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88-1881 WHITE - C�TV CLERK PINK - FINANCE GITY OF SAINT PAITL Council CANARY - DEPARTMENT BLUE - MAVOR File NO. � / �� Council Resolution t��f3 � Presented By � ,�i�/� Referred To Committee: Date Out of Committee By Date RESOLVED: That application (ID #28051) for renewal of a Class A Gambling License by the lOth Street Boxing Club at 1324 E. Rose, be and �he same is hereby approved/��. COUNCIL MEMBERS Requested by Department of: Yeas Nays Dimond � In Favor Goswitz Rettman ('� _��� _ Against BY _s�� wuso� �V 2 9 R�pp Form A roved by City Attorney Adopted by Council: Date Certified Pas e ouncil Se ry BY /' 2� � gy, t�pp v d by �Vlavor: Date 3 � �_ Approved by Mayor Eor Submission to Council By P�I.ISNEB ��� 1 t� 19$8 . ������ DIVISION OF LICENSE ANI) P�:RMIT A.DMINISTRATION DATE �v /$ � / � �9I� INTERDF.PARTMENTAL KEVIEW (:HECKLIST A.ppn Processed/Rece ved by Lic Enf Aud Applicant L�l,(, �n n �/ _ Home Address 2!a3 aQQ)'Y) _ Rusiness h'ame r0� `�'�� �5(.���j Home Phone Business Address 1�a� �. �o� Type of License(s) C��QSS � _ Business Phone �1'��J�. �QQ� ' � Q►'►� �j��n y Public Hearing Date �� � License I.D. 4{ « O� � � at 9:00 a.m. in the Council hau�bers, 3rd f.loor City Hall and Courthouse State Tax Z.D. �� N�/4' llate Notice Sent; p �` Dealer 4f 1J'/4' to Applicant ���I��O� 1.���, Pederal I'i.rearms �6 �7 Public He�iring DATE INSPECTIUN REVIEW VERFIED (COMPUTER) CUMMENTS A proved Not A roved � Bldg I & D � u�a ; Health Divn. � u� � ' ! Fire Dept. � � j ��� � I S¢iv� ( Yolice Dept. ������ I .J� � License Divn. ��'��I�; �� City Attorney � I�Iai � � 6 �,.. Date Received: Site Plan � I� To Council P.esearch Lease or Letter !O� l� ��� Date f rom Lar�dlord i .. . . . � - � . - � . . . ' . .. . _ . . . , . � , . , . ������ .� ,� r " � r�`>���Charitable Gambling'Con�oFBoard � 2�� FOR BOARD USE ONLY '�"` d $�` ��:Room N-475 Griggs-I�lidway Building ��" '� _ ;z�'�t.' f ����l 821 University Avenue �.��'� ; = ` � �� r'�°� c u�.�.,�.. ' _ �. ; :�� `'� _ , : � � �.'.St.Paul,Minnesota 55104-3383 .�:" � �.` �°�" y. - '� ��� t � { (61,21642-0555, "'' ` ' "�; °F :AMT '� :�'�,f " t ti� a� .��.;�� . T �`� 4 '4�t�.rv$ ���� .�'l!�'�Y�'�, ^�� . " ��� ♦ }• y�. �zxa��: � ; «S�.'x t��.., �.�_•. sr'S 7i+k �� r k�CHECK# 'S��J 4 :�`e� �'`N" i �r''�.�°:Z � , N� it i�,�at 53'E.'ti"� �z �e -r�;a- :��'� "L°` *�� c�i -c� ;?�'. $� r ._� �'k � . r. , �., �^, . DATE r . ; , ��,���" „ `�� ��GAMBLING LICENSE APPUCATION ���, p �� � z ��. � *;„'ti "`� �R � r ..� ' ��� �. ��.. � �w � � +v 't w� , se �.. � . a4,•. �y #. ���tx •'� "�l iF�. }�x�p �s t�a � �'t ,t � � ".��+�� a��.�'��' v{ �� �. ... . t. .. , .r (� xY . `r. : -�::. � S a.4 �� r "y �'�`� :i^ f'�' '•1 4 i y � a��.{'" ��.,>ta k�.. r s._ '. (��� '@� c . � ,. .. -� p ,�, a� �� h a . - �L ?� ' +Mi +tx'� fi� . ,•�{ � a '� t y.. `�1STRUCTIONS:,t� .: ��.. ��r "M � � ���t�� Y :. a� �TYPe o�pnnt in inic..�: :'.. .,�;,�'�a3��. ,:� ���" . ,... � . 3 �;,,;...'�.N ��y' :,�.�:� � •. :. . �, .,� °��r T�.,, � . � B �Take oompleted.application to locaf goveming body,obtain signature and date on ali copies,'and leave'C copy Applicant keeps t' 3 � ��"`�"copy and sends original to the above address with a check� " �`� u � �� 3 ���,,��- � � � ,r. ��*��• *� �t � ,�C itncomplete applications w�l be retumed ��,�-��tit�+��x"�;�t" ,°��,���ya " '� � L, ��.r'� ���,b�; `�.;��, "�>- • t . ° • _ , . . . ., , : '"��TYPe of Application: d+�x�- ntir _ «:�'. �i��' �'.F_�xi" # ����u.�,�sq�,4 tx'°s`s.' �,,, ,iy�'�..°�# a�,�� . K•. �. ��:r�� �*},p��.� • .;�F� � '7}" .. 'W' �T+t �:. .�P�S�� "'' ��� ' J' �Ciass/l— �.Fee S 100.00(8in9o,Raffles,Paddlewheels,Tipboards,.Pull tabs) �� � � � �����C�BS$Bi� y* � , b ;�?.Fee 8 ,50.00(Raffles.Paddlewheels.Tipboards.Pull tabs) �� �� �°°��'�'tO: i ���'e f �. `�'`-, �=;ry � �•�=OClass C y•,Fee$ 50.00(Bingo o111y) %"�,� � ;~� , i,=a s y t =,.` Mirnsou p�it.ba ciamwng Conuo�so.ra ,�1,r° ' � ^ .rY;.r,, '''�r -°:t..^: �-�.� ,�� .�Class D="�Fee S 25 00(Raffles only) "� 'i, . , , .. ,.., , - ,:• .�:�..,, : ' . � '''�,� .. Yi'��4�F�. � >.�.:;..�L�4 ... .. v::�' . . .. �'•....�:..�.. ' yt.1 '� ' .��Yes ONo ' 1: is this application for a renewall 'If yes,give complete license�number � �����`• �'� -�� ' 4:; ,. ;_a fi,��Yes�No , 2 If this is not an applicati�for a renewal,has or anization beenyicensed by the Board before? �If yes grve base � ��,�i" t� Y.�� +S: . r.v ��9",. �.:.. _��.'t , t. �`-1. � ' tr t i t'� 1. �,l� ; }�� ,���,�.��'?.���e�.���hcensenumber(middlefiveiiigits) "'1` �' • °'.�`"' � Y �-�`-�`� �w� �` * � �j � ��`� �r� � ��� }�� ' ;` : �i �, � ! .r �r su.i't�..� � �� ` ;,'� :'�.�rjYes�No .�"r3.=Have Internal Controls been submitted previously?If no,please attech copy. --':�'''x;�;�1��� ", �"-�'�. , �k�� � Y � ` "-�t 4 A IicaAt(Official,I al name of or arnzation) } � �' �'� 5.,Business Address of Or arnzation � '-'` -�� ��Y"�' � -t-�.ra t PP �9 ` 9 � ,� ��, ; w9 ��,':�; ''y '"- +,k� � � '�" * �.."`�y� �,."• ��: �.�S �rk '4�^, `�t��.� �,�'j*t'''v o+� y.... r�' �aK��^ '�� w ,'.'"� =.� ,�:,.i vh�`�'�= �'; _ e > :;1 � . }� /+ 1 , � . 4S', 6 �a tr��/�StBte L�p�,� �'� jy;.�w '� *i. Ei� i�}+7.a � i� 7 ,CDVn� �i� y �;K"� �, 8 Business Phone Number Y ,t*� �:,� ��.'_ .-%+`c�t ��.53 r''C`�:;��,�"u��ii'<��*.'�T..�"�c.,a,:�i�.��+y.rY"�4�"�- ,'�:�' s�( `.� � 8�j'.T'�:..^r� r ta•i��,:\ +v,'�',ii`�''�t. }�x:R''iL��.t, `�6�����`,li �/. � S�✓ e9:�` ypeoforganizspon,,��}5� F rtemat��OVeterans {QReligious," Otheri�onpro '„� � "''�`�j� '` �; . � F"`i'����� y..i ;�,. .. �a ♦ .Nr. t$G� i H or`gai�iet�on`ts an'"ather�onprofiY orgenaetion'ar�wer q�stia�:O du�, c If nat,:go to�est ort '`• t�er, ►o t, or9an�ati�s: +k . wrywf�+4��k'!t646d�"Ae�:a:.{�yr�+�w..waiw t �, a- rtMist docunlent it8 tex-Axlmpt Etetus: k ,�"��' . ,r_. . �:_ . . },as,,. . �k � 4,� _ • Y sClNo� Q� Is orgenizaboti incor`oratedas a ritx�profit orgsn�zatroit? esr�+ve num ":ass� A�ti:' ea ge and � _ , . : ,. . . �,1�' ��,�,,,�� ,r , . �r �• b book num� � "'�Attach copy of ce�ficate. . ,r . �.. : � , i ,�-<�`���i��`��`�'�+�`'�: t� : Yes�No.�1 t:,.Are efticles filed with the Secretary of.Statet,����'�,��.'�-� �, �, s , ' DYes�]No '�2._ �.��,._ , ._. . .�. .. � , . �f � =�Are erticles filed witti the Coun ?'�� ''�.: .� :. . . . . '�� � , .. ', . . " . : . `� Yes�No��►i.3:z ts orgenization exemPt from Minnesota oc Federal income taxT If yes,please attach letter from I S oc Departmeni o� ,,:fi �� • ' �;Revenue declaiing exempt�on or`copy of 990 of 990T.�s�� v�.� ��%"'"- : ` .� � . . .�. . ..- . .y...c�--3.' :�T�.� . ..:r.�:...,�.N. � . . . . . . ! ....�. . �. . � Yes o 4'�Has Gcerise ever Eiee ` ied`suspended or cevo 21f. es'~chec�C all thata� ly,. . ,Den ,. Suape ' R' e _, ; :s date - �.. y.�., � _. .'.�n��� : �'..,:... 11.. . . ...,..�.-.a.� ��'�.:i*1F:�i�S.��.4+r.,. � . . . .,. � � .♦ .i1»y9�h�. �.�. .,,� �.: e _ r.y . ,.:�. . � umber of,active membec� �G� � umber o rs irt.. nc� - ote �4 �iur�ea�,r ttac. e ree� ea i ce� . r __ �i . .. . . . . �. ' . ...'. .. .. ... wix,.� T.'�'i.... . .�..-�x+v +CW-"_wr.. .+�'�k Y.•... �. ..a�:tw ��..a�,j. ' Name of Chief Execiitive Officec'� ' ame oftrea'surer or personwFto'a' ou other: v.enu '�`ttis�`��e�m�iorr e, . �� .. . .-. .�. . � ....s.. ��rr�..♦ . .... .� � � " ".YMf.�p:, -1,�.. tw.. .. _ . . . . . .. u"siness.Phone.Num um ; _ , ., . � -T = �- .;.:, , �� . : - :: : : . . ;; ; . , ,_. .�. �'�i; � 9,`;Name of establishment where gambling will be '" 20�"StreeYaddress lnot P.O:.BoxNumberl ' ' � . �.:.. ''� :: �`�COnd�cted ��°'�` ` ",�' �``�i �' ����� .�- t. �^ '' � ; r l. Y. . ��� Ri k , . . ,:_ . � r�y. g�'.�pyP . , ?-0i".Y.�T�..4... �...�i�,._'i'IN.��� ��� �:�, �i'ii,+�$.. ..�'s� � �A�'�' t t �.7:o-3. ` j. i ,.y. . .. � . . , � ' :� � �, `;+' � CouMy�,(where gamWi premises is l+ocated)'� .� J,_ - r ��.:z: �21.�,�ty.Stste,Zip 1�,;'.: � �� �. ,�� , r � 22 _a �9 � ,�t' . , "t�,; . . , � ... _ �� �� �, w �'.� 4 . ,� . ' _`. � t. � �� CG-OOOt-02(8/86) ,r � , ������ Whrte Copy Board �'��s`��'`�#�Canary Applicant �� ���'����Pink Local Goveming Bod �� � � f �� � � +a x t r ,q- y a a ' r�?f � ' `'' A s Y::.� �7 r '_�: -r�-«� ai. j �� 1 ���r "�7 1't'i1 . �t�'!�t , T � 1i� , .�-� y` . 3 �� � � "X f ..�.,,n _ `O� � � _ �. . . ' . .. KII d�• . . � . . . . ��� .. t . . . . .. � . � . ' . . . . . • .. i ', ' � . . � . . � - ..... . , � .. � . . . � � - �. � . f �; ��,��,.s_. —���� . �� t . '"``- Gambiing Ucense Application ` - "` - � : , : . � � , Page 2 ' ' TYPe a�Application ;:�lass A � OClass B�,�0 Class C ❑Class D :� ..� <� . � " � _ . . ,. _ .. . .. ,�. .. ,:... esONo 23. Is gambling premises located within city limits? � - . r•.= :` '', -., '. .. -`;< " ��j es�No ::24.;Are alt gambiing activities conducted at the premises listed in#19 of this applicationT If not,complete a sepa�ate 'ti r ~ - :�:,r�' '� `�'�.'�`��Mapplication for each premises(except raffles)as a separate license is required for each premises. �+° `°` ' �` •:�Yea o "25. Does organization own the gambling premises?If no,attach copy of the lease with terms of at least one year. �.�A� . '� .OYes�N o .26. .Does the organization lease the entire premises?If no,attach a sketch of •,: 27. Amount of MontMy Rent � ' r r,' .r ; ;�"�the premises ind'+cating what portion is being leased A lease and sketch ,� �� g, . „,,'''1�€ "':�F{,�;''�,��.-�is not required for ClassD apptications:'�.�, �'<;-� „=r�: �, •�.:����r�;,�F: . `�` 4;.t. r�`,..'t�'w. :p'�(y �- � :'a, � : . . - . ,. f;�a L�lfes ONo. 28.;Do you plan on conducting bingo with this license?If yes grve days and times of bingo occasions � � �:��,� ,,� �., Y' <r f .v .. Y» 13�-� t.� c ••y ra; "c' rY �'.�`,a �'f + 13 { ,� " 1 �f '� . � s a-� t r •�j'���b""" :�s« � �rs �` r �t� r�,t 1r7Wnss � �` ��a't4ry�� r�> � ��. �'� � 3r�f�K'�� .�a�A��+�� ��'� R��l ���"{� ���`�,��@f,'/ t4� ;�'*B�`"e w ,� ,t y y,{��3 p'r�� �k,�at ��f "� .' �' t�'�:Fi �, r�.k'�i�; �t.;r� S-A�. v i.+�,'.�-+u ,..,e `.�,iJ�r,.,,,,,. ;' '� X. . "� .�A ��. Y`��Y a-6 �4, d s..`.W..����'�.��'�7 �a"�xi�'• .� , � •,.� ' ^ .ei � •�'�h?sj-_. . �'':-.; _ ...:: :'�..�., '.��.,. ,' ._� � � .::v.. .C.�}...��. . .. ,ryY �, .�' � .'. ...'= . "., -� �Gd'; _� �. . . - . . . ...-. . . . _ , . � . �es ONo 29. Has the S 10,000 fidelity bond required by Minnesota Statutes 349.20 been obtainedl Attach copy of bond. •:��'� y.y ♦r3� .:J� ws.? ..; �-' .0:� 2 � 4.' ,�4� 0.�Insurance Comrpany Name z � �,,����°` � ,� ,�5 ��! � .���x 3� Bond�Number � :� � " y� .�'�'1�<1t' ��. ' ,�,+. �'��y� � 3 1! ,�,.- �y,)'t y � n� .q .,�.+ : • �... :. � _., . �' : , � _ 32. Lessor Name .y�; �z�" �' .�'��`�� 33. Address �: �� " 34 Gty,State,Zip �, ' r,' ��^ � '. �.,i'-�c �.. �; � ,-"�'f '".�,;.� �t -r• � �t-4 � ��� �C. �� �'\i�'�� ���� �" �}��'. r 35. Gambling Manager Name - � 36. Address -: � ' 37. City,State,Zip - � _ , � �. i..� . _ ` {_ , . ... � ��,r f�\.�.;'�� ....,,�4'. � � .._.. � �, .�"�,j1 `.�.�..�, i"<. --T ..:�. . `` ,Y `.�.•_��. ��_i^�.�<.} `'�;� •C� ., ,e 38. Gambling Manager Business Phone : 39. bate gambling manager became � ' �;, . r :��: , ' , :� : ° �=, �- -F' , - ` member of organization '� - :tc.: . - .,y`�' �� � t r t� 1 '�'� '" , 'r ..� �p. '�.,-r `§� r . as+.^ /o:r � $f°,�-..; e a_,'#g ,S .r t ws � ye., ��.. � � 4� i ,� y� . a 3'l L.� ^,a .. 4:�x � �°'��� T ,.C;n� ;:.��.k '...�t�x.t�,� .J: "7 � �'' ;.. � � ,� �':� .�. ". �= ;�>.,.f ,. �='�;.GAMBLING SITE AUTHORIZATION . _ b`.�r . : . _= "� .'., '� _-' .' ;;:. �� `" `. �.By my signature below,tocal law enforcement officers or agents of the Board are hereby authorized to enter upon the site, �:• - �- '� ' : at any time,gambling is being conducted,to observe the gambling and to enforce the law for any unauthorized game o� :~;'=� �` � �:; practice ,.� srl t'.�x s� � s .d� +`�^';:1�t :d?:�,..� w�. .:`+ ,•.' �,'�, a'�..r:: '*a:t' �t � µ ..# �f ';a�t 7.�. . �' � . �- ... . �,'-�.r � "� ': ,1, s �s.f r` � ,r ! t y. `'� '�k�;."`.. .�.r=r'�'��..������"'�:.�����'-�����'�7�BANKRECORDSAUTHORIZATtON ,?:a��s'•��,� � ;,t,r.,�'+.�.;if�'.#��-�'«?=k � �' .� : '�,�By my signature beCow,the 8oard is hereby authorized to inspect the bank records ofthe General Gambling Ban�C.�4ccount' „�; ry � . , ,E_ ,. .., , �.... ;: �,., �y,. .���°.r ent gambling rules a�d law , . 'J.� whenever necessa to fulfiit r "�uirements o cun y� .r.�ry,E�•.� µ � •�,.,. ..��IF: " ��. Ji'! . OATH., �, �, :� F hereby dectare that .,, ' „ #� ,. ��, _ . , ,� + ,� ; . ".�°t ��l have iead this applicafion and all information submitted to the Board, t; . �� ��� �_ � �F .= ��2. 2-,All information submitted is true;'accurate and completeR � - � �,� '�' � �� ' � t � 3 ��All otheriequired information has'been fully clisclosed"� � �K ; , � �n �» ����� � �-�,,4 1 am the chief ezecutive officer of the organization, ��� ��'��. P. •�a r .g.�. ", ;�� �,� � #�<�_ 5 : I assume_fult responsibility for the fair and lawful operation"of all activities to be conducted; ,, , �� „��,�3. ,��� �-v '� 6 =;l_will fami�iarize myself with the laws o#the State of Minnesota respecting gambling and�tiles ofthe Board and agree,�- .:,. o_ ,�.,.,��; .:�if licensed`to'abide b'"tho`se laws and'nifes�inc(udin"�ame`ndments t reto:. . . �: . �-__:€+�_"> .. .< , .. . ,_-, ,� .._._ , . 40�"'A�Official,. �-elNameof.Orgaruzatiort' � � - �4 �' . a - st nedb Chie€ExecuUve,OfficerWf ., � � : r. s ;.. . . .,-_ � : -° , , ,� � ._ ,. . . � �-. ._ i..t�.. :s. -._.:_ Ttle'of Signer' Date'° ' +�t�gk�<i��a1r�a,�r.�'d�'rt�'"At?�!�'�'�u: " .� - , � ACKNOWLEDGEMENT OF NOTICE BY COCAt,GOVERNING BOD � , �'hereby c nowledge�recerptof a copyo�'this application':�ByacknowCedging�`ceceipt��`'admrt�av��gbee�served with• w �notice that this`application will be reviewed by the_Chantable 6embt�ng Control,:Board'an�ct�f�approved bXifie boa�d�il[ - . . .. . beco�ne.effect�"ve 30 days frort�the date of receipt�,noted befowy,,unless a`resoCutror�"ofitie�acatgoveming body'is pas�e�' _.._.�..:>,.�. .�;,�. ,� . . which,specificalty�disaltows such acti�t�ty`and 'cop of:tha�� esol�i n:is c e�ve tti .C[�aritabf "Gam6hng C a Board within 30 da s of°the tie(ow noteddefe �. .,.: ��rT.N� .�w-. Tdr -� , � . . . �. W�+L� 5'Y -+Y# ��.y�a . b.. �.,; .•1 . 42'�Name of C� ��Coun .l�.00aCGoyeming Body�W , - if s�te is bcatec�w�ttii�tatowns�i�i�� u�t�"`e comp�` .. �;.. _::x �,..�.,�.«�.,�y„ m� ; ;,.._ :. , � . �! 9. ".n � �' �� ; � .. _ , " _, :. .. addition tctf�e coun s� nature . _ . , . �� � .tY.. ......e. r... .�. �. .� ' �� :. . '. �. . "�`;Signature of pers receroing appticat�on� ` j , P � 43 Name of Township�-' , : ', , �' 4' �. - - �.r�,�*�� � � �s � .;.y� � ri,� N � ' ` F } � � � **����. ., y.*�,• .j �'� � �� ••�., a ��'.y �/j�, �y�� �,a �-[ S�Y�,{,y :.� ' . �� tJ� � ♦�'7 "�- �';=• +F�f� �� i�1^'� � .K r i^'�t!,"tc -��r . . `;!.'=�"r`�. �`� � /\ , � � . � .. '. " . . ::�: � , .� ' ." `'" Title � r�; : Date received(30 day period �.^ Signature of person receiving applicaUOn '� '���i: � .' �,�,. {� � -r��,. � ��y/-^� z .. ,•--; ` �r� y„�,�"�k Y��.r��a+� '''� be ins from this 8t4@) '� yy ��,�c s � 'i� a.v � � �. � �; r,. +;,�,�t'!,»�j�+iJl��i( �. ' ' -# •��'r;�+ii7�:�b *���1�V� ��fi,: �('`l�'�-����'�'p'''�" .����. '` r�:.. r , ^ , }��`44 Ne e t0 O Ing BfXly - TiL�@ ; ,�',��� ` ". � i � ?-� . . ,� , ty � .� . �. .. , ,^4�'r . ..i �.."�� �r _ 'n �+��'n��'�3?f ,'"�,t'!�" ��.;��� ..t�W�v!� �•'Y:..�:. 4,• &���rt �... '���� ..f<t• •,� -.v+3.' �s ` ' �CG-0001-02 (8/86) ,. _ .;>: White Copy-Board ;, , ` �,.;'. r '' Ca�ary-Applicant - Pink-Loca1 Goveming BodY �' ,. . . .. ; _. �. . _ . .., - , .. .r.; . „ .,,. . _ - - _ _ _ : . ,: ,. , � ~,'�=_ v[ v �—� [ : City of Saint Paul . , Department of Finance and Management Services ; l� License and Permit Division ������ �, 203 Ciry Hall St. Paul, Minnesota 55102•298•5056 ` , � � - APPLICATION FOR LICENSE j CASH CHECK CLASS NO. New Renew �� a �% �� �o a � � � Date �� j'� t9� f 1 ' Code Na Title of License From ��-� !�� 9=To � � ` �� 19'� 1 f , � ' , � q �� ;� :1 - �� ,, ,,r�t �. � y4��, s� . � , � ,; ; ,� /a �j�� �t. �.,,;�<,,,� �..�., �,� ; ApplieantlCompany Name � 100 � �} � � J?� � � �. �-,�SP. � 1r�� ��'.� �ct�i � 100 Business Nams � 100 � Business Address P�on�No. � �oo � � 100 Mail to Address Phone No. � 4 �� ` L�� �b ;I �1G. Jr � ManapeNOwner•Name 100 . I � ! � J ���Lt vn 1 � 100 AtanaqerfGwner-Home Address Phon�No. i 4098 AppHcation Fee 2. 50 � Recelved the Sum of 100 %l'�it � /�'� (� � - rJ e (.���v�, � SC� �. �� Manaperl0wn��-Cicy,State 3 iip Cods � 100 Total 100 t( t t ` �t License Inspector �% � �/ � �( 1 BY� S ature o(Applieant � ! ' Bond• I Company Name Poliey No. Expiration Oate � 4 � Insurance• � Company Name Potiey No. Expintlon Oat� I � Minnesota State Identiffcatfon No. Social Security No. : � Vehicle Info�mation: � � Serial Number Iste Number � Other ; THIS IS A RECEIPT FOR APPLICATION i THIS IS NOT A LICENSE TO OPERATE.Your application for Iicense will either be granted or rejected subject to the provisions of the zoning ` ordinance and completion of the inspections by the Health, Fire,Zonin9 and/or License Inspectors. 's I f ! $I5.00 CHARGE FOR ALL RETURNED CHECKS � , � Cicy oc Saint Paul � Gfi . ' , ' Deparcment oE Finance and Management Services ,� d'�'-�Od� � , • � Division of License and Permit Registration � ' ; . ( 'INFORM2►TION REQUIRED WITH APPLICATION FOR PERMIT TO CONDUCT CHAR.ITABLE GAMBLi*IG GAME I*1 SAINT PAUL �I � + � � 1. Full and complete name of organization which is applying for license �t � - S n�t r�. 5�t oS" 2. Address where games will be held Yumber Screec City 2ip 3. Name of manager signing thi� application Who will conduct, operate and manage Gambling Games � an,��/L� �n�(''��� Date of Birth �O- 7:3 � (a) Length of time maaager has been member oi applicanc organization 4. Address of Manager 53O ���'� �o� "' ���rvte�� �� N ��� �S Number Screec City Zip 5. Day, dates, and hours thfs apolicacion is ior T-'�i ��� V�'1 b. Is the applicant or organization organized under t:�e Iaws o: the Stace.oL :�IN? ��_ 7. Date of incorporati�n - a�'� / 8. Date whea registered with the Stace of Kinne�cca �' a�-g�] 9. How long has organiZation been in existence? , `� (q_,I(� 10. How long has organizatian been in exi�tence ia St. Paul? l��1 �,�.� . c—� T 11. What is the purpose of the organization? . O�-�� g� � c�, G- I2. Officers of applicant organization Name � � �l �� 0`��v���l.�( vame �O �0. �. �-�• Address � ��p� I'COuJ�'c0 �l?er/l�l.E.���-Address �Snw�-1� S . Title �t(�5 DOB ��-a-�-S � TitZe �iC2`1'�� e.� . DOB 3`�-3"�-'7 Name F�u. �I.J b�n�Ye ��C". Name. a�a3 �� Address (Y��n1F,ry�,1 . �c , Vyl fl� �, �,ddress Title ��.�`af('��_ DOB �-l�"�� Title DOB 13. Give names of officers, or any ot!�er persons aao ?aid cor se^sices to tZe or3an��acfon. Vame Vame Address �ddress Ticle '-'=�'-e (Attach separace sne�� 'a- acd_t:or.s: -a�as. � . � l��-���� 14. Attached hereto is a list of names and addresses of all members or the o:ganiz�,�ior. . . 15. ' In whose custody will organization's records be kept? � 1 a Ca..3 l�eA�rv ' Naaie _i�0 t,�, �C,,_,/��n,_, Add re s s _ JI/��l�o��VY1'(� 16. Persons who will be conducting� assistin� in conducting� or operating che games: � Name ..�oo,�,ne �M.. � �p�1��-; Date of Birth Address 'rj 3 Q �D�Op��''�' ��" ' Mp�.�/1'�wCe.�.'i � ✓Y1 1U SS 1 I� Name of Spouse Date of Birth �.�i Dates vhen such person Wtll conduct, assist, or operate � �•�CP� Name Date of Birth Address ' . Name of Spouse - - -- �-- � Dace of Birth Dates when such person will concuct, ass=st� or operate 17. Have you read and do �ou thoroughly unde:stand the provisioas af alI lavs, ordinances. and regulatior.s goven:ag ths operat=on of Charitabl• Gambiing g�mes�? �"�,S 18. Attached hereto oa t:�e fa:� °ur:::shed by che City o: St. Paul is a Financial Report vhic:� itemizes aI'_ :ece:�cs, expenses, ar.d dis�ursemencs of che applicant organization as we11 as a�l o:gan_zat_ons vno aave :ece=t�ed `unds zor c:�e preced:ag calendar year whicz Las beea s:3^.ed, grepa*ed, and ver::'_ed �y � J v8m2 � � �f� f���. '-� �,.� 1/Vl (�, �daress uho is the � �.`�p�,�T. oE che applicant Organization. Vame or Off=�e 19. Operator of premises where Aames :r�l� be held: Name �V�.Q�. ' ,,`;� Business Address [ �a� �, �Q,�. — �-�� � � � �'S ��� Home Address 20. Amount of renc paid by aop�:csnt Or3ani�ation ror reat o� che hall; specify amount paid per .4—hour se�s:on ���s� � � � .. � . � �,��� ' ,;� 21. The proceeds oi the games will be disbursed after deduccing prize layout costs and , operating expenses for the following purposes and uses: Cl� �� ' �le,�� �` ,M..s � � e.� �. 22. Has che premises ahere che games are to be held been certified for occupancy by the City of Saint Paul? � � 23. Has your orgar.ization riled cederal form 990-T? 1`,'� If answer is yes, please atcach a copy wich this applicacion. If answar is no, explain vhy: �t'0.�2. �o-� �l.P� �e��.�a�L C�csJe�►.� �'ect u�t�'Q Any changes desired by tne a�pl:canc dssociac=on may be made only wich cY�,e consent of the City Council. � � � Organ:zacion Date By: GT��G� � • �Sanage: in charge of game v a � � z z ;n � � n .. s Gf Cf c9 `C J C :s Si r9 O R R R 10 R �C� S :i :Q R r'S Y�+. C A7 r0 t9 't A 31 i�G �T r f0 7 7 rr 3� �9 ] 't �� 7 O � � R �9 � n 3 '-e � � ro 3 �e '7 3 C r� � rr +. n O � � �+ 7 :s ? rD r � C O +-n .• a C �e �e rT r+ �e r rn A 9 W S R^NNyy�n/y►■ '3. CA i-• S `�C � Sl 3 ►+ �+ �!�.•, R y � + %��'�y °, : � � R R m , m � � �i t 3 � ; �. /i i m r C w �o • � 3 m � � I � a n. I� � � � R •• 3 , 3 y Q J n � �9 7 Ct = � � ����_ � : _ � � � � � �^I � � ��� � - � _ � � ...,.. O h+ .�+ „me ''�" '^� :�, p C rt 11 t ul r �t r- � � � � ', r" � n� S w I w r ro n • - r n re �— � ' Hc � T � � m c� 3 I�•T a_ �: ? I� ^+ � n ( S l c� r tao 'a`e '� < -` �; � O � �. n � g �-j 1+ ►'^ � �+ V. (9 I� �T '31 f9 I R ir9 1 ,* `� y I � r3e E R i-r T S � . 77 fD •i 9 � O f0 � fVNWWWW• rr t0 < � � /► � 'A I _ OI � .s � = -� A �. y I I� m a ;o � m ►•• f t -, � v ao ^ o , I �OC �e o a"o °• i✓ �, � r- , �o -• i i '0 Citq of Saint Paul / �i ' � Department of Finaace aad Hanagement Services ��-/�� / Division of License and Permit Adminiatration ' UNIFORM CHABI?ABLE GAI�BLIIiG PIPANCIAL REFa1Cf � , Date 1. Aam� of Orgaaiaation ��� � `--��� 2. Address vhere Charitabls Gasbling is condneted � . 3. Report for p�riod eovaring 19� through o s 19� 4. 2ota1 numbsr of days pla�sd �� � S. Cross raceipts for abova psriod ; IST.(��G�O• �� �p � ' 6. Grosa prize pa�outs for abov� period (inclnd� ea�h short) ; ��� t �3��� � 7. N�t raceipts - lins 5 simu line 6 i � �A•�� 8. Expenses incurred in conductiag and op�ratiag gaae: • A. Groee wagss paid. Attach vrorker list wlth Q J � '1 . t� I names, addr�ss and grosa vag�s. ; �� �� °� T r B. R.n� fo= w..iu : 5(�?s.00 C. Licenae fee � D. Insurance S E. Hond ; ! ��• �G F. Dishonored checks not racov�red = G. Accounting Eapenae j a`�� ,�� H. Employars F.I.C.A. �Z/1-C.tu�.L� �'�' ��� � . � I. Pulltab ��.�,LIE$ � ��0• 3� � J. �dZ�e.r�i s�,� ; 345. �e, �. P�detal Excis� r� a se,mp = L. State Gambling Taz C��,�►� 1� `arC.� i �� `�• `,�7 - / M. Misc�llaneou� Exptasss. Id�ntify [h� asount and to vhom paid. 1. ��'\. 5�.0� ; .�a z. �,l-�� �'��'�2S = 300.� . 3. ���.� : atos, t`t- 4. i 9. Total Expenau '�'r� ; ��� °��, �� � �� � 10. Net. Income - lin� 7 siaus liae 9 i _��/ �����50 11. Checkbook balaace bsgi�ing of period S "�'' 12. ?otal of lin� 10 and 11 , � _��� ��� �� 13. Total eoneributions fsoa lia� 17 i � ��?• �� 14. Checkbook balanca snd of reporting period - �� / ���q liae 1Z lesa lia� 13 ; �o ! 1S. SQecify uas made of a�wnt on lin� 13: . ��.8'.�� O� -� C�, . � �- - , �`j a�.i �"v�j✓t'�S � .. � 1 G� l� � -�r� �, • ;o. 7's;_:se^e.^._s .:om a�aun: L1 i:ae l2: v' � /��j . • . . �lama ��C4� �Or���� Naaa Addreaa addre=s � Daca Ree'd �" Oace R�e'd �tao..� ( '�o C�IO �rn��oF� Signacura Signacure oE Rseipienc ot Aeeipi�nC Amoune �,��/ �� ��� Nane ✓�, Nma Addsaaa Addssss � Dac• It�c'd �� Dac� R�c'd Purpos� �Y��J'�Q JC:L1.Ce C/� Purposs Signacure Signac•�re at R�cipiene oE R�eipienc . �mounc ��a AO �� Aaounc Name Name Addrena Addr�aa Data Ite ' �� Date Ree'd Purpoaa�L(/1 V/Yd„y�, �,�'�1,4(,F-�"�'r ` ru�o t Siqnacur� S16nacure of �aeipisnc � ot Reeipiene Amoant O t`W Amounc �_ N� Nama A�dr�ss Addr�aa • � Dac� �ee'd Date Ree'd ' 7urpoae Pvrpose SLgnaeur� Slgaacure oE lteeipienc oE Reeipienc Amauat Asc+inc 17. iocal Diaburssssaes TfiIS REPCRT itUSi BE FILL�•I:1 COi�LE?ELY TO QIJALIF'f AYPLIGTION FOR CHARITADLL Cdt�OLiNC LICENSE. • ..� S �1 �1 N � �O 1� � '�1 �1 N A _ /� /_ S �O n T O �i .. w C > Oa �,.• ■M�VM�1�w w�* ^� ) ��." r � �l C � � I� � r� � � � y > ' J � � O►w � CO � A ^ .� O 6 �'1 U~f � r� '� � J s O '�1 "'� f- 7 e a'�i +�I � S 2 T O a� �1 = O > ! �t O Y L� :. � 7 7 > 2 A � � � �> _ :+t C N'� . a � a� S Z O � � .. a� S 2 ca O� � r J N (+1 rl � � � � y J C•a: � 7 �' rn N " '�,,, q i 7 �i O ;�1 !Z Q 1 v S 2 A - � � � � N M S is � n ! 2 �1 C Z - n ! a ° I � ,�, p r ' O r C � O e1 N� � � n ^ � y � .�vv n � � �s n vvv � T � � �' n � e � S a � ' < .��i � � 7 �e n a o � ' � Ib `it ^ � � �j� � � A w � ^ d � i u V .= w ] C � a C � C q y � J 0 � _ � � � � g � z � .. o y � r a�i � n n w > s � :. 'r �' S� S � � ^ f1, ,� � � � o � I` � ; ..r � � � I � ^� o) � ^ . � •wvw�n�� � '� — o t —O �� 'i ' —Q a�� �T' i (�� � � � A 70 W 'f� � 7 �./ � I �. .a� 3. o•i y- 1 a � . ' .. .�.. i`::..:52^!.^.�S .:OCt 3rOL•.^.0 !1 ��.^.t :�: (�'" � ��/ • � � `�ame � v�� I Yame ��SS IN�Q,(� �! t � ' � Add:ana Addre�s Dace Rec`d ��Ol I�$� Da�• Rae'd , Putpots ��Q� ��iC:,NR ��,•,vr� Purposa � h1 Signacura Signa�urs � ot 4�cipiaac oE RatipienC ��p� 3�.��0 � �,�� 3�Soo � Name �� �� ST.� Nms �"Y�C�t�.L�J� ��K�11'� n I t�li'►'l.GV1 Address Addr�as " Oaca R�c'd Dac� R�c'd � �l u�� °urpoa� l�l'�'�.n L/��CM Parpou � '��1+.. '�r r1JlAJ� tZ� �-l� Signacure Signacare T�� of Qseipienc oP Racipienc p� `�r� � . Amounc O. Amounc �7.J V Nama��s�l•l��l� Name ��Q ��.,iVIQ..�G. Addrees , Addreas Daca Rec'd �/O�t O° Data Ree'd "��-�� Purpoaa��� � �[�1�1�/y� Purpoaa �y'YL�n.�' r ��,(�.�Q. Stgnacur� � 5lgnacure ' o! 2aelpiane of Reelpieec Amauat 3��Q�{/ Amoune � � �/ Naa� ,I�.LL. �dU. `C,�..10 Y� Nama �i►IV� ��a-✓l�Q+-7 A�dr�ss Address • � . Dace �2�'d "'T— Date Ret'd �" (�� 2 e irpaai3 O O Purpoae �l.l y� � ��.��. Signacur� Signacura T— of &eeipieesc of �eeipiene Amouas ��� V Amcsmc �. . �d' � 17. Tocal Oiabursemaacs THIS R�ORS MTST 3E t2LL�•IY CO2Q�LETELY 'f0 QV/1LIFT APPLIGTION FdR CHARI2Abi.d Cd2�LiYG LICr21SE. _ i •� S �-1 f1 N pl �O A � 'AJ i � Pr =f �.s. � .�w n C > 0� .. o C > 0a .+ � O 2 -{ n � � w n ^1 PI A A O �t � C. ^ � � n � o a �+ O � i � a�i � � S 2 T � a�i +�i � o > a� o = v o '� n „°. s .. _ -i � .�.. �` S � '� z " w i+. "r A 1 ns. 0� � 2 �f C ►� a a tn oi •i J `� ° ,+Ni cn m � s s x o s o � 9. �s s � -� o ;w > � n s u -� s a e 9 a -� � � o n I � � e ►a► ►. n � I. > S � � a � � � n o 3 n � n � , � 3 s O u "'S ..� y e� vvv w n vvv e l s �� � y 3 � � 5 � � a � e �s n a O � A n a �e � < ' n o u •w ^ � N �s u 7 � , ` � v � „ � � n c y w �w � O � a o s •. o � n n = � .w � w � � o a� � � a y I � ` ' n � n � ' � � T n 7r ^` ���}'y '� �..�'i �a T 3 v 1 � a n s �lc� � � � � c � ` � _' .; a� y� n � � f "� �� � ° /� ��� � a �� � � `� i f _.1.__. , � � _ � � ;�-� �n ` .(� ��- � ��� . . o„�..,,,,,� �,�� . „� a, �i�#���i �l��` No. U 0��.3 9 : Mr. J. Carchedi �* o�r,�a„rarr a�ecro� .Mraa�,►s�rMm � . Christine Rozek ��t �a�,�s�w�n� "..'�,«r«�c , . ra. p��p —euooerrna�c;roR ��OUI'iC��� RBS.ed1"C11' f : � 2 8-5 55 _ °r�`` �; ��,-�. -�� : ;: , _.. � . � Application for renewal of a Class A Gambiing License. Notification Date: 11-18-88 Hearing Date:�� .;: �o0we���nor+s:cao�.�►or A.r.a cF»> oouac�.aes�►�a+n�ort�r: >> .;: _ rwa+wo c�o�► cnn�semnc�oo�issror+ a+�w o��arr uw.rsr' "n�►a. � ZONN(3 001AMISSION��� . ISD�b 9GWOL BOARD - . . .. . � . . . . � . `: -. ETAFF� � . ..` .�.' : . ; . Gi11RTERCGiN�8810N . ._ ��t�L£�E AS�� . ��ABDI.MPo..AODED'� .�.-��Pf�JR��i{0�0'I.MFO��� �.T$�• - . �.:�. � " 061AICFCOIAiCIL _ � - � � *EXPLANATION: - .. .. . . . _. . � . � '� . � 8U/PORI8 NIINW COIMrCL OEJBE11VE1�. . . . . � � . � . . . , .� . � � - � - ., . . , . C�„���1 RQSear�t� �enter. . . i�dOV 21 i:�3 : � .�.ru►�+a w+o.c�a�.a..o�«n►c,�n,�.vw�:w�,.wm�..w�n�: � . � - Lou Danna, Jr. on beha1f of the lOth Street Ba�ing C`1ub, request� -Council � - approvarY �f h�s appl�ca�ion for. renewa1 of a Class A��ambling Lice�rse at ° ; I324 E. Rose. Weekly bingo ses.sions are held Friday's between �he 'hours - � ` af 1:� PM and 5:00 "PM. Proceeds 'are used to sponsor a g�lden glaves boxing pt^ogram�(gym in the Rossmor Bui1ding, Robert St. ). The program currently - t�s 12 active bax�rs. " �cR�orr tc�.�+e�rr�.�+as1: , . . All fees and app1ications have been sul�nitted. The organizat�ion is current with 10% contributions to the Ci;�y Wide Youth Athl�tic Fund. " , �OIN�OII�C�Mmr6 when.ana rd wnom>: . ,. ; s : If Cauncil approval as given, the lOth.Street Boxing Club will continue to sponsor a weekly bingo session. �.��.: ra� � coMe Nisronr�rrs: ��t.�: - .