88-775 wri�TE ---'CiTr CLERK COUf1C1I G
PINK - FINANCE G I TY O SA I NT PA U L � � v�
CANARV - OEPARTMENT /1 � 7�
BLUE - MAVOR File NO. �� �
C il Resolution ��
;;�i1,
Presented By
Referred To � Committee: Date
Out of Committee By Date
RESOLVED.: That Application (I.D. 67098) for a One Time City of St. Paul
Gambling Permit for The Chureh of St. Andrew, 1028 Van S2yke,
on May 22, 1988 at 3:00 P.M, be and the same is hereby approved.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
�� In Fa or
coswitz
�he� �,/ _ A gai n t BY
Sonnen
'VPtlae�.
Adopted by Council: Date
MAY 1 7 1988 Form Appro by City torn
Certified Pass b ou cil Se ry By— 5��
$y� �
Approv by INavor: Da � Approved by Mayor for Submission to Council
By
pi�llSHfD «'��Y 6198 _
, �~�- 77��
. UIVISION OF LICENSE ANI) P�RMIT A.DMINISTRATION DATE T � � p a l� 0 0
INTERDF.PARTMF.NTAL REVIEW CHECKLIST Appn Proc ssed/Received by
Lic Enf Aud
�(� � �
Applicaut �aT►Vl �'` � . a '� Home Address � �S� CQ h^D
Rusiness Name � p��, t') �/�(6{,Home Phone
Business Address �0 o1g 5� Q� Type oF License(s) � 1 �+'f��j ��Q�b�t�'l
� � - �a � � � �
Business Phone ? 0 � �77 t,�'1'�L� � �r N
' G7o �g
Public Hearing Date � � License I.D. �f
at 9:00 a.m. in the Council Cham er ,
3rd floor City Hall and Courthouse State Tax I.D. �� N l�
llate Notice Sent; �' Dealer �{ /J I�
to Applicant �/ � 7
g�Pederal Firearms 4� �}
Public Hearing
DATE IN PECTIUN
REVIEW VERFIED COMPUTER) CUMMENTS
A proved Not A roved
�
Bldg I & D *,�A �
!�
Health Divn. '
�
�v�A �
__ �
�
Fire Dept. � �
' NI� �
�
Police Dept. I St� I
s�� r
License Divn. O� �
i
�' 3
City Attorney
�����
Date Received:
Site Plan 1v �
To Council Research 5 � ��
Lease or tter �r/ Date
from Landlord b
-:�: (�,C�-T�.s�
�� Minnesota Charitable Gambling Con rol Board LAWFUL GAMBLING EXEMPTION
,: Room N475 Griggs-Midway Buildin
� � 1821 University Avenue FOR BOARD USE ONLY
�� � - St.Paul,MN 551043383
• •�. ....� (612)642-0555
,;^ �;.
��=�. INSTRUCTIONS: 1. Submit request for exemption t least 30 days prior to the occasion.
2. When completing form, do no complete shaded areas until after the activity.
�4 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 Iif currently or previously
�: 't. - - � •
Iicensedl and/or permit number.
Address City State Zip County
�:�.. , , _ . � ' �
Chief Executive Officer's Name Phone Manager's Name Pho�e Number
� � i •� * �. � � , _ � � .
Type of Organization If Other Nonprofrt O�ganization�Check One and attach praof of�onprofit statusl.
❑ Fraternal ❑ Veterans ❑ IRS Designation
0 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,drawinglsl
.N
Premises Address City State Zip County �
'�' . ' � .. - : ' . .. _ . _. ' ... ,
.., <. ... . . -s: ,.,, � `�
;
r, s3
- ,., -,:• �x.,-- ^
Game Yes No ' `>�. � ,. r�
Bingo
� . _Raffles .: _ :, .
. ._ . . .. --w �- _ _.
Paddlewheels ,�,,
• Tipboards �-;
��,.:
Pull-Tabs �� � '�
,., �.
Uae of Profit
.�-� _ -. ._ : .,.." { . ' .. . .. . '._' . ' . -. _ ' . _
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v � �� �
f' ` �-� �a ��
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. . . .._ .. ,. .,.. . . . . . ...,. <,s: F ; ,. ; ..:�
I affirm all information submitted to the Board is true, accor- "��� �' � ` �
ate,and complete. �
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...,; •,- r✓ � - �.- � .. � ' .. . �°" ,&, �s� � � � �
Chief Executive Officer Signature � I' Date �. _ , q �,�' ,� ���
` 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 Contro�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 Governing Body(City or County) Township Name(Must be notified when County is the approving bodyl
Signature of Person Receiving Application Signature of Person Receiving Application
�
Ttle T ' Date eceived Title Date
CG-00020-01 I6/871 White—Board Canary—Board retums to Organization to complete shaded areas.
" ' Pink—Organization Gold—City w County
_,a��
�6,�-
� City of Saint Paul `� � /f�.. /
� , Department of inance and Management Services (i1`"� 7�`�
; . Llce se and Permit Division /, G
; 203 City Hall� � 7v 7 �
j - St. Pa I, Mfnnesota 55102•29&5056
� . Y • ` �� APPLI ATION FOR LICENSE
; CASH CHECK CLASS NO. New Renew
� o o ! ao ,� ��
r ��
oate � ts �
� Code No. Tttle of Ucense �j ,�� �rJ
j From_ 18_To 19
� �OCOo�-� i I\.�2 -� � `� ) ,L �Q I 1
? 1 ��L Pvhi� �
r I..G �t �`�.� 11V�v{ lD�. ' 1� APPHCan�pa�'yf Name`' U T � l • �t t) C(r�G(.•J
I�:: _ �t L
� 100 �,
t � � �1.--�, ; �!�� ;!� .�,. �.:_�.
100 Bualness Name � -�
t_/ oa
-, C, �iS
, ,00 �. i � `�<<��'..
Business Address Phon�Na
� 100
, 100 Mail to Address Pho�Na
,o0 1� i. i% � �',,
�'J � �c �. `�_ ���f , �/_ )
- � —
Man�psMOwner•Name y ' r
' 100
� / .� .1 � �!
� � sJ��•��,
100 AlanaqsrlGwnsr•Noms Add►eaa Phon�Na
4098 AppHGatfon Fee 2, 50 ,�,J- j
' Recefved the Sum of 100 �� ' -�G( l�,1 , t'? r) �.:: 'V�)
�/� � � ManagMOwner•City,Slah 3 Dp Code
100 Total 100
�/' n,I� . �J'`��lJ
, Ucense InspeCtor —�t � By: \� " 1 /� Signature o(+Applicant
, V
� Bond•
: Company Name Policy No. Expirstion date
� Insurance:
Company Name Policy Na Expiratlan Date
� Minnesota State Identification No � Social Security No
j Vehicle information:
$erfal Numbsr ate Number
� Other.
THIS IS A ECEIPT FOR APPLICATION
� THIS IS NOT A LICENSE TO OPERATE Yow applicatfon fo license witl either be granted or rejected aub�eCt to the provisions oi the zoning
� ordinancs and completion ot the inspections by the Healt , Fire,Zoning andlor Ucenss Inspectora.
i
� $15.00 CHARGE OR ALL RETURNED CHECKS
� ��
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s ��.� �� c.,�.
r �. . ��,_�75�
.. T? 0_ S. . ?iL
� ' ��r:u�T:•�=.';T OF r yr1:.C:: �IID i�1�i,rC::�:T 5.:=?�TICES
' • DIVISIOiI OF IS S� bND t�',jt{�' �ffT �'JI°fft?IS'M''A�CNT
I2T0��'.ATICN �CUL':� 4•tITF �r��C�TIGN aR �'u'�S'� '�0 CC!•�IIC'^ Gxi��'TG SE�SIOPT I.� :.T. ?AIIL
?. ?:a�e o� Oz�anizat�on
2. Ad��ss where C�aaization's re� ar mest;�s azb held ���,Tl�e,�.�
3. DaY and time of �eetinFs
L�. Addrsss Where Gamblinp Session wi be held �n�R ��an S1�kP A��P_ �t- na„i
�. Is aap�icant owner oi pronerty Wh re Ga�bli� Session �i.11 be �elc' yy Yes "o
5. If I.eased, who is awner of prope p w�.ere Gaa�b2in� Sessior_ �riL he �:eZd?
7• If leased, attach l�tter of pe , ' sion to conduct Ga.�blir.� Session, s?gned by lessor.
8. idame of officer maIa.ng applicatio (Rev. ) Joseph L. Wajda
9. Address of officer ma�d.ng azplica ion 10 51 Como Ave Date of birth 2 9/4 7
10. ilame of msnager who wi]1 condwct -ambling Session Michael Weber
L. �ddress of zanager 1291 W. Ida o Ave. Date of birth 7/13/54
I2. In conaection with what event is h:.s Gambling Session beir:g held? Annual Picnic
13• �y'hat type of gaabling device(s) • '11 be used? PaddleKr.eel Tipboard F.aff`Ie X
I.1t. Day, dates and. hours this applica ion is for and number of sessions.
Dap(s) Sunday �ates i��urs 3 :00 PM tio. of Sessions
15. rri?.i prizes be paic �u �one� or , rc:�.andise? Both
16. Is tY�e applica.nt association or� 'zed under �he laws of �r.e State oi ::inr.esota? ves
17. How long has Cr�anization been in existence? 92 vears
1�. 'rJ�at is the puraose oi the Or�ani ation? Rel;aioLS and education
19. Ofiicers of the Orgaaizatioa
�jame-Title 9ddress �ate of bir;,•h
Presi�ent
Arrhhis nn ,Tnhn R _ Rnach
_ _
Rev .T=�h r. wa;aa �� pr��l 1 2/9/a7
Jim Ta��e�, �cY°��r�, ^ 1 1 10 Ar 1 e St. Paul 1 1/9/28
20. Give na.r�.es oi oi:icers or a� other persons paid _°or sez�r_ces 'r.o the Qr�anizatior..
Name-Title Address �ate oi bi�tr�. � � •
21. In w'r.oss c•,istod,; T�ri.11 records oi Qrga.a�zation's Ga,mbli.ng Sessions te kept?
idame(Rev) JoseAh L. Wajda �ddress 1051 ��mn Avr�nna �
22. Attach a cop� of govr Orgaaization's �aemberst�.ip roster and date each member �oiaed.
23• A�tach the Ganb �r Session lanager's bond.
2L. �ttac� a cogy oi the Depa.rtment oi the Treas��g, Interaal .'.evenue Service "FtetUrr. o�
Org anizaticn �zr.mti from Ir_car�e '"ax", Fos�r,i 990. (Cha�ter L1Q.OL (I.).)
25. �ttac:� a cc�, of DeDa:t:�en;, of the T=�asur?, Intzr-ial 'e*renue �ervice, °'��te:+mt Grpan-
ization �usiness Income Taz", �'i'orm 9°OT. (Cr�.pter �.1°.OI� (2). }
26. attach tY:e a.*Lnua'_ report req•a:�.red of ckaritable or�anizations by ,4ir�nesota Statutes,
Sec�ien 3�9.�3• (Cha�tzr a19.0l� (3). }
2?. F:ave �ou read and do pou thorou�hlp unders�ar.d the prov=sions o�' all laws, ordinanc�s
and re�vlations goverm.ng the operatian of Gamblinsz Sessioas? yes
28. Ar� caanses de5�.3'ed by �he a�plicant association may oe ma�e or.ly *.�rith the consent o�
the License Coumiittee. �
, 29. �2s 2n� pers���s) gartic�pa��.ag in the operation oi ans �� the gartblin� sessiors cov-
ered bp this Lcsnse ever been convicted of a felo� in tre State of iiinnesota or in
ax� other State or �4ederal Court? Yes No X . Ii answer is "yes", provide
r.ames, addresses a.nd birth-dates.- -
� Church of St. Andrew
Qrg 'zation
� By � Vice-President
(Off c -_itle
- � ����.���G����
(,4anager in c�:a�e oi Cambling Session
State of 2�i.nnesota)
iSS
C ounty oi ?.aias ep ) .
G�S2 � �,-. Wif- CJ�/�' and �l�c�Re� l� - �elO e�
being duly sworn sa� iha tney a e tae pet�tieners in the abo�e a�plication; },.hat �:�ev havs
r=ad the foregoin� pet�tion a�d Tmasr `�.he contents �:�ereof; Lhat the same is true of t::e;r
oc,m, ?�.owleci�?e.
Subscr-1 d ana swo . to before me t:-.is
yay oi �7 L Z°� ~ WILLIILIA FA.R�tiL� �
�� - � NOTARY WSllC—i�;l!:NEiCTA
.c �.��r rnu�r
' a axy Public, Cavatv, :ii.nnesota �rcoa��.ptpi�a�.2a, 1991
;•�r co�i.ssion ���s '
�ui.ldln.F� �enarV^.eat dnproved uisa�v-'oved �y
Fire De�arc:aent .�pv�ved ?isaa�roved bp
Po?ice �eoartner.z Approved--Disa�roved—�y
oaow�rD1� . o�Te o�te oor�am ��—��
�.F.•c��a�. G��E�� SM�E?' �o:0 017�0 8
� . . � � DEPARTAAElR DIRECT'OR� � � MAYOR(OR A�18TAN1) . . . ,.
�l�l�'�Si@ �P.�C • NUMB FOR wMr�a rvvuoe�rt sEnv�s o� �crrr a.��uc
�. carr�cr ppU71 euoc�r ox�ECion ?�C�:�. �&�'C�'1-
�FiIk�10e & M�1t1t. 2�8�-5056 �crn�r►+�r
Applicatic� far a City of S�i�rt Paul ing Penni.t - R�£�le anly.
NOR'IFICATIC�+i D�ATE: 5/4/88 L1�Z'E: 5/1�/$8
7lONS:(APP�e(�)a ReJect(Ri 1 COUNC RESEARCN RFPOIM�: _ : ,
�� ��� . � DATE IN DA� AWILYBT . � PFiOWE NO.
. - .. �ONMiO OL�RM�&ON. - .. IBD�46 8CFq0.BQAi� . � �. � � � . .. . �f . .
. STAFF . - . . � p1ARTEW CGI�NBBION�- AS IB. � � ADOL 1NF0. D* .. .flET9 M COHiA�T . . �CONWRNB�If� � .
� ' - � � " . � - _FOR ADD'L RiC. .. _fIEEDRIIG(AbDED+
WSntlCf COUNCL *E% TION:� . .. . . . .
� BUpPORf8WMp1 COUNqL�OB,I�C11NE4 � - . � �� . . . . � . . - � . .
. �eu��i1 Reae�rch Center -
.
_ M�Y � 01988 -
wrru►��,�w�,e�o�rnu�nr(wno.wnat,wnen�wnere.wn�rY :
Fatt�ex' Jos� We►jd�►• c�ri behalf of the of St. Ar�drew. request� Council apprvva]:: of his
. r+eq�est �or a..C7iie '�ime Ga¢nblirig Pe.,�mi.t.__ Raffle c�.l.y. Tt�e raffle will be he�d on I� 22. 1988
at_3:00 p.m. at t�•Q�urcti, 1028 Van Sl . 'I'he raffl�e wi11 ]ae held .in oc�ju�xcti.ot� witt� the
> anrYUal c;t�r�.Picni.c,� Proaeeds will be by the �rY� ta c�tinue wa�ks of educatioc�
aryd autreach t�cj the m�nbers of the pari .
�:�r. - -. - ..
All fees anci app].ieaticros have been 'tted.:30 dal� Pral.c�r to the �t. 143.1 requ:isene:�ts
of 442:06 - 402.14 l�ave been met.
CAiMl�lWl�e�l.M�hrA�nd To'WhornY ' •
If �il appraval is given, th�e of St. Andrew will be ab].e t� hold a raf�le at its
annual picni:c. Tf Co�an�cil appraval-is given, a raffle will not be hel.d.
�u.�r+nmr�s: wros cais
wsro�rriPnc�oeHrs:
��uauES: �