87-463 WNITE - CITV �LERK
PINK - FINANCE COIIIICIl ,`/
CANARV - DEPARTMENT G I TY OF SA I NT PALT L Cj{/J �
BLUE - MAVOR File NO• ���/ r
COZI C�l SO ZO ��"��u°�,
Presented By .
/� .
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D.#64772) for the renewal of a Class A State
Gambling License by St. Paul Turners at 900 Rice Street, be and
the same is hereby approved.
COUNC[LMEN Requested by Department of:
Yeas Nays
Drew
Nicosia [n Favor
Rettman
Scheibel
Sonnen �—__ Against BY
Tedesee
Wilson
APR 8 - 198T Form Appr by City Attorney
Adopted by Council: Date
Certified V s Counci , cret BY
BS'
Approved b �Vlavor: '��� 19P�' 9 — ��U7 Approve y Mayor for Submission to Council
By - - BY
Pti������ aP� 1 � �987
J
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..�o.�?g #��,,,a,r' le Gambling Controi Board FOR BOARD USE ONLY
� m N-475 Griggs-Midway Building u�e��N���r .�
: � � 821 University Avenue � `�
' � St. Paul, Minnesota 55104-3383 PAID �
•. . ._.: .
'••..= ' (612)642-0555 AMT �;
"�i',�••'+''�� :�
' CHECK#
° . DATF
� - GAMBLIN(i UCENSE APPLICATION � � ' ' i, . ' ' `
INSTRUCTIONS: , h
A. Type or print'in ink. , ; ` ' : :. ';
B. ` Take completed application to locai 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.
,,�'`' T pe of Application:' •
�Class A- Fee S 100.00(Bingo,Raffles,Paddlewheels,Tipboards,Pull-tabs)
G`iass B— Fee$ 50.00(Raffles,Paddlewheels,Tipboards,Pull tabs) Mekecheckapayableto
❑C18SS C — F88� �O.Oq'(Bingo only) 3r;, , ^ i�^nesota erkable OambYng Gpn�d�oar�,�,
❑Ciass D— Fee S:�2�5.Ob(R'afNes oniyj �°`� ��' �' � '��� y �-� �
I�res ONo 1. Is th'is application for a renewal?�<�If yes,give complete license'number Q y -, � +
❑Yes�No 2. If this�s�r�o�,an a�pplication f,��e renewal,has or�a'ii�2ion been�icer�sed�by the Board before?�If y�s�give base
i . license number(middle five'�igitsl Q � ' u:"��`�` " �� `"� � _
esONo 3. Have Internel Controls been submitted previouslyl If no,please`attach cop ,•�:: . ��`_�
� � Applic (Official,le al name of organization) - 5.�usi ess A dre of Org���R�tion �
,c ' �I
! 6. City,State,Zip ` ' 7. Co� 8. usiness Pho Num er �'
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; ,.� , ; C4.�!+�s . � i�ilE,�`—,t,,,� ' ; • � ✓ � ` ,, ;�< � J,Zr1��: ��'' �
' 9. Typeoforggnitation: `� �a�ernal� �lVe� `rans, OF�eli�lous,�::�.lbfherno�pt fit",Y� �� �� ki� �' � •m ,� . .
� `If organization is an"other nonprofit"orgarnzation;answer questiops 10 through 13:.If nat,gb question.14: Othernonprofit"organizations
� must document its tax-exempt status. +°> `�; . `` ,
OYes C1No 10. Is organization incor orated as a nonprofit organization7 If,yes,give ny�m�ex a� �gned to Articles or page and °�
book number: � �- �� -:Attach copy of certificate.�� '� ����< ` � � _
i �es�No 11.;Ar.'Q�rti�le�f il�si With the Sgc�etarY of,.$�ate�7:,{,,,Y :y' ;,� `f j;�� � _ �
�YesONo 12: .Are.articlesfiledwith�heCourity7 ` `� � *�� ��`�.� �:� e� ',�` ^ r
❑Yes�No �3. ls o�9anizatipn,exempt frqr�Ainnesota or Federal income tax�;lf yes,please attach letter rom IRS or Department of
- Revenue declaring exemption or copy of 990 or 990T. �- � ` ' `� � `
DYes o - 14. Has license ever been denled,suspended or revoked7 lf yQs check all that a ly •�
' ❑Denied ❑Suspended ❑Revoked Give date: - °�
, 15. Number of active members 16. Number�of years in existence Note: If less than four years,attach �
` : evidence of three years : s
� D 1� �,:`:,, � existence. -; . "
17. Name af Chief Execu 'v Officer 18. Name of treesurer or person who accou s for other revenues ;�
, � of the organiz tion.
' ��.Q�,,-rtiK../ �
Title Title ``
� ' S
�/ �"'�''��w�^."r' ' `�
� Business Phone Number Business`Phone Number . . '. = �
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19. Name of estab(ishment whe� gambling will be j` 20..`Street,e+ddress t Pp;,Box Numb r)� `"
conducte ;<,� �`u�, " �
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f . - , �„Lx!'i��,w�' }t ^r/���ra� ~J .r a' i :?�
21. City,State,Z'ip � `. , :.� £ � ,`�` 22 Cou� w ere gam�ting premises is IoGated� , ,j ,�° , ,�
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Gambling License A QI' #ion ` Page 2
Type of Applicatio� �Class A OCl�ss B ❑Class C ❑Class D
esONo 23. Is gambling premises located within city Iimits7
�'Pes ONo 24. Are all gambling activities conducted at the p�emises listed in#19 of this application? If not, complete a separate
application for each premises(except raffles)as a separate license is required for each premises.
❑Yes�0 25. Does organization own the gambling premises?If no,attach copy ofthe lease with terms of at least�one year.
❑Yes❑No 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 Isased.A lease and sketch ° $ Q
is not required for Class D applications.
es❑No 28. Do you plan on conducting bingo with this license?If yes,give days and times of bingo occasions:'
Day .d f , Times. s,....� t'j �
Y '
es�No 29. Has the S 10,000 fidelity bond required by Minnesota Statutes 349.20 been obtained?Attach copy of bond. � •
30. Insurance Comp y Name � ' 31. Bond Number
c� � C� / �-�
32. Less N�� � ' 33. Address � 3�., C�,�,SIt'a�t , i .' f*�/�.�^9 •
f�l} � G�G�' z•S �/
_
3�,,, ambling Manager�j�e 36. Addre s , '' 37. Ci ,Staie,Zip' �
`=";t 1�.� t 2 /'�1 (.�' ����' � IY �/� ,L'�Gl,.�+�%c� �liK.c• ZC.�t��t��.
38. Gambling Manager Business Phone 39. Date gambling manager became ` ,` ��
r'( �j' 1 `�v U/ (.I— �/l �/� 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 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 1�'
practice.
BANK RECORDSAUTHORIZATION }
By my signature below,th B ard is hereby authorized to inspect the bank�ecords 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 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; � `
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. �ffici I,Legal Na e f Organization � 41. Signature(must be signed by Chief Executive bfficer)
,�% —';(,,� {.�;,.��(. ;'j X _�
Title o igner ' Date � � �j r�
�� �.�► �/
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 that this application will be reviewed by the Cha�itable Gambling Control Board and if approved by the board, will
become effective 30 days from the date of receipt Inoted belowl,unless a resolution of,the local goveming 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 a township,item 43 must be completed,in �s
� , ,,—� , '�''�� addition to the county signature. �
1 -�.,. �:,. `�..-(� -�"r,�..�.
Si`nature f son receiving application 43. Name of Township
X��� ''` ` �(,�n c.Mc1 i t� C �Y:•
Titl� Date receiv (30 day period Signature of person'reCerving application ���';
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