88-1644 WHITE - C�TY CLERK
PINK - FINANCE COURCII �//jG
BI.UERV - MAVORTMENT OF SAINT PAITL File NO. "� -/�� -
' eso tion r��`�,
�� �
Presented By
�.___��
Referred 4 Committee: Date
Out of Committee By Date
RESOLVED: That application (ID #21041) for renewal of a State Class B
Gambling License by Como Area Youth Hockey at Ted's Rec, .
1084 W. Larpenter, be and the same is hereby approved/dwq+Feet.
COUNCIL MEMBERS
Yeas Nays Requested by Department of:
Dimond
�� [n Favor
Gosw;tz
Rettman B
Scheibel ��_ Against Y
Sonnen
�Yilsee�
�y i � � ��� Form Appr ed by C' torney
Adopted by Council: Date ' .
Certified Pas• y Council Sec ar BY �/�
B� .��Q
Appro e by Ylavor. Date �� ! �� ��c71i Approved by Mayor for Submission to Council
By
�;�a�,�;m� 0 i;I- � .. 1988
, � ���,���
DiVZSION OF LICENSE ANI) P�:RMIT A.I)MINISTRATION DATE 9 q 88/ � a� p O
INT�.RDF.PARTTfE1�TAL REVIEW C:HECKLIST A.ppn rocessed/Received y
Lic Enf Aud
Applicant �,(�` ,�.h��sp� Home Address ��g� �Q hQK�(J
Rusines5 Iv'ame Home Phone � �—
Connfz.�„ �ockt� .5'� � 1�0
Business Address '�g � �. ��t�{rType of License(s) ��,�- C lAt'S *��
Business Phone �D��SS�.'3 er,�(� d,'
Public Hearing Date �� �� gg License I.D. 46 e� I (� � �
at 9:00 a.m. in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. �� �J�'
llate Notice Sent; Dealer �f N'�
to Applicant
Pederal F�_rearms 4� N ,A►
Pub.lic He�.iring
DATE INSPECTIUN
REVtEW VERFIED (COMPUTER) CUMMENTS
A roved Not A roved
�
Bldg I & D �
��� ;
Health Divn.
N �,� ,
�
Fire Dept. I � �
; N �t �
' SthC �
Yolice Dept. n���
��
�
License Divn. �
City Attorney ���\�� O �
�
Date Received:
Site Plan � I� (,� �^ �
To Council P.esearch � �7V
Lease or Letter �i� Date
f rom Landlord h� ,�fr'�V bG
�� ��� ��
u n�� t tvotx.w�btr, 19s�
T , ..-
�',�. " ,. _ .. ..��Q��
'` : ' � City of Saint Paul :.
�-�_ . ' Department of Finance and Management Services
, ,. • , Ucense and Pennit Division �(������
�.,�..�; ; - . ` 203 City Hall • 0
�.„,.�; . ,._ ' :�i ,:,_ . ° St.Paul, Minnesota 55102-298-5056
� _ APPLtCAT10N FOR LICENSE
�CASH .�CHECK CtASS NO � �,�t `� f. New Renew _
f� : 1 . !� ,� "�?4 '�rs+�y�`.w ...� a "' y""{ .. .-. . '
' x , . :t 'h � Y" rz . � .. . - q• ' U
�,d . :� '�^` -• OStQ � ��
:,�,Code No. . Tttle of Ucenae ` �From � /D t��To �19�
ti
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'",� IC� 'S . �' U w'ti ���r� � J .� . •
� �:,:. . . , _ ,� � �o mo �rt� ou�� �a�� .
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� L I .. 11 e LIJ� - ,APPIICanHCompany Name �
..� �^_ .
100 .
`� �O �� Ct) L �r i��°u�^'
100 Busin�ss Nam�
; - . Y. '� , c` - �[� ' / � n
JT
Busl�ess Addnss Phoe�No. .
100
100 Maft to Addreas Pho�e No.
. ,00 �q U e. ,Q nc�v-son �.S�S 5 3
. ManapedOwner•Name w � �y�
y ' �� . � �
�� � _ � I�� � Co�anSpy �
.. 100 , Atan�q�r/Gwne�•Homt Addross Phon�Na
}-�. 4p98 AppltCatfon Fae 2 gp . . .� '.<
M .r� c� F
j' Recelved the Sum of � - 100 . ` ` . �� • �(,� ' ":� i J 1 �J��7 ;�
. ,,,.
�...� x. _. _
- . 3'��,J� _� Manaqerrowner•C1ey state b Ztp Code
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° .,,wt. .., . ._ . ..,� a,�, a � � ' -
�Ctcense Inspecto� ' ,By:� �T Siqnaturo of Applfcant
-,f -
BOnd• . -� .. - r'�-�;Y ,...'':� " - j _ : _ :
`i��• • CompanY Name _ , . : Policy No. Exp�ntion Oats
�•I�surance- __ : -:._. -- . . .
s : Company Nsme 4..-: . . Polley Na . Expfntlon Datt
k'. � . . . . . . . .��.r,.},�.. . . . .
�?.. . ... . .. . . .
:`Minnesota State identificatiort No � � � r � "' ' Social Security No
� .:.:. : . . a .- -: .. :. . .
.. - ._: _. . - ._ : , ..
. .: _ ::: .
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� Vehicle Information: :'� , r � _ � - �:
_ S�ial Numb�r . . _ . ste Number
"`�Other _. . . . .
�- THiS IS A RECEIPT FOR APPUCATION
�� �` THIS IS NOT A LICENSE TO OPERATE Your application for Iicense wilF either be granted or rejected subject to the provisions of the zonlnp
�'�' ordl�ancs and completfon of the inapactions by the Hsalth. Fire.ZoninQ and/or LicenseJnsp�ctors.
�u� ,. ..
� �;` � - ' ' •
j� . : ' _
� $I5.00 CHARGE FOR ALL RETURNED CHECKS
,b •
i
A
� � . . � .. . � - .
��t
{�:' '
r�` _
���: q�-aa�-�-�
� Charitable Gamblin Controi Board ���/��
9 For 8oerd use Ony
Rm N-475 Griggs-Midway Bldg.
1821 University Ave. P��
-' St. Paul, MN 551043383 Check No.
�...:'�' (612)642-0555 Date:
�' GAMBLING LICENSE RENEWAL APPUCATION
UCENSE NUMBER: 8-A@126-+�5 !EFF. DATE: 101A1l21 /AMOUNT OF FEE: $5�.A9
1.Applicant-Legal Name of Organizatio� 2.Street Address _
HOC�B� ASSOCiA4IaN CO!(0 ARB� YQOi9 1826 Coio P1
3.City,State,Zp 4.Counry 5.Business Phone ,�'
St Paul, M� 551A3 Ra�seP 612 498-46T8 �
6. Name of Chief Executive Officer 7.Business Ptior�e �^ }
David Zndersoc Lt �'� 5�JS3
8. Name of Treasu�@r or Person Who Accounts for Revenues 9. Business Phone
fJAV i D 1�+�CEs�SON m!Z ��5553
10. Name of Gambling Manager 11. Bond Number 12.Buainess Phone �
� t7AV 1!C7 �'1aO��SOi.� 2;299T �vlZ �I84-SS53
13. Name of Establishment Where Gambling�11 Take Place 14.County 15. No.of Active Members
!ed's Rzc St Paul 8a�sey TS
16. Lessor Name 17. Monthly Rent: �p
Araold Aa�ga .�50 -�
18. If Bingo will be conducted with this license,please specify days and times of Bingo.
Days Times Days Times Days Times
19. Has license ever been: ❑ Revoked Date: ❑ Suspended Date: O Denied Date:
� 20. Have internal controls been submitted previously? �Yes *0 No(If"No,"attach copy) ...�
21.Has current lease been filed with the board? `�Yes ❑ No(If"No,"attach copy)
' - 22.Has current sketch been�led with the board? � ... , �Yes ❑ No(If"Na,"attach copy)--- .-�- -.____ -�..:.. :�. _.,.,...:-
;z. . _ GAMBWNG SITE AUTHORIZATIONti,
By my signature below, local taw enforcement officers or agents of the Board are hereby authorized to enter uponThe site,at any tlme,gambling is
being conducted,to observe the gambling and to enforce the Iaw for any unauthorized`game or practice. '
; BANK RECORDS AUTHORIZATtON , ` ' ' :
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.
OATH •
I hereby declare that:
1. I have reed this application and all informatlon submitted.to the Board; ._ • - -
2. All information submitted is true,accu�ate and complete, ..,M... ,...�_ :_°; . .__.,.. . -._ ..� .. * :
3. All other required information has been fuAy disclosed;
4. I am the chief executive officer of the organization;
5. I assume full responsibiliry for the fair and lawful operation of all activities to be conducted;
6. I will familiarize myself with the laws of the State of Minnesota respecting gambling and rules of the board and agree,if licensed,to abide by those
� laws and rules,including amendments ther�o.
23.Official Legal Name of Organization Signature(Chief Executive Officer) Date Title
- �
;;
ACKNOWIEDGEMENT OF NOTICE BY LOCAL(30VERNING BODY
I hereby acknowtedge receipt of a copy of this application. By acknowledging receipt,1 admft having been served with notice that this a{�plication will
'' be reviewed by the Charitable Gambling Control Board and if approved by the Board,will become effective 30 days from the date of receipt(rroted
below), unless a resolution of the local goveming body is passed which specifically disallows such activity and a copy of that reaolution is received by
, the Charitable Gambling Control Board within 30 days of the below noted date.
24.Cfty�unry Name�,(L,ocal-.Governjng Body) Township: if site is located within a township,please complete itema 24
�;i...`�-'A !�i�. �;,�.i-{.. and 25:
Signature of Pe's'on Receiving Application: 25. Signature of Person Receiving Application
� �� �{�.�.." ��1 cu,� � �.�{�
- Title .r Date Received(this date begi�s 3p d�Y��e�ry'od) Title:
4���a. .�� .�.Z.J �--;Y"..�-�:.� C`.t^� �� 'l I%`�i
Name of Person Delivering Application to Local Goveming Body: Township Name
3�
CG-00022-01 (5/8� White Copy-Board Canary-Applicant Pink-Local Goveming Body
�� , Cicy oc Sainc Paul ,�(�
� '�• ,�� , Deparcment oc Finance and Managemenc Serv:ces �����r ,
� • Division of License and �'ermit Etegiscration
INFORMATION REQUIRED WITH APPLICATION FOR PE?tMIT TO COIVDUCT CHA.RITaBLE GAMBLIVG GA,*t� I:�
SaINT PAUL
and complece name of organization which is applying for license
�o m o ���. � . �rr c, - �s j�-
2. Address where games will be held ��B"r �U-1„���'��c.�`TE�ie LT. L ��jC�
►lumber Screec City Zfp
3. Name of manager signing this applicatioa vho will conduct, operate and atanage
Gambling Games L/�71�t 1� � • �1 f�/���ati Date of Birth � -Z�J °�a
(a) Length of time manager has beea member of applicanc organizatioa � ��r's- _
4. Address of Manager ` � 7 .r NAI�-3S� �.� v/ - / U � � ^� l�
Number Scr ec City Zip
5. Day, dates, and hours chis applicacicn is ior
6. Is the applicant or organizatian orgaaized under the Iaws o= t�e State o= �1? �
7. Date of incorporati�n !'���
8. Date whea registered With the Stace of :linnesoca � ���
9. How long has organization been in exiscence? 8 �I�S .
10. How long has organizacion been in aYisteace ia St. Paul? C� �l"-�.
11. What is the purpose of the organization? 1, O � /Z�Z-.���Lb �f�t�T6-�
. �
12. Officers of applicant organizacion
1� Yame � .- ,1�SET�T'14-A�
Name � �A � � ���-- �
Address �Ji�� �hna V�_ Acfdress t 2J�� ��g�+��
Title 1 r �E,_� '�' DOB / -�-4�� TiC?e ��.��C- � D�B
vame �p.�L� 7�S �1 SS 6� vame S+�i�-12Zi4.� �'T EL M A 'L t 1
Address fJ�(� Gj • ��c�lr.��7� address �`�'J��J � t....�SA1�4 ��,
Tit1eT2LS _ DOB iitle c� rC _�_ '�aB
13. Give names of officers� ar any ot::er ?ersans ana ?ai� cor serr'_ces to _ze o:3ar.:=at:�n.
.. /
�ame , .%�h►�!: Vame
Address address
Title -='-e
(,lctach separace sna�- =^� ad�=::or.a: ��==s. �
�.. /'/
� ���/r ! �
14.� �►ccached hereco .s a lisc of names and addresses of a11 Qembers oc c:�e :-3ar.:za__�- .
� �
15. In vhose cuscody vill organlzation's records be kepc?
Nam� �`1���E �Q2'�d�U►J �ddress �3E7� �Of'►�p �V�
16. Persons vho v1I1 be conduccing� assistinR in conduccing, or operRCing che games:
:�ame �ta�V L t� � . J�1.�£������ Dace of Birth �--Zg--Q...Q
addres. �.4 v"7 �o t-�r�s��-I �e,
�ama og Spousa �y-���j�2� Dau of Birth�-24 —'`i'2--
Dates vh�n such person vill conduct. assisc� or oparsce �-� -�� Z'� 8 -�~ ��
Yam: �' Y l��-n `�•Z < < aS�C�� Dats of Bi:th � ^ � �� �.--
4ddress 1 � �� �J�'t. v ' =
Nama of Spous� ���'^� C� ���'C- � Dice of Birth � °����
Daces vhen such person *.�iL? con�ucc, ass=st� or operate �`—c�� "` �""'l�
17. Have you r�ad aad do ?ou choraughly uade:3t3Ad cha provisions oE sll laws, ordiaances,
and r�gulitior.s go��e-.^.=ag �:�e operac=on o� Cha:itabl� Gambling gan�s?
18. Actached hereco �� c4s Eo:; .`cst�:shad bv �h� C:cy o:; Sc. Paul is a Fiaancial Reporc
vhic:� :csmizes aI: recs:�cs, exp�aa�s� ar.d disbu:semencs o= che applicant organizacion
as ve?: as a:: o:3an:za:=ans vaa zave :ece:v�d 'unds zor c�e orec�di^.g ca'andar �ear
whica �as beea s:;::ed, pra�ar�d. aad ver_::ed 9y /���D 1�. .'�1�0���
• �iame
� �- �� �d �1�A�1�-y-� .� � 1 A-t�C�� 1'"l 1�� S S 1 ��
�d�r�aa
vho is chr �AMS�,t�G, �C-a2, aE che applicanc Organizac_or..
Yam� �t Of:=�s
19. Operacor of premises where ;am�s :�:�: �s he?d: ,
Name �1.�C�l..p A1�t p A
Business �►.ddress �� �� LCJ - �l�����U.E
Hom� Address ��� �- �N��-�.00�
20. aasounc of ranc paid by acp:::aac Or3ani:acian cor cezc oi ctte hall; speci:y amounc
paid per b-hour se=g;on �/.'�G� ��Q��11'1 D�
• �—�
, ', , . � �����
�
<� ' 21. The ptoceeds oi tne gacnes will be disbursed after deduccing prize Iayouc costs and
operat�ng expenses for the iolloving purposes and uses:
-�eC 7"irnE �EQvr���T
22, Has che prec�ises where the games are to be held been certified for occupancy by the
Cicy of Sainc Paul? y�c�,
23. Has your orgar.ization riled Lederal Eorst 990—T? If answer fs yes, please attacn
a copy vit:� this applicacion. I: ansver is no, e plain why:
Any changes desired �� tze apolicanc �ssaciac'_on ma� be made only wich the consent of �he
City Council.
�2��I �f�{ L�.�l'C�
Organi.za c;.on
Date � — g —�j�j Bp: '
`ia. ger 'n cha e a i game �
� `
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7
' , Cit� of Saint Paul Q _� ///f�
, Departsent of Fiaaece a� Managem�nt S�rvicas N` [0 r /
- Division of Licea�e and Pes�it Adniniatration
• . . � UNIFOFti CHAAI?AEL6 G�LING FINANCIAL REPORT
,
D.�. S3� � , 8�'
� �. �.�. of Organization erno rtcA �o�-T � 1-� o���y Ag��:e� .
• 2. Addna� whers Charitabls Ca�bling L co�net�d � 0 g Q. �3 • �-.A�Lp�1J�t.0 '�
3. R�port for period cov�riag ��~ � 19� through v V�� �� 19�
4. 2ota1 msmber of days plarid �Z.8
5. Gross r�ceipts for abova pariod . ; �� 8 ���.g�
i ' 6. Gro�a prize pa7onCS for abo�a perid (iaclud� euh short) = 2.� ! ��LlJ•J�d
� 7. Net receipts - lin� 5 ainw liae 6 � �a � �����
8. Expecass incurred in conduetiaz aad op�r:tin` ga�:
� A. Gross wagea paid. Attuh wrter liat vith �! � 0
names, addresa and gros� vagss. i ��fG`F-�-
B. �snt for �3� we�b � ���-�
, C. Licease fae g�'pT� � K�Gtt.�E� �
/��.�—°
D. Inaurance �,tJORItE2.S GOMP� ; �D " � .
E. Hond i ���b� '
P. Di�honored checks not recovered ; ����
G. Aecounting Ezpenss � —`
H. Employera F.I.C.A. ; —
� I. Yulltab Ta�t Paid to Departsant of Ra�em�e � ����.''O �
_ J. Minn. U.C. ?az � „ ;
�. Pederal Excis� Tas 6 Sta�p � � '
L. State Gambliag Taz � �••
M. Miscsllan�ous Expsnsu. Identif� eh� a�onat
and to whon paid.
i. e�r�► RE,�-c s 2fi'�
�r
���.,.., y��. �EaN �vrL —
2. t�n�se.�c�uta��n�.�r s �� -� ��c.�«�oc<. sc,r_ - n,a��s �x�c
3.C�T� io?�o Tt��l i '..�.��5." �
4.Ml9C. �XP. SvPplFS, i ��•d�
9. Total Expensas 'fOTN. 4 �Y'�7 ' �
' 10. Net Incom� - lin� 7 ainw line 9 1 ; ; -���3�-70 _
11. Ch�ckbook balance begianiag of pesiod S �
12. Total of liae 10 and 11 , 4 3����v
13. Total contributions froa lins 17 ; �3 7�•�
c K. �o�r gc� 2Z 7�G�
14. Checkbook balance end of reportin; p�riod - . _ �
line 12 lass lin� 13 5TA2T I�D/��r`rC AS H = t - � � 5'93
15. Specify use mad� of asomt on lla� 13: 4 T ����
1 e� 7�.ri� � 7vv,"r,.a��i��'s �v � oe� ��c.s � �ih.�
' ��.��J �A�Q/��i��
C..
, . , �• ' .... i�::.:r56.^.tt.^.:a .:OCI 3:Olt^C �1 1�.^.! LZ: /�� r'����T
lA V �
yame Name
, Addre�s Addr�ea
Dace Ree`d Date Rac'd
Purpose Purposa
Signacure Signacure
oE R�cipianc of Aseipisnc
Amouat Amount
Nam� Nama
Address Addssss
Daca R�e'd Dac• Rac'd
Purposs Purpo�a
Signatura Signacire
of Raclpisnc oE Rsciplent
• Amount Amou�t
Name Name
Address Addreaa
Date ltec'd Date Rec'd
Purpo:a Purpose
Signacur• Signature
of Aeelpienc o! Reeipiset
Aawunt Amoune
Nsma Name
Address Address -
Dact Ree'd Dace Rec'd
' Purpos� Purpoae
Si�naeure Signacurs
of Recipienc of Rseipient
Amouac Ameunc
17. iocal Diaburse+eencs
THIS REPCRT MJST BE FILLID•I:t COl�[.E?ELY TO QUAL2FY AYPLICA?ION FOR CHARI?AbLE Gd1�LINC
LICENSE. ,
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(� n r R> '+ l��\ � ��JG�(.e�
` � s � r o�i � z o n • f! .S. a S 2 J� � � � Wi,/
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- �C1TV AlTOR1�Y
� .. . � � . . .. � � . � . . : � .-. . . . , . . . � .•i
` Applfi�ation for Renewaj of ar Class B Gambling License. �
Notification Oate: 09-3�-88 Hearing Da�e: 10-1i'�88
�.inor►t+qwik uV+a�•a►t«�(�+)) e�,NC�R�ncx+�+oRr: . �. ; .
���ris� :, c�sE�oor�asaH ' o�ff w o�re aur :�rsr �►+o�wo.
aorra oo�oN re�en xaoo�eo,w� .
WD
� . .: . ..STIIFF , � � . � �� pNRTEfi COA�9d188�P1 . � � , CAIuMLE7'E AS IS . -ADD'l IN�AOOW� -__ I�Y.Y�If�O�' . �11�!��. �..�
DI6iRICT�00il�ICIL � _ �� ��T— � _ . . . � .. � �`'-' . .
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�. ..�i5 WIAf:It COIiNf�ORiBCRYl1 . . . - � . . . ' _ � . -� . � . : : � �.� �- . . . . �.
_ ��un�� Research Centsr
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Mr. Dave k�r5on., an behal.f Qf the Como Area Youth I�cke,�r Association, ;
requ�sts Courtcil approval of his applicati�on for ren�wal o� a State �'l.a�s' B=
Ca+�1.1r�g l.ice�e at Ted's Red, 1Q$9� W. Larpenter. Prt��eeds f�om pulltab: sa��s
are used to support youth hockey in the Como A�ea.
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Al'1 fees �and'�appl�icatior�s t�ave been submitted. Cano :Hockey is current on _
; •:.its �0% Pa�nen�s to. the ��ty�Wide Yon�th_Ath'�etic�fund.
,M�AR wl�,�k?n��: , . , _ .- . _
. If Coutic��-apprc�ra� 'is giv�n, �aqo Rrea Hockey will continue puifitab saaes
at Ted's.Rec. ; � .
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