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87-462 WHITE - CiTV CLERK � PINK - FINANCE CITY OF SAINT PAUL Council C4NARV - DEPARTMENT File NO. ��` ��� BLUE - MAVOR Co n il lution ,-,..� 1 � � Presented By � ' Referred To Committee: Date Out of Committee By Date RESOLVED: That Application (I.D.#88619) for the renewal of a Class A 5tate Gambling License be St. Mary's Romanian Orthodox Church at 900 Rice Street be and the same is hereby approved. COUNCILMEN Requested by Department of: Yeas p�eW Nays � Nicosia ln Favor Rettman Scheibel � Sonnen __ AgalOSt BY �� Wilson Adopted by Council: Date APR 8 ' �g87 Focm Approved y City Attorney Certified s•e ouncil ta BY sy Approved by Mav r. ��` ���'� � '� � ��1�� Approved ayor for Submission to Council C�—si . BY - — — BY 5�7, ' � �/2 9 L9 L7 ._ - � .. i.�� 1 ,.,�.. ........ „„ . . ,..� � ...,, _ , _ .. _ _ . . . .m , �. .n -��. . . �� ��,� if77111 .. � ,.aa y.• 11�41. �y__.. btppEDUNpA;,,�i� Charitable Gambling Control Board FOR BOARD USE ONLY � �•4� Room N-475 Griggs-Midway Building ; �;�8�$eN�mbe� � ., ;'� 1821 University Avenue _ - St. Paul, Minnesota 55104-3383 AMT �`•� �'� (612) 642-0555 ,S ': ��•i�a+� CHECK# ,: DATE GAMBLING LICENSE APPLICATION INSTRUCTIONS: A. Type or print in ink. � B. Take completed application to local governing 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 returned. s: � �T pe of Apptication: Class A — Fee$100.00(Bingo,Raffles,Paddlewheels,Tipboards,Pull-tabsl ❑Class B — Fee $ 50.00(Raffles,Paddlewheels,Tipboards;Pull-tabs) nnakecneckspayan�eto: '� ❑Class C — Fee $ 50.00(Bingo_only) . Mtnnesota cnarkable GambGng control soard �,� OClass D — Fee S 25.00(Raffles only) ' r�`� P�Yes ONo 1. Is this application for a renewal? Jf yes,give complete license number � - �C�L7s�..L - � + ❑Yes�No 2. If this is not an application for a renewal,has or anization been licensed by the Board before? `If yes,give base ,.� ficense number(middle five digits) Yes ONo 3. Have Internal Controls been submitted previously7 lf no,please attach copy. 4. Applicant( fficial,legal name of or anization) j �5.' usiness Address of Or�at�,ization .�,.,,,r„ ''j�Y{ d tt�r c ��5' r� c�c` �, �'/ . 6. City,State,Zip 7. County 8. Business Phone Number �^,�"'. � f l"7 � - ��c�n S e. ; : � ��, � �- �' " 9. Type of organization: ,OFraternal ❑Veterans Religious ❑Other nonprofit" •If organization is an"other nonprofiY organization,answer questions TO through 13.lf not,go to question 14."Other nonprofit"organizations ' must document its tax-exempt status. �Yes�No 10. Is organization incor orated as a nonprofit organization7 If yes,give number assigned to Articles or page and , book number: 5 � Attach copy of certificate. � 2 �Yes ONo 11. Are articles filed with the Secretary of State? . ` ' �Yes ONo 12. Are articles filed'with the County7 BSIYes�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 copy of 990 or 990T. ' ; ' ❑Yes1�No 14. Has license ever been denied,suspended or revoked?If yes check atl that a ly: ❑Denied ❑Suspended ORevoked Givedate: - - 15. Number of active members 16. Number of years in existence Note: If less than four years,attach �� �� evidence of three years � existence. 17. Name of Chief Executive Officer 18. Name of treasurer or person who accounts for other revenues of the organization. � , �,, � �- � � s Title Title a � �,.,, � ""�'""` "� Business Phone Number ' Business Phone Number � � . . � . . . ' .' .. SI"�, ( �;�. 1 �531 "�� 1 �m1� ) �� •"' �f'j � ;; 19. Name of establishment where gambling will be 20. Street address(not P.O.`Box Number) - � conducted � � t : ���'� � 21. City,Stste,Zip 22 County�(where gambhng premises is located) ;� �, � • r� { ��,�•c, . � ,.M .'�� ,��. .� k' � ,�^ r .+ fl. a �� • �1 � 4�' €.� 9 A'3` �y:�3 F .�`.x,�;paaGt-+, 'r� ,� n'�'"'�k ��31 ,Y�."14'1'7'ri .��-0�rd�'±Y x �' � N+ ' n. � White Co Board � ` ^ '� 'Can�i"j' �iI1C8n ,� " s �k � CG-0001-0218/86) PV � � �, � , � ,�f�� ,� �,�` t � pi -Lo�C�1z �, Y,: ,` �~�- � � - �,, : t r.c+ >mra u t '����< � s$`'� ,�+ ��^�"`$�'�kr� t�.°€�a i,�r ''v .� ` st e, �� 'F. �� '�. i '} ��f�a�� .�; �9tk a� ,r�;r� �`�k+� rfrc�rA � rh i j's,� �� �- '� {,y} 3 . k � },,, . � +. ?; _ �'r.. �` L � t.�'<'� �; ;� �a �.i �h�z-,�,' � ��.+��,�'w a � 3 ��� b �., 1 A . 3 ,( �� .� � �� - �t Y,k /a' T ' l'a �y. � S' . ( t°a.+�'t S , �f F � �,+. f � • �y� x � a � ' r s 3e �y, � +�, +��{ Y Y � ;i ���+t7^:'�1� � ��: ,�? ,y r fa .rr �" �ad � '� 1� s "x`y�'�'eb 1 Et�� ,�'t e�-`�b °r h k � $t` � °^�"` }3 ,i ,_ �a ? . �� �t �y a: J �;d v �,i k�qa� .r g ��� fi3 ��,�4„g»aaa. � p�,i,���g ,��,fi.�� E,�` y. �,�, .. �,� �� � s »..... . ,':'J'�t . . ,. . �_ . . . . ,'� ,.:�'� . ..� .�r�6" .���• > _ �d�"+.nxhY.,.J��t,�"F .YSi;o. . va:.,`i "�`��ti..s.r.3[�'� �;�' ,,,e-`{._ k . � � � �� G��� .! _. ' kf ' + �Gambling License Application Page 2 Type of Application: tBClass A ❑Class B �Class C �Class D 1�Yes�No 23. Is gambling premises located within city limits7 �YesONo,¢ 24. Are all gambling aciivities conducted at the premises listed in/�19 of this application7 If not, complete a separate application for each premises(except raffles)as a separate license is required for each premises. ❑Yes�1No 25. Does organization own the gambling premises?If no,attach copy of the lease with terms af at,least one year.- OYes Q�No 26. Does the organization lease the entire premisesl If no,attach a sketch of 27. Amount of Monthl Rent the premises indicating what portion is being leased.A lease and sketch S �� ��) is not required for Class D appfications. �Yes�No 28. Do you plan on conducting bingo with this license?If yes,give days and times of bingo occasions: oeri...�Gt A��cR+t �����. `��.°GL� p/f f•_ Yes DNo 29. Has the 510;000 fidelity bo d equired by Minnesota Statutes 349.20 been obtained?Attach copy of bond. 30. In� ran e mpany Nam �J � 31. Bond Number � t�� { ,r �}' � � �. .�� ` �?���y � 32„ esso�Name ,�, .-, 1`i, 33. Address . -�+� 34. City,�tyate Zip _ � , � t � ��'C:P�^i�. ��0�� !��,�u r.;�1 ��' i�t.�t� ���l ,;;;.,y /�� 35. Gambling Mana�j N�me , 36. Address €, . . 37. Cit�y,State,Zip '"h;;.-n:• ' l^t� • K cs�G r � �� V I�..�G?�`t� i�'�.�c:E 1"�'�� � ,.j-r.� ^�, 38. Gambling Manager Business Phone 39. Date gambling manager became � ( (C�;t,� ) ty LS''�.. #:�a�' member of organization: �,�- - b'"�v�� � GAMBLING SITE AUTHORIZATION - x By my signature below,local 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 or practice. _ , BANK RECORDS AUTHORIZATION � 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 read this application and all information submitted to the Board; ' 2. All informetion 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; �.`" � 5. I 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 thereto. 40. Of 'cial,�.eg I ame of Organiz tion 41...Si tur ' ust-¢ s° ig d�5y Ch,i�f"�xecutive Officer) �,T� r S � �C rc x----�r;' � ,C � Title of Signe� J �/ Date � � � `� ��c:i T� ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY I hereby acknowledge receipt of a copy of this application. By acknowledging receipt, I admit having been served with notice hat this,appli ation; ill be reviewed by the Charitable Gambling Control Board and if approved by the board, will - becp[t� e�fec ve ays-�m t�ie date of receipt(noted below),unless a resolution of the local governing body is passed which•s�e��allq�sallov��t�Judh activity and a cop of that resolution is received by the Charitable Gambling Control ` Board Within 30 da s of the below noted d e. , ' 42. Name of C�ty u y Locel�ove ning o If site is located within a township,item 43 must be compieted,in ;1! ��-" ( �� • � (�. 1i:�<�.� � . addition to the county signature. � - �1 ,.�,,+, Signature o��st�o,�r �e}yjng application ?�� � 43. Name of Township . `,rr _. �.l�� . . . . � �� .. . X .f . � . . . .. .. � � . � . . . � . . .. �. ' :Title � Date received{30 day period Signature of person receiving application : ` : � begins from this date) �� , X ;r`� 44. Name of Person:delivering appl�cation to Locaf Gover�i�g Body, . 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