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87-467 WMITE - CITV CIERK . PINK - FINANCE G I TY O F SA I NT PA U L Council (? J CANARV - DEPARTMENT FIIC NO• (' • � �� " BLUE - MAVOR Cou c� R esol 'on ��`� �. = Presented By Referred To Committee: Date Out of Committee By Date RESOLVED: That Application (I.D.#15975) for a new Class A State Gambling License applied for by Midway Training Services, Inc. at 1324 E. Rose be and the same is hereby approved. COUNCILMEN Requested by Department of: Yeas DfeW Nays N"°S'e [n Favor Rettman Scheibel so��e� �,L—__ Against BY �...�T -+ .� WI�SOfl Adopted by Council: Date APR 8 - 1987 Form Approv d City Attorney Certified Y•ss Council Se tar BY By- `n `�'� APR 9 ° �'�l Approved ayor for Submission to Council Approved b ENavor. D —1� By _ � gY P11�1i��i�D �+;�; . .�,,,,,, �,r �7-��7 •i'HE,�"`',. �-'� �TFr-. Charitable Gambling Control Board pILF LU�VO�'• �;,�t - , � FOR BOARD USE ONLY �;��' ��'�'•�i- Room N-475 Griggs-Midway Building �� '•�� HZ� Uf11V@t'Slty AV@f1U@ License Number b� � �> St. Paul, Minnesota 55104-3383 PAID .� - (612) 642-0555 AMT ��':�.;�*:..:.X;�^.;� �'°�� CHECK# DATE GAMBLlNG 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. Type of Application: CY�Class A - Fee S 100.00(Bingo,Raffles, Paddlewheels,Tipboards, Pull-tabs) ❑Class B - Fee S 50.00(Raffles,Paddlewheels,Tipboards, Pull-tabs) Makecheckspayableto: ❑Class C - Fee S 50.00(Bingo only) Minnesota Charitable Gambling Control Board OClass D - Fee S 25.00 IRaffles only► ❑Yes C�No 1. Is this application for a renewal? If yes,give complete license number � - � - � ❑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 _ license number(middle five digits) �Yes�No 3. Have Internal Controls been submitted previously?If no,please attach copy. _ �. 4. Applicant(Official,legal name of organization) 5. Business Address of Organization � ;�tidway Tra•inin�a Servicas, Inr,. 1549 Uni:prsity Ave. 6. City,State,Zip 7. County 8. Business Phone Number �r. P-�i, ��1nri�soCa s�i(1�+ �tdws�>Y ( f�12 1 u�.i-071;-3 9. Type of organization: ❑Fraternal ❑Veterans ❑Religious C�Other nonprofit* - 'If organization is an"other nonprofit"organization,answer questions 10 through 13.If not,go to question 14."Other nonprofit"organizations must document its tax-exempt status. [�Yes C7No 10. Is organization incor orated as a nonprofit organization? If yes,give number assigned to Articles or page and book number: z'� Attach copy of certificate. [�JYes ONo 1 1. Are articles filed with the Secretary of State7 ❑Yes�No 12. Are articles filed with the County? L�Yes❑No 13. Is organization exempt from Minnesota or Federal income tax?If yes,please attach letter from IRS or Department of , Revenue declaring exemption or copy of 990 or 990T. ❑Yes C�No 14. Has license ever been denied,suspended or revoked?If yes,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 � , ::.?a ��rs as �3erri��,� Parsc Ul�� evidence of three years �� t. Y��s as rsicfara,� Trat,ifn<, 5e�vices existence. 17. Name of Chief Executive Officer 18. Name of treasurer or person who accounts for other revenues I of the organization. I Cr��r'ies �a;';°r �Ed:l Q8I� Title Title i'��as ident o: Yye tloarr� Trea�urHr Business Phone Number Business Phone Number ( 07: 1 ��`?7-5256 ( 5!'L 1 7l�f-�'t7�� °1( 19. Name of establishment where gambling will be 20. Street address (not P.O. Box Number) 1', .. } conducted i� ��_�.: /�i 1�,'i1 1,` r�.'�l. 1... I ."i��iy't (.' �C'�-ih.- ��j. ' r,- �;��5.[_ )�`�,\U^1 '� . 21. City, Stste,Zip 22. County(where gambling premises is located) j� -, i� � �;,,_l L.,. ,.. . 1 ��iN1� �-; ,�.,.fr� � CG-0001-02(8/86) White Copy-Board Canary-Applicant Pink-Local Goveming Body �� !, _ I� !I ' �j f >-,,,_3 _ . ,<_.�}_> _ ._ --..,__ ... ._> � _... ..nr._.,..� ..,,.� >,s-.1�>:�--,.--�.,.,--: �.--°__��._-.r.a:�,-,»,,..�:s.�,�.�--�«.,.�k.,�,>�z.,-_,.._� .��.=.,a.-�-,>-„�-�_--.. ,- ., ,.. , a � . (��- �/�� .,ling License Application Page 2 pe of Application: ❑Class A ❑Class B ❑Class C ❑Class D �Yes❑No 23. Is gambling premises located within city limits? �Yes�No 24. Are all gambling activities conducted at the premises 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�No 25. Does organization own the gambling premises?If no,attach copy of the lease with terms of at least one year. i, ❑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 leased.A lease and sketch $ 7.;'n f�' •��' �j s�'t' '��'�'s�cF � j is not required for Class D applications. i DYes ONo 28. Do you p�an on conducting bingo with this license?If yes,give days and times of bingo occasions: Days Times �' .-xar��.` �Jc':i,)��nfG-- ii li Yes ONo 29. Has the$10,000 fidelity bond required by Minnesota Statutes 349.20 been obtained?Attach copy of bond. 30. Insurance Company Name 31. Bond Number AE:"f<Iw C�;, �enu•ing 33. Address 34 City,State,Zip 32. Lessor Name � � { ,e, ,�, j�l�°.�.� ;�-�t,; '5 lrt,--,, . �+:� r ��;,�'i",.(i. ^�'-y-� t �_' � �.• . . 35. Gambling Manager Name 36. Address 37 City,State,Zip f ;,, x.r -��-t �! ;{Grn1d �'e�rne�' ��•��'�� 1��:1��1:;�1 „ "�1� ' � ` �` 38. Gambling Manager Business Phone 39. Date gambling manager became ( U}4 � �;��_��;�� member of organization: �;�7ri 1 1, 197ca i' GAMBLING SITE AUTHORIZATION By my signature below,local law enforcement officers or agents of the Board are hereby authorized to enter up��n 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 � I hereby declare that: 1. I have read this application and all information submitted to the Board; ' i 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. Official,Legal Name of Organization 41. Signature(must be signed by Chief Executive Officer) � � � �;�t�i-+�.y 7rair��l�� . ��rvrC�s, in�:. X � �4 � Title of Signer Date ,. � ,.� ; /:� 1F �7 � 1 i .'P_Sli�'-'fl� U� ..IiP �J..�iU • .. � . i 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 Charitable Gambling Control Board and if approved by the board, will 1 become effective 30 days from the date ot receipt(noted belowl,unless a resolution of the local governing 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 � . 4 � addition to the county signature. � : �•• ,, �'�.:� �. �� 4 �,�, 1, Si,�nature pf person receiving application 43. Name of Township X ` �. tJ ' ��1 Title' Date received(30 day period ' Signature of person receiving application begins from th�s date) , � �, � ,.�...., ; - . X ,_ . � , ,. . �. , 44. e of Person deli ng applicatio}�to Local Governing Body Title i` _• �t f 'r./� , tf-./J CG-0001-02 (8l86) White Copy-Board Canary-Applicant Pink-Local Governing Body