rate a pulltab
bo�th at �uby`s. If Caunci2 app;�rova1 is riot given, th�e pulltab oQeratic� }�r Sylvan Boos�er
Ci�1b wi11°be disc�ontinued.
K'[�IA'AriR 1110S C�lp6
MYT61lY/PIIECEDEUTS:
t,i�!Ii9UE8: _