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�
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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 .. . . . � - � . - � . . . ' . .. . _ . . . , .
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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. - '�
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N� it i�,�at 53'E.'ti"� �z �e -r�;a- :��'� "L°` *�� c�i -c� ;?�'. $� r ._� �'k
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`�1STRUCTIONS:,t� .: ��.. ��r "M � � ���t�� Y :.
a� �TYPe o�pnnt in inic..�: :'.. .,�;,�'�a3��. ,:� ���" . ,... � . 3 �;,,;...'�.N ��y' :,�.�:� � •. :. . �, .,� °��r T�.,, � .
� B �Take oompleted.application to locaf goveming body,obtain signature and date on ali copies,'and leave'C copy Applicant keeps t'
3 � ��"`�"copy and sends original to the above address with a check� " �`� u � �� 3 ���,,��- � � � ,r. ��*��• *� �t
� ,�C itncomplete applications w�l be retumed ��,�-��tit�+��x"�;�t" ,°��,���ya " '� � L, ��.r'� ���,b�; `�.;��, "�>-
• t . ° • _ , . . . ., , :
'"��TYPe of Application: d+�x�- ntir _ «:�'. �i��' �'.F_�xi" # ����u.�,�sq�,4 tx'°s`s.' �,,, ,iy�'�..°�# a�,�� . K•. �. ��:r�� �*},p��.� •
.;�F� � '7}" .. 'W' �T+t �:. .�P�S�� "'' ��� ' J'
�Ciass/l— �.Fee S 100.00(8in9o,Raffles,Paddlewheels,Tipboards,.Pull tabs) �� � �
� �����C�BS$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,
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'� ' .��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"
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;,'� :'�.�rjYes�No .�"r3.=Have Internal Controls been submitted previously?If no,please attech copy. --':�'''x;�;�1��� ", �"-�'�. , �k�� � Y
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` "-�t 4 A IicaAt(Official,I al name of or arnzation) } � �' �'� 5.,Business Address of Or arnzation � '-'` -�� ��Y"�' �
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,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
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S�✓ e9:�` ypeoforganizspon,,��}5� F rtemat��OVeterans {QReligious," Otheri�onpro '„� � "''�`�j� '` �; . �
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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 ,�"��'
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_ • Y sClNo� Q� Is orgenizaboti incor`oratedas a ritx�profit orgsn�zatroit? esr�+ve num ":ass� A�ti:' ea ge and �
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. �,1�' ��,�,,,�� ,r , .
�r �• b book num� � "'�Attach copy of ce�ficate. .
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t� : Yes�No.�1 t:,.Are efticles filed with the Secretary of.Statet,����'�,��.'�-� �, �,
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' 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�.� ��%"'"- : `
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� 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�. �.�.
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� umber of,active membec� �G� � umber o rs irt.. nc� - ote �4 �iur�ea�,r ttac.
e ree� ea
i ce�
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' Name of Chief Execiitive Officec'� ' ame oftrea'surer or personwFto'a' ou other: v.enu
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u"siness.Phone.Num um
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�'�i; � 9,`;Name of establishment where gambling will be '" 20�"StreeYaddress lnot P.O:.BoxNumberl ' '
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' :� � �, `;+' � CouMy�,(where gamWi premises is l+ocated)'� .� J,_ -
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��.:z: �21.�,�ty.Stste,Zip 1�,;'.: � �� �. ,�� , r � 22 _a �9 �
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CG-OOOt-02(8/86) ,r � , ������ Whrte Copy Board �'��s`��'`�#�Canary Applicant �� ���'����Pink Local Goveming Bod ��
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a ' r�?f � ' `'' A s Y::.� �7 r '_�: -r�-«� ai. j �� 1 ���r "�7 1't'i1 . �t�'!�t
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t . '"``- Gambiing Ucense Application ` - "` - � : , : . � � , Page 2 '
' TYPe a�Application ;:�lass A � OClass B�,�0 Class C ❑Class D :� ..� <�
.
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. . ,. _ .. . .. ,�. .. ,:...
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 � � �:��,�
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<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�'•
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_� �. . . - . . . ...-. . . . _ , . � .
�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 .,�.+
: • �... :. � _., . �' : ,
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32. Lessor Name .y�; �z�" �' .�'��`�� 33. Address �: �� " 34 Gty,State,Zip �, '
r,' ��^ � '. �.,i'-�c �.. �; � ,-"�'f '".�,;.� �t -r• � �t-4 � ��� �C. �� �'\i�'�� ���� �" �}��'.
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35. Gambling Manager Name - � 36. Address -: � ' 37. City,State,Zip - �
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,e 38. Gambling Manager Business Phone : 39. bate gambling manager became � ' �;,
.
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, ' , :� : ° �=, �- -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 .,
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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�`
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addition tctf�e coun s� nature
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�s ` ' �CG-0001-02 (8/86) ,. _ .;>: White Copy-Board ;, , ` �,.;'. r '' Ca�ary-Applicant - Pink-Loca1 Goveming BodY �'
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: 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
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; ApplieantlCompany Name
� 100 � �}
� � J?� � � �. �-,�SP. � 1r�� ��'.� �ct�i
� 100 Business Nams
� 100
� Business Address P�on�No.
� �oo
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� 100 Mail to Address Phone No.
�
4 �� ` L�� �b ;I �1G. Jr
� ManapeNOwner•Name
100 .
I � ! � J ���Lt vn
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� 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
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�t License Inspector �% � �/ � �(
1 BY� S ature o(Applieant
�
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' 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
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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�,
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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. •
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Add:ana Addre�s
Dace Rec`d ��Ol I�$� Da�• Rae'd
, Putpots ��Q� ��iC:,NR ��,•,vr� Purposa � h1
Signacura Signa�urs �
ot 4�cipiaac oE RatipienC
��p� 3�.��0 � �,�� 3�Soo �
Name �� �� ST.� Nms �"Y�C�t�.L�J� ��K�11'� n I t�li'►'l.GV1
Address Addr�as "
Oaca R�c'd Dac� R�c'd � �l u��
°urpoa� l�l'�'�.n L/��CM Parpou � '��1+.. '�r r1JlAJ� tZ� �-l�
Signacure Signacare T��
of Qseipienc oP Racipienc
p� `�r� �
. Amounc O. Amounc �7.J V
Nama��s�l•l��l� Name ��Q ��.,iVIQ..�G.
Addrees , Addreas
Daca Rec'd �/O�t O° Data Ree'd "��-��
Purpoaa��� � �[�1�1�/y� Purpoaa �y'YL�n.�' r ��,(�.�Q.
Stgnacur� � 5lgnacure '
o! 2aelpiane of Reelpieec
Amauat 3��Q�{/ Amoune � � �/
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A�dr�ss Address •
� . Dace �2�'d "'T— Date Ret'd �" (��
2 e irpaai3 O O Purpoae �l.l y� � ��.��.
Signacur� Signacura T—
of &eeipieesc of �eeipiene
Amouas ��� V Amcsmc �. . �d' �
17. Tocal Oiabursemaacs
THIS R�ORS MTST 3E t2LL�•IY CO2Q�LETELY 'f0 QV/1LIFT APPLIGTION FdR CHARI2Abi.d Cd2�LiYG
LICr21SE. _
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„� a, �i�#���i �l��` No. U 0��.3 9 :
Mr. J. Carchedi
�* o�r,�a„rarr a�ecro� .Mraa�,►s�rMm
�
. Christine Rozek ��t �a�,�s�w�n� "..'�,«r«�c ,
. ra. p��p —euooerrna�c;roR ��OUI'iC��� RBS.ed1"C11'
f : � 2 8-5 55 _ °r�`` �; ��,-�. -�� : ;:
, _..
� . �
Application for renewal of a Class A Gambiing License.
Notification Date: 11-18-88 Hearing Date:��
.;:
�o0we���nor+s:cao�.�►or A.r.a cF»> oouac�.aes�►�a+n�ort�r: >> .;: _
rwa+wo c�o�► cnn�semnc�oo�issror+ a+�w o��arr uw.rsr' "n�►a. �
ZONN(3 001AMISSION��� . ISD�b 9GWOL BOARD - . . .. . � . . . . �
. `: -. ETAFF� � . ..` .�.' : . ; . Gi11RTERCGiN�8810N . ._ ��t�L£�E AS�� . ��ABDI.MPo..AODED'� .�.-��Pf�JR��i{0�0'I.MFO��� �.T$�• - . �.:�.
� " 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. "
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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.
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