88-1371 WHITE - C�TV CLERK 1
PINK - FINANCE COII�IC11 /(��
BLUERV - MAYORTMENT GITY OF SAINT PAUL File NO. v _ /��/ -
Council Resolution : --�
�: .�-:F,; ,;
Presented By
��
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D. #85762) for a State Class B Gambling
License by Trade Lake Camp, Inc. at 1178 Arcade Street
(B.V. Peppercorn's) be and the same is hereby approved�d.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
I.o� [n Favor
Goswitz
Rettman
Scheibe� a A gai n s t BY
Fieeee�r-
Wilson
A"� , � For Approved y Cit Attorney
Adopted by Council: Date �—I $
Certified Yas• nc' Sec ry BY— .
gl,
Appro by 1�lavor: Date U`7 q 1988 Approved by Mayor for Submission to Council
y BY
Pt�.es��a .-.��� � � 1988
a1MY�umn , ' o���tta,er o�n c�rEO �d�"I�?/
v ' _
- ' ' Mr. �. �arct►ed� ,:.. f�E�t�1� S��' No. Q 0 2 0 9 3
_ �,�,�� - �„����
' Cltristine Rozek �� � �d����� –3'��
. . Rou,� �� � Ccwncil Research
�. Fi _ nce & � t. :. 298-5456 _ o�: � ��,�,r —
11pp1ication for a State C1ass B Gambling L.icense. �
1!t�tification Da�e: 7-�7-88 Hearing Date: 8-16-88 .
'tl�l�:(JM�Pro!ro(�)a.�(A1) COUNCIL R�8EARE111�!Q1�1': _
. . PLANlMb ODM�BqM. , .. . qVIL S�VME.oOMM�s810N . � DATE ni �� . .� .ol1TE OUT� �� . .N�IN.Y$T� �. � � � � P}K1�IE ND. � . . .
�OIW�Ki t)OMi16810M .. 18D 62S 9d1001 BOAi� .. . . . . . . . . . .
. . �� . - STAFF� : �- . � . . CHARTER COMMAI3SION . . COMPLETE A8 13- .- , ---ADDL MiFO.ADOEQ'� .� l�Tfl TO CON�A�T. - OOpBR{�I19QT - .
� � _ � � _ . � � _FOR'AODL MFO. . ._FEEOR4GC ADDED* .
0197AICT OOtlqCil
�EXPLN�ATqN: . . . �
� -BtNrOF�B NMqi OOI�L CBJECTNE4�' . . � �. . . . . � .. . � .. . � : � � . .
RIMIMIQ"l110�1.lM.M�O/POR7lNiRY(VM10,W11et.VWIBn.NRMI9.'�N�: .
E. Thomas Bauer, on behalf of Trade Lake Camp Inc. , requests Cou�cil
. ap.praval of his appljcativn for a State Class °�•C�mb�ing licens� at . �
1I78 Arcade.;Street (6. V. Peppercorn`s�. 'fir�de Lake Camp, Tnc. has
been i n exi stence for 14 years. Proceeds fr�m tt� 'pul l t'ab sa1 es woul d - �
be used tfl serve retarded handicapped youth with ath�etic & summ�r camp Fj `4
_ activities.
itl�l�1�710N ccx.�e«b.4;Ad�rne.pe.,+�,R�: _ , . : _ . ' . : _ :`
All fees and applications have been submitted. �
�unc� Research Center. K
A UG 8 -�8 __ . _ .
, �.
{YN�M,YNw+.�nd To 1Mam)� , _ •. .:: -`� ' :. ,
�� If Council approval is given, Trade Lake Camp Inc. wi11 be ab'te
to sell pulltabs at B; V. Peppercorn's.
p:�ara„vea: . . . Pnos . . , caMs
�rero�r�+�+rs: _
Trade Lake Camp did have a Class A Licer�se at 1324 E. Rose. This license
has been discontinuer! as of Janua-ry 31, Y.988y
`�` ` Note: There is some question as to whether this organization solely supports youth
� athletic activitie� (Section 405.22�A)) and whether it spends its proceed:s so�.ely on youth, a
ma'ority of whicTi are from St.: Paul and/or spends a majority of its reven�s on St. Paul youth,
(�os.z2����
. � . � ����'�
� 'DiVjSIUN OF LICENSE ANI) PERMIT ADMINISTRATION llATE �p 3 0 � G 3O �d
• LNT�:RDF.PARTMENTAL REVIEW CHECKLIST A.ppn P oce sed/Rece ved y
Lic Enf Aud
.— 1
Applicant . rn ��uc-r' Home Address �Sg �rnarran
T es .- � Cts�•!�
Rusiness lvame . V Home Phone
Fusiness Address �� � g �rG.t,Q�/ Type of License(s) J�''1�� t,.t�E.SS
Business Phone �7� � 3 S o�.o� � ����jl��� �l(,�ihs.�
Public Hearing Date V �(p �� License I.D. 4{ g� 7�I L
at 9:00 a.m, in the Council Chauibers,
3rd floor City Hall and Courthouse State Tax I.D. 4� �� S3 3��
llate Notice Sent; �i�""-� C, Dealer �� N �7'
to Applicant �� $ � a
rederal I'i.rearms �6 N
Public Hearing
DATE INSPECTIUN
REVtEW VERFIED (COMPUTER) CUMMENTS
A roved Not A roved
�
Bldg I & D �
�J�'
�
Health Divn. '
� A �
�
Fire Dept. � �
� r � �
i
Police Dept. ' ��� I�I°Z'��
�� �j �� ��
,
License Divn. �
� �� � � ��
City �ttorney �
� 4 �
Date Received:
Site Plan � /�,3 �� Q�' � p-(/
To Council P.esearch C� � f
Lease or Letter � Date
from Landlord „�
� ,-�,• : • . City of Saint Paul �r�ji�3��
�� . . � Department oE Finance and Management Services �f`
. ` Divisioa of License and Permit Registration
ITF'OPMATION RrOUIR;D �:ZTH A?PLICATION F(1R ?ER'SIT TO CONDUCT CHAR.ITABLE GA�iBLING G� IN
SAINT PAUL �
1. Full and complete name of organization which is applying for license
�"r�� �""7
c
2. Address where games will be held V • , � ��
Ivumcer Screec Cicy Zip
3. Name of manager signing this applicaLion who will conduct, operate and manage
Gambling Games C, ��5.�(��� Date of Birth � v��i
.
� (a) Length of time manager has been member of applicant organization
� �_ =
4. Address of Manager � � �
Number SLreeC CiLy Zip
5. Day, dates, and hours this applica�ion is ior �(,�,�J�,���.��iiN f0`�:�e�M�
6. Is the applicant or organization organized under the Iaws oi the State of I�1?
7. Date of incorporation �1�� a� �('f�0 �
� T
8. Date when registered with the State of Minnesoca �eb tr .�O �g�7✓-
9. How long has organization beea in e:ciscence? �� e/�.5�
10. How long has organization beea in existence ia St. Paul? �� �S
11. What is the purpase of the organization? D G ,N �
4' i �'. Ir, 1, U �
12. Officers of applicant organization
Name C�Ie�F G�OS f�/l� , :vame e G +E%�Cv �
�
Address � �
�fs3 �(�MM l 1� 1�'P. � . dlL 9ddress �t ��
�
Title DOB �x/7 ��. Title �� , DOB �uG 3 �/
z�s�
Name RI p.n� �. JL�s Dll� ivame ��,�" �n11�T'1
Address (/� /� U �cdress �3 '', Lr1 h! �
�
Title � 1 DOB � T�tle . DOB '��� J��
13. Give names oi off ers, or any otaer persons ano paid �or serv`_ces to =ne o�gan��2Lj011.
'�I �
l:ame C`)vdy lJ�• Va�:e 770`���C �0��
add:e�s �T� T�j � Ut2G.. vV/S ..:c:s�s 1�5�0 L�/1�S'D.0 �V�� �►,Y f��
�--�- 5���6
:'�cle __,�! �/. ., e �DR2 .�._e v SD�Q
, �',��tach sepa:ate saee� �c: ac�;==or.=: -� s. .
�.. - � . . , . C��i��i
� 14. Attached hereto is a lis[ of names and addresses of all members of the organization.
15. In whose custody will organization's records be kept? �
Name _ q'J'�' K�fl Tl GX_� ^ Address �
a�l� ?'h?ve �. A�.. tc�,��L
16. •Persons who wi1Z be condurting, assisting in conducting, or operating the games•
Name � •
���`I`� ���� Date of Birth ��
Address ) 3c'jp �/tS'sw �tf� r �V L
Name of Spouse ��+pj„Q�,p,.� Dace of Birth -
,
• Dates when such person will conduct, assist, or operate �j� 'j�,QL �p� .... l.�;_��
c��
I o ll:oo,l7M. l�c �.,� as S6'ai r i . S Lis� .
Name Date of Birth
Address
Name of Spouse Date of Birth
Dates vhen �such person will conduct, ass{st, or operate
17. Have you read and do vou thoroughly understaad the provisions of all laws, ordinances,
and regulations governing the operation ot Cnaritable Gambling €ames?
18. Atta�hed hereCO on the form fumished by the City of Sc. Paul ±s a Financial Report
which itemizes a?1 receipcs, expenses, and disbursements of che applicant organization
as well as all organizations wno have received Funds Lor the preceding calendar year
which has been signed, grepared, and tre:i�ied by ��, � �f'-,�����(�
y �ame
.
�s �M�Roa � L , .��o �-
�,ddres
who is the _ ���M C���,,, �q �p��Q of the applicant Organization.
Name o= Office
19. Operator of DT2mises vhere �ames will be held:
� ,
Name iv� IU 0�/19(�N 1
Bcrsiness Addr=ss ��7g a � $— �
'r.c:.^.e Address
20. �.�ount c� rer.t �a_.. :,�� a�p'_--=' �-_=- -=- - - = - - . -
�vCl.Ti4(3�p (� - � '°�' --- -��_ �_ _,, ,._;_, spec�z; a�ount
�a�a . ' . - . - �' Y DD, �—° p,
: � � � � . ������
'." �21•. T1�e proceeds or the games will be disbursed afcer deducting prize layouc costs and
� operating expenses for the tollowing purposes and uses:
. �
a c
w ' or �� �-� '
22. Has the premises where the games ara to be held been certified for occupancy by the
City of Sainc Pau1?
23. Has your organizac�on riied cederal forsr 990—T? � It answer is yes, please atcacn
a copy with this applicac�on. I: answer is no, explain why:
U , � �' Q-1
�o Cwc Lvs
Any changes desired �v c7e a��?;canc �ssociac'_on may be made only wich the consent of the
City Council.
�I� �e. '�w l�'� .
Organ�zaci n
Date �� a � Hy: , lt� �
Liaaager �n charge of game
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• ,� • City of Saint Paul /� ! '/
' Department of Finance and Management Services ������/3
. License and Permit Division
� 203 City Hall
, St. Paul, Minnesota 55102•298-5056
APPLICATION FOR LICENSE
CASH CHECK CLASS NO. New Renew
a a -r�- - a o r�
Date � /°`� 19 J
Code No. Title of License From � � 1��To � � � 19 '�C
.� � �' � 5 �
� • �
�3� .��� ; �a�.�. 3;��i.o�� �
loo Irr�dz. �.G���- � �i �1 u __�._�c
�,�,;�m DI' ��.i ���1rt Q�. ApplicanUCompany Name 1
� �oo � -- ,
,�( �%(� ,;� °) �2 p�o r���2.r� <
�
100 Businesa Name
�o0 1 � ^% � /�P�'ut� �` � 7'��-���
Business Address Phone No.
100 �,.._ r` —�
v. � . �,4�.�i M ,� .J��c�
100 Mail to Address Pho�+e No.
100 �' � li �/�-(.��? �
ManageMOwner•Name
100 ` �_�, �-� �
..:. � ( ; ✓yl/i !Y��r�
100 AlanagerlGwner-Home Address Pho�e No.
4p98 Application Fee 2. 50 (� /
Received the Sum of 100 L iti I�Z, r � /� y^, .�
�/�/ ... �-r �1, �.'(.��-�Z�
3 T/ -.~i v ManageNOwner-City,State 8 Zip Code
100 Total 100
LiCense Inspector )� By: ��� Signature of Applicant
�l � r` % `�n�
Bond: S� S u. v 2 ti} t- ^,-�j ,�S
Company Name Policy No. Expiration Date
Insurance:
Company Name Policy No. Expiration Oate
Minnesota State Identification No. /h�`� .33�5 Sociaf Security No.
Vehicle Information:
Serial Number Plate Number
Other:
THIS IS A RECEIPT FOR APPLICATION
THIS IS NOT A LICENSE TO OPERATE.Your application for license will either be granted or rejected subject to the provisions of the zoning
ordinance and completion of the inspections by the Health, Fire, Zoning and/or license Inspectors.
$15.00 CHARGE FOR ALL RETURNED CHECKS
��� ������
.... j. . .,_ . ` .�
� � '�'�',•'�'"v`1��°0• Charitable Gambiin Control Board
�z��.�d�•y;:.. 3 9 FOR BOARD USE ONLY
S� Room N-475 G�iggs-Midway Buildin9 u�,Na,�«
�''^�':; 1821 Unive�sity Avenue
�� � �
,���, � St. Paul, Minnesota 55104•3383 PA�p
�'`. (612) 642-0555 AMT
�`"�` ���' CHECKF ' •
DAT
� GAMBLING LICENSE APPLlCATION
INSTRUCTIONB:' .'� :'
A. Typs w print i�iMc.
B. Taks compietsd spplicstion to local goveminq body,obtain siqnatun a�d dau on all copies,and lesve 1 copy.Applicant keeps 1
copy and atnds origind to the sbove�ddress with a check.
C.. Incomplets applications will be return�d,
Type of Application:
�Class A - Fee i 100.00(Bingo,Raffles,Paddlewhesls,Tipboards.Pull-tsbs)
,�Class 8- Fee i 50.00(Raffles,Paddltwheels,Tipboa�ds,Pull-t�bs) ����p+r•a.so:
OCI�ssC - Feei 50.00fBinqoonly► ' ��•��a�"o��
OClaas D - Fee s 25.00(Rafflas only►
. CYs o 1. Is this applicstion for a renewal� It yes, ive complete license number
• YesONo 2. If this is not an application for s renewal, hes or anization besn licensed by the Board bsforsl If yes,Aive base
license number Imiddle five diAits) �
Yss ONo 3. Have Internal Controls been submitted previously�Ii no,please aRach copy.
4. Ap_pfcsnt (Official,lapal ame of or�enization) 5. Business Addreys of Organization
� �
8. Ci State,Zip 7. Co 8. Busineas Phone Number
/� s� 1 1
8. Type of or9anizetio�: r�ternal OVetera�s GReliqious ther nonprofit•
•If apsnaacion is sn"oth�r no�prolit"orpsnu�uon,snswer qu�ssions 0 ttuou� 13.If not,po to qusttion 14."Oth�r non�ofit"orp�ni:ations
must document its tix-ex�mpt ststus.
Y�s�No 10. Is or�anizat�o�incor orated ss a nonp�ofit oryanizationT If yss,pive number assiynsd to ARicles or p�flf snd
book number: Attach copy of certificate. •
Yes'-JNo 11. Are articles filed with the Secretary of State7 •
Yes JNo 12. Are articies filad with tha CountY�
Yes 7No 13. Is organization exempt from Minnesots or Federal incom�t�x)If yes,plesse attach lstter from IRS or DepsRment of
Revenue declarin exemption or copy of 990 or 990T.
�Y� No 14. Hss ficense ever bee�danied,susp�nded or revoked?If yes. check sll that e ly:
ODenied CSuspended ORevoked Give dste:
16. Number of active m�mbers 18. Numb�r of yaars in existsnc� Note: Ii less thsn four yesrs,sttach
' D evidence of th�N yea�s
b �� S sxistence.
17. Name oi Chief Executive Officsr 18. fV�me of treswrer or person who accounts fa other rsvenues
ot the rgana
�� �� ��
Tit1e Titl�
/ � .
� S �•�d oC ! '7J s �i�li,v�rrR,q?'o
8u�l�ess Phone Number Business Phon�Number
( �D�2 � �7� - 35�� � � �d2� 7�"'�s22.
19. Name of establishmenc wher��amblino will bs 20. Strset addres`Inot P.O.Box Numberl
c d ted �/ ��
l��t�
21. �cy, S : ,Zip 22. Cou iwnere gambling premises is Iocacedl
�� . n1, � D(p wiSe �
. CG•0001•OT(8.'Fo1 Whice Cooy•8o�rd CsnarvApphCint P��k-Locsl uoverrnnq BodV
3
• fi
.. : � . � � . G����3 ��
4��mbMg Uc�ns�Apppcadon Psp� Z
Typ�of Application; OCla�s A �lass 8 OCt�as C OCl�as D
'_''Y�s ONo 23. li •mblin premit��located within city limit�l
•��No 24. Ar� all p�mblinp activitie�conduct�d �t the premises li�t�d in M/9 Of this�ppliGatiOn� If nOt, Compl�t� a ��par�t•
application tor�sch premises lexceoc re}flesl as a separece license is required for esct+premises.
�Yss o 25. �oes or anization own the qamblin prem�ses? It no.att,chCOpy of the lease with terma ot at least one yesr.
`Y�s o 26. Ooes the organizstion leaae t��ent�re premi:ea 7 If no.�ttaCA�sk�tch of 27. Amount o(Monchl�i Rent
ihe p��miaes i�dicating what poRio�i�b�iny lea��d.A I�as�and ik�tch (a �
is not requirfC for Class 0 applicstiont. �
CY�s o 28. Oo you pla�on conductiny binpo with this licensel If y�s.pive days a�d tim�s of bin90 occasions:
OM TMn.�
Y�s ONo 29. Ha�the S 10,000 fidelity bond required b Minnesot� St�tut�s 348.20 been obtainedl Attech copV oi bond.
30. Insur�nc�o�,,mpany Nams • 31. Bond Number
"e S� 05''
3Z. L�ssa �m� 33 dd�esa 34. Clty,S ,Zip �
, CzS , � a.,�Sal
38. Gambll Maneper Na � 38. Addrest 37. City, Stat�,Zi
� � �
38. Gemblinp Manepe�8u:ine:t Phone 38. Dace gamblinp mansper bscame
( � 7� _ member of or9anization: 7 .
GAMBLING SITE AUTHORIZATION
8y my signature below,local law enforcement officers or agents of ths 8oard ere hereby suthorized to enter upon the site,
at any timo, �amblin9 is beinp conducted, to obse�vs the qamblinQ and to enforce the law for any unautho►ized 9ame or
practica
BANK RECORDS AUTHORIZATION
By my signature below,the Board is hereby suthorized to inspect the bank reco�ds oi the General Gamblin�8ank Account
whenever n�ceasary to fulfill rsquinments oi curre�t pamblinp�ules�nd law.
OATH
1 hereby decla�e thst:
1. I hsve read this application and ell information submitted to the Board;
2. AH information submitted is true, accurate and complete;
3. All other requi►ed information has been fully disclosed
4. I am the chiet executive officer of the organization;
5. I assume full responsibility for the fair end lawful operation oi all activitie�to be conducted;
6. I will familiarize myself with the laws of the State of Minnesota respecting gemblin9 end rules of tha Boa�d and agree,
(f licensed, to abide bv those laws and rules includinQ amendments thereto
4 OfticiN, eQsl m�ot Orfla :�tio� ^ �41. Si u Imust ��iQned by Chi�f Ex�cutiv�Otiic�r)
� K � X ��, ,,
Title t Siyr�°► ' Dat• '
� �- � �' �''�"l ��
ACKNOWLEOGEMENT OF NOTICE BY IOCAL GOVERNINO 80DY
I hereby acknowledge receipt o( a copy of this application. By acknowledging receipt, I admit having been served with
notice that this application will be reviewed by the Charitable Gambl+ng Control 9oard and if approved by the board, will
become effective 30 days from the data of receipt inoted belowl, unless a resotution of the local governing body is passed
which specifically disallows such activity and e copy of that resolution is received by the Charicsble Gambling Control
8oard within 30 da s of the below noted date.
4Z. Name of Cicy or County(local Govsrn�np Body) 11 aite is located within a tow�ship.item 43 must b�completed,in
��� �� ��` L�2 � �1 addition to tM cou�ty siqnaw��.
T (��.1� ;
Siynaturs qf persor rsceivinQ spplicacion � 43. N�m�of Townthip
' ,,, n� n �
, �
X �, / y�' ,� ..It, ; /d; �i f. ,'`Y���
Tit�• Date�ecbived(30 day period ' Siqnature of per�on rsceiviny�pplicstion
) ' bepint Iro�thi�_dstt) _ '
�1•�.<•,-..1�_�i�-.% _` C ,'/'l! T, X
44. Na f Psrson de1 nnp applicatwn co Local GoveminQ Body TiUs ,
�
CG�OOOt�OZ 181861 Wh�t�CopyBoard CanNy-Appliwnt Pink•Loaal Gowmu�p eody
���� "In Tune With Nature" u f-��'� ?�
��" - RADE LAKE CAMP RADE AKE AMP
. T
• � 919 East 7th Street ��
St. Paul, MN SS106 , - �ANS
(612) 776-6945 � •
NON-PROFIT FOR MENTALLY HANDiCAPPID
ENDER OvING ARE
� ..
OG� - -_____--__--�__. . �O�
_. __._____ ----- .__. _.._ __ .
PR PY
�
�P ANDICAPPED
�;
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THLETIC Gg�1�
_-- _ PR� ppY
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�, LANNED
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� -- - ROGRAMS FOR�
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OUTH .... � -
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AN EQUAL OPPORTUNITY CAMP �'OR THE MENT�ALLY HANDICAPPED
! _ ___ .
— Supervised — _ ; _
Special Training for the�Special Olympics
7NCL UDES:
• Week of Summer Camp Experiences �=' �
• Swimming Pool i ` i�
-- Water Games with special training in:
• SWIMMING
• WATER VOLLEYBALL
• Athletic Field —� one acre _ � � �" �
— Special track events,for mentally handicapped youth
— Softball team training for mentally handicapped youth
� BA TTING
• PITCHING
• FIELDING
• TEAMWORK �