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88-1366 WHITE - C�TV CLERK PINK - FINANCE GITY OF SAINT PAUL Council �_/3�r— CANARV - DEPARTMENT BLUE - MAVOR File NO. ��� C ci esolution �����, , ��� Presented By �^�- \�`—""J��/ Referred To Committee: Date Out of Committee By � Date RESOLVED: That Application (I.D. #67675) for the renewal of a State Class B Gambling License by Brian Brunette's Youth Boxing Association at 1091 Rice Street (Lentsch's Bar) be and the same is hereby approved/c�eYr're�: COUNCIL MEMBERS Requested by Department of: Yeas Nays Dimond ��g In Favor Gosw;tz Rettman Scheibel � A gai n s t BY Sonnen Wilson AUtj' ' 6 '�8 Form pprove by C ty ttorney Adopted by Council: Date t Certified Passed by n � Secret By J gy, A► r d by 1Aavor. ate ���r, 1 � I� Approved by Mayor for Submission to Council By BY ��:�i�i� . ._ �: ,r ��f ,198.8 _ _ ��`/.� >, 'FOR . . �„h..�,,,TlD [N4�fl4�.,�R,,,p , Mr. J. Carchedi ..;� �71����` �H�� Ho. ������ ca+rA�C'r P�q oR�►Rr�r o�croa r�va+cai i�er�rr► ' Christine Rozek "�1°" _ � �•�►��, �`�„«� � °�. �°"• . "uR�'`OR — �,� � Cvuncil Research Fi nance & . rnt� . : 29$-:5056 oRO�: � ��„� — Application �For renewal�- of a State Class B Gambljng Lic�nse. Notification.fla�te: 7-26-88 Hearing Date: 8-16-88 iIONB:(APpaio fA)a F�sject fi�) COIAICIL Ii�SEARCFI RE�OlR:" - . . . . . �fIANJ�COMMIBSION GNL SERNCE COMAISSION DATE M � - � �p11E�0UT - ANALY3T � . �. . .Pl�NE:NG. . . . � . . � 20NMq COMM�BION IBD E26�BGIOOL�8QM0 . . . . � . . . � . . � � � . . . . . . . $TAFF . . . QHARiER OOMd18&ON COMPLETE A8 IS . .. � ADD'L VJFO.ADDED* . � RET9 TO CONfA�T � - - �pg�T � . . . . . . . . _ . _FOR ADDL NPO. __F�ADOED* . ONTFLC�COUNCN_� � - _ . *DQ+UW�TIdk � . - � . . . . si�vdR�e�ca�t.aa�r�r - M7fA'1�19 lROSLEY,IN11E.OPPOF1t11qItY(IM1A+u.W1wt.4Yhen.WMre.WI+Yk _ Donald T. Nayden DBA Brunette's Yauth Boxing Association at 1079 Rice Street - ` (Lentsch's) requests Council approval of h�s app�Tication for renewal b� a - $t�ate: Class B Gambling License. Brunette''s Youth Boxing has bQen' in . existenc� far four (4) years. Gambling funds are used to pranote aimateur boxing. .,,,�..c„ �esearch Center �►n�rr��►aM.M.o.a.�: _ . , AUG 5 A11 fees and applications have been submitted. A11 financ��l statements . and 10%. contributions have been received. � _ . �- .co�erc�s t�n�ac wnen.«a To wnom�: , If Council approval is given, Brunette's Yauth Boxing will continue pulitab sales at Lentsch's. _ �u.'�u►�: vr�s e�ows _ �o�rrs: t.��nst�: _ . � ��'��� Di�lISION UF LICENSE ANI) PERMIT ADMINISTRATION llATE � �� �/ / .S � ' INTERDF.PARTMFNTAL REVIEW CHECKLIST Appn ro essed/Recei ed by Lic Enf Aud Applicant �O„Q� T �'���j7 Home A�idress e�3�s �Q�br�d�.��t Rusiness Name � y��an Brun�t�t�5 L��� Home Phone ' �,X�� Eusiness Address LOCj� �� � � T�pe of License(s) �1�� C�f�Scs � � Business Phone � ��— � (�o C�,ry�,bt W►! ��n���� Public Hearing Date _� (/ p License I.D. 41 � 7 �p 7 S at 9:00 a.m. in the Council hambers, 3rd floor City Hall and Courthouse State Tax I.D. �t N'l4 llate Notice Se Dealer �� ��� to Applicant � � �� rederal I'irearms �� Public Hearing DATE INSPECTIUN REVIEW VERFIED (COMPUT�R) CUMMENTS A proved Not •A roved � Bldg I & D � N � , Health Divn. , � �� � � Fire Dept. ( � ���- � Police Dept. I �„� I ��a i f�i� o� , License Divn. ' c�S�l� � � 4�. City Attorney � ' � � Date Received: Site Plan �, '# Q ( � To Council P.esearch O J Lease or Letter ^ �,�J Da e f rom Landlord o�.� � �b � • Ci.� oc �ainc Paul !,� , Deparcment oc Pinance and Management Services �d� "r�3�� � Division of License and Permit qegistracion INFORMATION REQUIRED WITH APPLICATION "OR ?ERMIT TO CONDUCT CHAR.IT�BLE G�MBLI�G G�ME' I� �S.�INT PAUL 1. Full and comolece name of organization which is applying for license �P� � T�` / 2. Addzess where games will be held �J�� j /�j '� ,�� �k U � .��.SI I 7 �umber Screec City Zip 3. Name of manager signing this application vho will conduct, operate and manage Gambling Games � Date of Birth Sr- � �C, -J�� (a) Length of time manager has been member oi appLicaac organizaLion ;� r Y S 4. Address of Manager /y�o,�� �� v✓e lI /f J� Nc,' l��tri;.� �:� .S�C;c�x SS�'iL/? �umber Screet C�c�r Zfp 5. Day, dates, and hours chis applicacicn is :or �_� � �`� �- � " S� 6. Is the applicant or organization organized under the Zaws o= c;�e Stace o= `�? � � S 7. Date of incorporati�n �p - � S �- � 7I 8. Date when registered with che Stace of Kianesoca (� -' 1� - �� 9. How long has organization been ia esistance? � r �C C� / S 10. How long has organization been in esistence in St. Paul'. � ��q y � _� 11. What is the purpose of the organization? / p �',� WIOrt � Wl �t. ��trY` a - ' ` � i2. Officers of applicant organization Name �r�lt �, � � r �n H �' �'�"�' ,Yame ��►l�� r �'� ;1 � r' ;.s vt ��f � Address -�,� �� �D v�LC /'� V� Address �j � � C..O iNt O /`f 1/ � Title �` -� S Da8 � ` � '.5 Tic?e � � .p S DOB �' �p"-S�� �Iame � w Y � �'/v� �V r �n v����`'C ya� Address �3 �J �/!��ot� �j r' i �o�� ���rp�f �ddress Title s�c��c�tT j� DOB - - :j � :'i�la DOB 13. Give names oi offi e s, or any ot:^.er ?ersans ano ?aid cor se^��ces �o �Ze o:3ar.:_sc'_or,. tiame � t Vame n �' �l H � ��� f 1� vt (`/� , t��t 4 !� -� Address �j� r �r' ,G�i�ci ►` `�� l� ��✓1 v� addre9s �� .�j 7 �l V�'�Q S��e ✓ � /� V"�ti' /' J /� f � / , � Title -��.5� ( _ f' G3(�(�( #�a,� ,`,�,� /:,�wt '��?e �9 rz .- � �d4 i ual (J�/GGf -- � (Actach sepd-�ace7sne�. �^- ac�==:or.�_ ::��as. �� � � ���u� 14. �ccached hececo :s a Iisc or names and addresses oi a11 �embers o: ��e :-5d^:Z3_ :�- . 15. In whose custody vill organization's records be kepc? �_���b� ��y,e ,5�-,-,�.�� �/l�1 r i'S j►�. J ib ^h in'e`�'� Y '�� y 5 ,/� � Name �n ti P r"t J � :•�K�t�' �ddress SS� 7 Cvt�o •�,/-e S� r'%�� � 16. Persans vho vill be ccnducciag, assiscin� i� conduc�cing. or operxcfng �he �ames: �i wi �.+� 7 �;�ti ,��`f�'� f3;i a� Y'�K `�`�7 t' cj-3 t -lra l h'ame R c 1�„y��� � f'�ru .t r'1`�-�c Date oE Birzh �- l,r-- 5''�v /O �'� y'f'�i i,.9-YOr P�..r 1C�w=� c '��O �3 addresa �C� � G o,,K � .����e J t �a v� � �2 vi �� �ama oc Spousa Dace oE Birth Dates when such per�oa vtZl conduct, assisc, or op�race �' �- �`� - �/- tJ_ ��� r::( �� �� j!J ;'wiK -C �t ti' Z-�/s- � ,- Yame � ,,��, �i� �T N�v c�r f� Dace o f Bizch _S-�� G - -5-�f $D: ( o wr o �¢ y 1 �-t /'u w l w�w �5�r �% 3 �± �ddre s�J l`�/,. r/1 /'�.v r. �� /" 'v r !vU l^!a►^i'rc r � .� �'�t-e- 5�` (.. �o (i� �.S D y'7 Nams of Spouss Daca of Birzh Daces vhea such persan •.ril? corc�ucc, ass_st. or operace ��- �Z� �7� — �-�- 5'��' 17. Have yau r�ad aa� do ?ou charnugftly uad�rscand ch: provisions of aIl 1avs, ordinances, and regulacfar,s �o�re^=.^.g c�a operac.aa oi Charitab_• Gambling games? t/ z � 18. Acta�hed here=o o� c::e ca^ .`urished bv cFt� Cizy a: Sc. ?aul is a FinanciaL Reoarc whic:� :cemizes a?= rece=�cs, ex�eases� ar.d d!scurssmencs oi che aeplicanc organizac=an as ve_� as ai: o,3an:za:=ans �ao zave :eca:�ed °und� co c:� orecac'!:g ca'•_en ar year � � vhica `as bee:� s_3^ed, p-aparsd, and ve==:=ed 5y �//� � � � . � Yamt �f��7 �� m �� v� ,�`f �t �, � l��r� �-�'/ � 3 �adr�ss �vho is che ���'-,� �r � 5 oE c�e applicaac 0-ganizac_or.. Vams ar Of:=�e 19. Operacor o= premisea vhere �ames :r��= �e `�e?d: Name ,5��'V� �� Li�SCGI Business Address �� �� f( � C_ �' Sf r -� �e� ✓ 7� �� � l 6� "�vc. .�.5���� � j � ' Hom� Address � 1 � r �,1-� �.T ���� � -r' ���-�t� c- �� �� G �� vl 20. amouac oE rene �aiQ by app::�snc Or3ani=ac:on cor cezc oc che ha1Z; speci:y amounc � -� �ti /1/ � , paid per b-hour ssa4:on . f� c' i ,, , , `�r�� � ' 21. , The proceeds oz che games wili be disbursed afcer deduccing prize layouc costs and • operating expenses for the iolloWing purposes and uses: 1" ` �T� `S �C Y � k�f SS ' �' - � 22. Has the prec�ises where che games ara to be held been certified for occupanc� by che Cicy oE Saint Paul? y� � 23. Has your organization ciled :aderal fora 990—T? � It answer is yes, please accach a copy vic:� chis appI.icac�on. L? answar is no , explain vhy: � ' /�� dl , �l� �O /� � L 2° f r ✓ Any changes desired :v cZe a�c?'_canc :�ssaciac=oa ma� be aade only vich che conse^t of che City Council. ���uu ��u,� ��`��s y��,�� ���x;s«, �-l.st�t Organ:zacion Date ���� U '' 7�� By: r /� `4aaa��}n ha e � gaae � t , �: : , ---�-, �n�ww�,�iN. � 7 � E � Z! �,` :A � — n .. � c� :n � 3 � -e � 1= � � � � � ., r- R T (O T f ` �' 3 � T �� �+• � S7 tD c0 �t %1 3 v CA !T r9 7 3 r* :i a ^ -t ; � ,� 7 v � n ;D . n � •� t < z� � _ ro - �e � : 3 c� S� C. �,.-- rr - � ^. J � 3 "7 � D t!) :� , T r9 r C J �-'� .- 3 a C �� �o�-+ �e '�o �-• r- ro r- � ' n 9 'o S n{z 2 ;� � — 'e = � 3 �-..r- � .;o c D � s 7 � 7 � � 3 3.. � � • ��mr � 7 3 � n t9 � :7 � r* 3 �7 � ,�-�,n�v� � � ,' E 3 � • � • �y � C7 . � �. + :1 I� r+� O 11 rD (9 . ��S rf� rf ;9 � � � � z� a a = I �- `� � r-r � �2 £ '� � rt rr ro myZ 3 ' T'�� f7 7 :7 � ^t O rn _� , � �a rA �O >� � � O � 1� cs a�-e In � ro t �� �e •••• •.• ^� -� I r* _ O ►► � �r-{� .! ■VNWyyyyy• O � � � ` r n r rt C�/ � � � �o (� � r- ro n _ � rv r n ro 'S' - ' ro � � r+ rp c7 �+ I -, � n S a I� �e I�o � � � � -+ � 3 c7 r 7 C i � � � � ra T �D ��lJ+ I � � �i �9 � r9 I� �+. n� '� �� ... � ;7 T -' ^ ^� �_ - � � E �+ � S T 7A .. O f0 7J !,�f7 rr J ;9 < I 71 I 1 D I �� � �' �� �D � � � I� T� � � I Jl � 'D J 3� r ^ � :7 I � t .'t '� �7 m � �9 �J T �. � -+ � r� . � I a �. I I � �A�a ' r'°+=r�r—'�:+Swc�a .-. r -.�. -- - -•- �seT- „ . � r . , ... � _ .. � \ ' • . �y ��r" . :.: � - � �_ ��, S. � ... , , : . , _ . _ .- . : yy�"� :. ,.,. .��, io, . . . . i . .- _ . . . .?�.` . . � . . ,�' �� . .. . . , ,�. .- .� ' . . �� _. ��_�. ,. r '. ..:. v+�� .,.:�.. . .. . �...-.. , � �:r.. �i .�t_ . . . .. . -. . ���r_�, � , ' • "'° � ";: CF�aritableGambling:.CocrtrohB`oacd^ � :. , FOR'BOARDi,USEONl.Y"�- ' �: " .,`. ..Roomr N-475:Griggs:Midwaya Building� ` - 18Z1 Unive�sity�Avenu�'�� ��N� :� '"z � ; ` -' . �,4x_ .� S�,Paui��Minnesotas�1Q4338���,�g� ,.�� 3,- �r }M ,`M�� �; °` ',�' �:fi �, �;c�' " `� : ta � :� �'�"(6Y21.64�-055� .,. ��.� .��, -� � � �, � �- - . , . : �1,:�?'�,,w � ..,�� '.{ � + '�-a'F'� r A.. �;. �,�.. c�'MV�.,:�s'�µ. �.'.L�` .. �� �", N`,Iiar "r._r� ""�.i"'. . ,- �d��'..�. � ,� r CEiEG{.7" '-`� � � t, , ss: ;; .j, . . ,D`AT�. _ . . . , ,, = r�=° - `� - : -� �'�"' , � � . � � �s G74MBCIN'(iLICENSEAPP�LC'ATION`t: . `�4 _. _ , . �..�,� .. _ . �.: �4� . �- - ' .. . . � �", �� • . �� ... , � L� . � .. .. � . , � . .,�.�, INSTRt1GTtONS:,i ^�.-.. . ' ��� A�_ Type>or.prinrir�inlr _ _ _ � -_ '� B'�. Tak�completedapplicatiorrtolocabgoveming•body;.obtainsignatureanddateonalfcopies,aadleav�lcopy�Applicantkeeps:�1"- r • - copy an�sendsoriginal tathe�above-addres�wittra check:.- • � � �� + ' � C_ Incomplete applications will be returned:, - � Type�of Application� _ . ❑C1ass A— Fee:S 100:00(Bingo,Raffles;.Paddlewheels;.Tpboards,Pull-tabsl ]$Class6'— Fe�S 50.OQ IRaffles;Paddlewheels;;Tpboards,Pull-tabs)- � ��a�sreasto�.. `. , � - OCIassG— Fee:S-'50.00IBingo.onlyl' - : _ _ >- , Mtnnesosec�aeiesbleGamwrwconnaeo..� .= ❑Class 0 — Fee�S 25.00(Raffles o�ly) (3fYes�Na 1. Is this application for a renewal� If yes,give complete licensenumber 0_- -x U - LS�1J � ❑Ye�ONa 2_ 1f this is notan application,fora renewal;has-or anization beert licensed by the Boardbefore? tf yes,.give base� _ .. . . license number(middle-five.digits) YesONo•. 3. Have lnternal Controls beerrsubmitted previously2lf no,pleaseattach copym 4 Applicant(Official,legal name ofi o�ganization) 5_ Business Address of Organizatior� � Q�2 ��.� 13 4 v.r�-�1�-S 1rn�.f r �x•'� �:sc:t:.,.;,� 3 S�S� Gs.�GG+i'��P"�'� ax ��'. !� 6f City�State�.Zip}�_�' '' 7.. Co. ty>- _.. 8»:.Busines�Phone Number•.: S.� � .�v � S�fl� _.�,, �'�- �: �"� � ��S/ o/�`� 9:.- Type�o�organizatiorr. �Fratemal�.QVeterans:+ ❑Retigiou�. �thee-nonprofiL''" � • '_ 'If'organization:isarx"othernonprofi�"orgarnizatiort;answer.question�l0through-l3�lfnot;.gotaquestion 14.�,`Othhernonprofi�,"'organizations..'_ ,: •.. • . '�'� , ,�_,. . . must'documenfitstax-exemptstai`us4.� ", ` �' �.r . • ,<<: ,,, , " J�Yes��JNa�:• _10_Is organizatiorrincor orated:asa nonprofito�ganization�lfyeswgive�numbecassigne�taArticle�orpag�a�d!" :. :_ .� _ - _ _,.. _. _ < . _ - �. . � .. . , � �. book number:� '� � - Attach copy of'certificate=� � � ��` �� � Yes�N� 11:. Arearticlesfiledwith-th�SecreiaryofiState2` ` � � 1`�(Yes�Na: 12:.. Are^articles.filed:with.th�County7' '� � .. -=:: �Yes�No� 13.. Is organization exemptfrorrrMinnesotaor FederalincometaxZ lf.yes„please�attachletter»frorrrlRSor.Depactment.of;F �� ' � " Revenue�declaringexemptiomorcopy of 99Qor.990.T ' ' ` _ . ap '. � . _ _ . . ... _ :.O ... - -�' �Ye� or� 14':: Ha�liceoseeveebeert�deniect;suspertdedocrevoked?'If.yes.checkallthata lyt� -.�:, w��� �*� • " •� � t . ... , . .. _ _ _ .�,,_ .. : �-_ .-- - �Denied QSuspended ❑Revoked: Givedate: - - � ` 15s:.Numberotactive�members 1 fi� Number.otyearsin existence=--�, . Note= lf`lesstha�fauryea�„attaci� . : . J� , :. evidenca�o�thre�years�� '., .. .-. ` ��4 . . -',�� . E.'.Ql�'.� � �. .. existencer�{:: ..;,.;- . _ � � 1 17:. Nam�ofChief.Executive Otficec . 18= Nameo�treasurerorpecsorrwhaaccour�txforothecrevenues:; ��7 / of,�.tyhe� organizafrort� -:.. -= ."��! �1� ��.$ /'i �C..?. /�Vr7 �" �T`� / " �d�f f� - ��: �lZG+�J���'� ' Titl�. Title>. � � � � ,�;; � i �; _ �1��S•c�'�vt �- �rcf.�c����' l •.� �" . -. Business:PhoneNumbec• BusinessPhone�Numberr - - , . , � � ,.. . � � ��z � 7� � - .�� �'�' � G�z , �y�1 aI� � , 19_ Name�otestablishmentwheregamblingwill b� 20.. Streeiaddress(notP.O..BoxNumber►- conducted:L.€�1 �E C �1 ,S C� 'Q/� l0�j 1 /� c� " .S � 21. City„Stste;.Zip. 22. County(where°gambiing.premises is locatedl. ,5� ���� /'1 i� S Sr// � � /� ,,,.,,,5�: r' _ CG-0001-02(8/86� White Copy-Board Canary-Applicanr. Pink-Local•Goveming.8od�r ...: �_ � - ll�nw: ���v�:y+a+:»«nt...rr-.rwW..r.�«.�e+.-v�.,.+�ery..vev---•^- —' :>.s�'��--+.s. -�w...o:.,wr.�-...+.- -� . � � �� ,�c`h- r�- 'v� . _ . ' , � .s � i . t` � {,� � � �:�-. s t s�f �4�e +` T.!�'.l _ z �' . a �� ..�..�� �a.�`?��,,,.. ' ` T&� ; -' � k '. � � a t S.- � ..::� . . .. . . �tGamblin�,LicensearApplicat�onr .'`-""'-+�� .: : .`r �. , = : �: `' .' , Y�-� � 9 Pa ��� . � �Typeto�Appl�catioc►¢-•QCfas�A� (�tass�_ QCCass�C QCfas�Dt� /�,,� /! tas ,. � - .:� . ,. . _ . . , � . � .. ,,,:,, .. ;,-� .. _., ,:... �- _ _ �r- - ��: - " �' ` '� �Y.7�'� '��.�5�`� . ,_ .., . . , , _ -�... - , ,. '' r . . � .. �i. ..,... _ . .- . ..._.. . . .�.� , ��•�Yea�Nailr23���Isgamblingpremise�locatedvKithirtcity�limi���` ; _. , _ , ;;: .,, . _ . - ._ . : �� �.I4 �-��.e - � � . .. _ . . Yr . �" � +„ esQ�2�A�eeall.rgambling:activitie�conductecka�ttrapremises:listec�i�n#t;9"o�thi�applicatiort?.'Ifinot:.:complete�aaseparate.,� . x _ , `;:,. .. •�: '.�'applii;atior�foreactrpremises(exceptrafffesf�asasepatate-licensgisrequiredfoceachpcemise� .--': - - s�-.'� ��Yes�1CoF 2�.�Doesorganizatiorrowrrthe�gamblingpremises7.lfno;attach�copyofthe�lease�wittrtermsof-atleasto�eyea�.' `� `• ,`aYesl�i 11�;2�:.Doe�th�organizatiorrlees�th�.ertirepcemises2ifno�attaEtrasketchof y:.: .2T�AmountofiMo�thl Renr �2►��. .;� r«,- �:'tharpremises.indicatinginFhatporEiorrisbeingleased.:A.leaseand;sketch� °.,F,. ;� <,� _:� ' :- 'i�notrequiiectforCfas�t3:applicatio�s:.-' ' ' �, ' ;; , ' ,_, - . _.:r.. _ _ .��� _ ,,,-;. �s DYes� a°'�2g'h,Q�b�yor�ptano�conductingb�ngarwittrthislicense7lfyes,9ivedaysandtimesofbingQ:occasions '�yt ,..- .... �f1�..�.r h.'� F ..�.�. • Y�_� � o�ao . . .� . ' �. � .�� - , .. '� . x- 1 � ... �_.-� . . - :�: . . _ . ._ . : . .. ,,.. . .. . .._.. . ' _ - . .*'i ° :-:� , '� .: . .. . ', .-.: �.-. �.r ,. . . . .,.. ,� �� •:. .�.. - � - . . �fes�No� 29..-Has.the 510;000.fidelity bond required by Minnesota Statutes•349.20 been•obtained�Attach copy of bond_ . 30� Insura ce.Compaq�Y N � : ` �� � 3.t': Bond.Numbec- " rf--�a=tJ� �` ��E� ��" . �r4 G1.4 • a, . . 32_ Lessor•Name4 � 33:.,Addres�. 34': City,State;Zip.:: - s-�E���, L �� �s� � � . . �, � ��,�►�-c.� - - ��.�4 � ,�,7 ,� �,; 35� C'alambling:ManagerName�� �' _ 36_: Address , . 37..City,.State,Zip.• . . l�o,?� .�� J . �y��� y �9csc �:z�;�!.r,.�;�.: ���� �.� r.�� ;�?.► f.f�� 38a:,Gambling Manager Business Pho�� 39�..Data gambling manager became- " ":: ' . ( ��Z ) �$�." ,a g�r, � memberof organization:"- _ S.— � !7�T" • ' - `-r.�;;, : - . . : ` GAMBL"ING':SITEAUTHORIZATI�N� _ .,��_," . Bymysignature-below,focallaw_enforcementofficers.oragentsoftheBoardare�herebyauthorized.toenteruponthesite��. � ata�rtime;gambling�is beingconducxed;.-taobserve th�gambling;and.ta enforoe:the:lav�forany unauthorized'game or:. � practiceU -� , : : - � � . : BANKRECORDSAUTHORIZA�TION� � � 4 By�signatur�6elovvt„th�Board isherehy authorizedtainspectthebankrecordsofthe�General.GambhngBankAccoun� ' � r : ;.whe�reve�necessary:tafulfitl:requiremecrtsn�cu�rentgambli�g;rulesand:;lavw�. ' , , s! � ` - _ ��' ��'':« t .7�.�� t,Y ,`,y�� s'";;� � �.. � � . �" _ :.� ..� �.. .-� ;,r y, - v,�;�y:�, QA� . . � r' '- ` I herebycdeclace�ihat� :` � � �: . . �` °.-;-- _ _ _ - -. 1��� I.hav�reac�thisrapplicatiorr an�all°infocmati��rsubmitted to:the�Baard;. .' °a - .=:_ Z:,.: Albinformatiorrsuhrt�ritted:is..true�:accurat�andcocnplete�.,. =� � � � - � ^�;; 3':�:��All'otheGrequiredinfocmatiorr•hasbeerrfulljr.disclosed�: : 4f. _ I artrth�chiefexecutive:officerofthe.o�ganization;, • - � � " > : ` ' : , " 5" ,Cassume�:full"responsibility.;forth�faicand:lawful:operatior�of all activitie�to b�conducted�. . : ° ` � - � 6.,..I"vailCfamiliarize�my.selfwitt�th�Javvsofth�S3ate:o�Minnesota,respecting;gamblingand:rule�otthe�Boardandagre�; - - � - � ifilicensed;-taabide�b thos�lawsand rules,=includin amendmentsthereto:.�^ : - '`'�� � - � ' ' ` ��� , Official,.Le al Name of Organizati pn 41 Sign (mustbe° ' d ief Ezec 've•Officerl" . - '��!:4.� - �7u�►��.*�: lout4'''�0�:;_ . -�SSAC.` 7�:°� ' Ttleo igneQ ' » Date-;�,fp .. - ; + . / _ . ,, � '�K�'C�'.SS.�d'+r7- . ,,.. �.rv.�.;� - ' � �'� ��: ACKNOWLEQGEMENTOFNOTtCEB1fLOCALGOVERNINCBODY*' ` " � I herehyackrtowledg�receiprofa;copy-ofthisapplicatiorr..By�acknov�rledging�receipt; l admithaving-beertserved�wittr: natic�thatthisapplicatiorr wiU bereviewed.by-the Charitabl�Gambling:Gontcol Board°and if.approved by�the board;.will-• � become'effective30daysfromthgdateofireceipt(noted.below►;unlessaresolutiorro�thelocalgoverningbodyispassed_ 'whictx�specif.ically�disallows:suctraetivity:and;a:copy ofiihatresolutiorri�receivedby,rthe�Charitable.GamblingControh.t; � , _ Boar.d'withirn�30 da sofithe�belovu.noted date:�.. . . . ~ -:-� � : ' � ' _ ; 42:. NameofCityorCouniylLocalGoverningBody► . Ifsiteislocated:withinatownshi���itertr43-mustbecompleted;.inw ; � . ... _ , ., . - • • � • � addition to the:courrty sig�ature� - " 'gnature of.persornreceiving-applicatiorr' 43'_ Name�of Townshi�s: � ` r �� � ��t�{r ,� � '�c�- ;� . _ ' ' Titl . " - Date received l�0 day period Signature of persorrreceiving applicatiom . t begins frorrrthi datel° . • �1.x�` � �'.^;�.� � a ' ��� X". 44: N �e/of PersEm d�livering a ication;taLocatl�Goveming Body. Title• - � l�(�f�+r�;� � � �j�L'�>�'I ?�yf!' � � ; CG-0001-0�: (8/861` White CopY-Boa�d:' . Canary-ApPlican�� ' Pink-LocalGoverning Body, r . . . . � +1i Y th 1 q�� .'g-_ -,s -s_#T� . --�fl� S��h� '� ,� �` � r� •` _ . -�. ..� *.k�v.._.t E � :.: .¢ �N.,.- ! t' -"�.. `�`, _e. � �� �"��''"9',�r''�-+1E+'�. ��^' t�.-•• Clfys�rSa�nCPaui�.�,'"`��w -`'41'.�i�°�`�"'���/;���,�. L-� ` .,,_ ` -� �- ;,�- O�@ SCt[11@[t�0� 'F�lIiSRCl8f1�IIICBR enrenitSecvi" ��'3 �" �-�"�_ +� �-: . 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' . . . .. . .. . _ � _ . . . . . . . :: . . - - � ' � . - ;.� . - : $Ix 0�CHI�RGE FQR`AC:L.RETURNEQ'CHECiC� -- � - -. � rr _ _ . _ ,�.: - �. - �, ..t:r . .{ _ .. _ . - fa - ,. , . , � - - - �.� � ����e�� ���:����i � , City of Saint Paul n !`'�/��/_ ° Department of Fiaaace aad Managemnnt Services � ���1� �� Division of Licenae and Petmit Admiaiatracion ('��` UFRFORIS CSA1tITABLL GAl4LING FINANCIAL BEPORT '�_�G- O � „ Date � � '/ / �f 1. Name of Orgaaisation ��i�r u ��r+��?Y/':+ �(� � ,:✓��:'<!i1 /'r' SS�t 2. Addr��s where Charitabls Gambliag ia coaduetsd ���� �t`P�t Sr/��� � ��'A ( 3. Raport for period covaring "�— � 19�J 7 chrough �� � 19 9� 4. Total mimber of days plsyed �(��t' J U �oT� . S. Grose receipes for above pariod ; [ ,� l�`J , � � c� 6. Groaa prize payoats for abova period (iacluds cash ehort) � �/.�/,/(p�, 3 /,� : I 7. Net receipta - line 5 minus liae 6 S � 7 ��, (�f 1�. `` 8. Eapansea ineuzred in conducti.ag and operatiag ga�: A. Groes vagea paid. Attach worker list rith �7 -Z �-0 namea. addreas and groes vagas. S �� / =J��. B. Rent for �� wneks � C � �•�� . v`'y / ; Ov C. Liceass fee � ! 5 � D. Insuraace i � �,�� E. Bond S �v�� F. Di�honored checks not recovered ; G. Aceounting Eapease $ �3r (y> yL3 <'G H. Employers F.I.C.A. S I. Pulltab ?ax Paid to Department of Ravaaue � J. litnn. O.C. Taz � R. Faderal ExciBe Tau 6 Stap ; L. Stata 6ambliag Tax 3 ��, Ci v 7, y4 M. Miscellaneous Expeaaes. Identify the asount and co wham paid. � i. L �a K ��r r ��5� s 3 �%', �7 �l 7. `�� z.G�M,���hy ��. .�;P��f k7 : � . D �f y�f`° - �,���f ,9 3./w' J7z�v�-C r t 15�K.� i 4. ; 9. Tot�. Expenaes TOTAL S �` J���� 10. Net. Iacoma - line 7 minus line 9 i r � � 1� 11. Checkbook balaaca begianiag of period S l� 12. Total of line 10 aad 11 � ��a � ��'. �2 13. Total contributiona from line 17 S / �7 � '7 / ,7 : y� 14. Checkbook balance end of reporting period - � '� � Lsne lz 1�88 lia� is s �r•j.�� .� '. 15. 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