87-461 M�HITE - CI7V CIERK
PINK - FINAN�E G I TY OF SA I NT PA U L Council � �7W '`��
CANARV - DEPAi7TMENT u
Bl_UE - MAVOR File 1�0. �L
Coun il l ion -
Presented By
l� �
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D.#�g�6S7) for the renewal of a Class A State
Gambling License by Monsignor Ravoux Assembly (4th K of C)
at 408 Main Street be and the same is hereby approved.
COUNC[LMEN Requested by Department of:
Yeas p�eW Nays �
N��os�e In Favor
Rettman
Scheibel
Sonnen —��__ Against BY
.��eeaa
Wilson
Adopted by Council: Date APR 8 '" �98� Form Appro by City torney
Certified P•st d b Co cil re BY
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Approved by � avor: D ���� � �' — 7 Approve y Mayor for Submission to Council
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( �.4�p�LtOU�?�,� Charitabie Gambling Control Board FOR BOARD USE ONLY
� '•� Room N-475 Griggs-Midway Building ���e�$e N�mbe� .;��
; 1821 University Avenue ��
St. Paul, Minnesota 55104-3383 ;
.•., - '. f612) 642-0555 , AMT �
����+ CHECK# �,
, . DATE _ �
GAMBLING LICENSE APPLICATION �
� � ;�
INSTRUCTIONS: �,�
A. Type or print in ink. ,'
B. Take completed application to local goveming body,obtain signature and date on all copies,and leave 1 copy.Applicant keeps 1
copy and sends original to the above address with.a check. �
C. Incomplete applications will be retumed.
TYPe of Application: ``{
I�]Class A — Fee S 100.00(Bingo,Raffles,Paddlewheels,Tipboards,Pull-tabs) ��
OClass B— Fee S 50.00(Raffles,Paddlewheels;Tipboards,PUII-tebS) , Makecheckspeyebkta h
OClass C — Fee S 50.00(Bingo only)
;; Minnesota Che�itable GambYng,Control Board '
:�_�..: -k�C�P D — :FQ $� b.00,lR�ffle ,on F:
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ts7Yes�No 1. Is this application for a renewalT�' If yes,'give complete I cense mber � �� �` ���''�'`'`�`{ A"� ''� - ;��
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OYes ONo 2. If this is not an application for a renewal,has or anization been licensed by�he Board before?- If yes,give base �
,��. '
license nurpber(middle five digits) �� • .d.
�]Yes ONo 3. Have Intemal Controls been submitted previously7 If no,please attach copy. '�
4. Applicant(Official,legel name of organization► 5. Business Address of O�ganization
Ms ,r. Ravoux �?nR�mbl (4t11 K ot C) 4�$ N`,ain S�reet `�,
6. City,State,Zip 7. County 8. Business Phone Number
St. Paul hi:d ��102 Ftams�ay 1�i12 1 22f3-10�37
9. Type of organization: �Fraternal 'OVet�'rans� f.3Religious-'«�Qther nonprofit* ;
`If organization is an"other nonprofit"organizefion;answer questions 10 through 13.If not;go to question 14."Other nonprofiY'organizations
must document its tax-exempt status. ;�i
C1Yes�No 10. Is organization incor orated as a nonprofit organizationl If yes,give number assigned to Articles or page and �
���k numbcr. Attach copy of certificate. ���
❑Yes ONo 11. Are articles filed with the Secretary of State? .; - `�
OYes�No 12. Are articles filed with the Countyl �R
❑Yes�No 13. Is organization exempt from Minnesota or Federal income tax7 If yes,please attach letter from IRS or Department of `"'
Revenue declaring exemption or cop�r of 990 or 990T. �,
❑Yes�]No 14. Has license ever been;denied;suspended or revoked?If yes,check all that a ly:
�Denied OSuspended ❑Revoked Givedate:
15. Number of active members 16. Number of years in existence Note: If less than four years,attach
..... ���.;_. . ,_ �8 ears , evidence o three yea �,
_ _..- ,, ,� , .. . _ - : •.� .�, r . -.�_ existence.f �;:
_ .: : , _, ,_., .,, . .
17. Name of Chief Executive Officer 18. Name of treasurer or person who accounts�#or other revenues `'�
�
of the organization. �;;
., « Jogc��ah ?ec�cere
Title Title
,�,s.vigator �tarser �:;
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Business Phone Number Business Phone Number
� ,;-:.2 1 2221�9� ( 1 f
19. Name of establishment where gambling will be 20. Street address(not P.O.Box Number)
conducted
ti.0 �3ingo Ha1Z 4Q�3` P��3ri :�t. . :�
21. City,Stste,Zip '� , 22, �County(where gambling premises is located) . .�
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CG-0001-02(8/86) White Copy Boaid - Canary-qpp(icant' =�� Pink Loca�Gover�ling Body
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.mbling License Application -
�ype of Application: %E7CIass A ❑Class B ❑Class C ❑Ciass D P89e 2
�Yes�No 23. Is gambling premises located within city limits7
C�Yes ONo 24. Are aU gambling activities conducted at the premises listed in#19 of this applica�ion7 If not;complete a separate
application for each premises(except raffles)as a separate license is required for each premises :
OYes(�JNo 25. Does organization own the gambling premises�If no,attach copy of the lease with terms of at least one year.'
❑Yes�INo 26. Does the organization lease the entire premises�If no,attach a sketch of `' 27. Amount of Monthl Rent
the premises indicating what portion is being leased.A lease and sketch
is not required for Class D applications. S
_ ;. . . la .00 r. esei
fe�Yes ONo 28. Do you plan on conducting bingo with this license7 If yes,'give days and times of bingo occasions:-
..
�evs �IQAdt3�i' Tir�e� $# ;
810� PM .. .LZ!W P�''
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�Yes ONo 29. Has the$10,000 fidelity bond required by Minnesota Statutes 349.20 beeri obtainedT Attach copy of bond. "
30. Insurance Company Name
�United �ire � 31 T Bond Number �.
Casualt �,�, �- .�
32 Lessor Name .�,,. � " "' � - = ?"
, 33 Add
��� .��:.:��€�t� �t� �x° �` °} 4 � ress ; �,: << 34 City,Sta�,Zip r�: {
;� 35. Gambling�nager N me � 1� 36: � . ��'� '' �r "'� � :� �� `:' �, �� :�.02 til.
: � ,�.,i 'Address ;:;>. «. �. 37 City,{ ...��_::,
30 �'r' Lr@Lll:� . Let@�ZIp .:� � :.;� '
, T807 Bellor+� t�. 9t. Paul '�N�5�1I8
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, 38. Gambling Manager Busi ess Phone 39. Date gambling manager became �� �� � ��
` �`�a►�,.: .
( bl� ) 22�YCif37� member of organization: '
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GAMBLING SITE AUTHORIZATION -=� �. �
By my signature below,local law enforcement officers or agents of the Board are hereby authorizetl to enter upon the site, ,;
at any time, gambling is being conducted,to observe the gam b l i n g a n d t o e n f o r c e t he law for any unauthorized game or - .-
practice. _ �
� , r�IF� Ct1T.! . ' ' . .:. '.. ._.. ._.. .� �_..
°�° : BANK�RECORDS AUT,F( „
�F����T�O�.Y�� . � �.
By my signature below,the Board is hereby authonzed to in"spect th�'6ah�C records of the General Gambling Ban��count
whenever necessary to fulfill xequirements of cur�ent.gambling rules and law,
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I hereby declare that:
OATH �:�,...�.�:,.,�..,,r.,. .
1. I have read this application and all information submitted to th�Board;
: . ..
2. All information submitted is true,accurate and complete; , " � " ' �
3. All other required information has been fully disclosed �
4. I am the chief executive officer of the organization; -
b. 1 assume full responsibility 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 b those laws and rules, includin amendments thereta
40. Official,Legal Name of Organization 41. Sig a ure(must be signed-b�r�ef Exedutive Officer)
i's :r. :tavoux ��sembl (�+th K of C) X < �,,,./ �.�'"�/v'��.',.�..��..--
Title of Signer
' ' t ` �'�A Date
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ACKNOWLEDGEMENT OF NOTICE�Y LOCAL GOVERNING BODY � �
I hereby acknowledge receipt of a copy of this applicat'ion. By acknowledging receipt, I admit having been served with
notice that this application will be reviewed by the Charitable Gambling Control Board and if approved by the board,'will °
become effective 30 days from the date of�eceipt(noted below►,unless a resolution of the local ` �
gqyerning body is passed
which specifically disallows such activity and a copy of that resolution is received by the`Charitable Gambling Control "
:: Board within 30 da s of the below noted date.
42. Name of City or County(Local Governing Body) If site is located within 8 township,item 43 must be completed,in
:-1;. Pau1 addition to the county signature. �� '
Signature of person receiving epplication � 43. Name of 7ownshi
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Title. Date received(3, day eriod ; Slgnatu e.qf person rec�i`ying appliCat�on :`♦-, �
be ►ns rom; is tlate) �Y�$ °k$ a� � , ,
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s �. ax Ka�a �t '. � s�z{�X �a��h��r���x x
44. Name of Persqn�leU ng�p�li�at�artE�� 1 Goiie ��I¢` �" �„f� �k p� x ` t�
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