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87-632 WHITE - C�TV CLERK PINK - FINANCE G I TY OF SA I NT PA U L Council CANARV - DEPARTMENT 7 ��JJ BLUE - MAVOR File NO• � • `� � Council 'o �. Presented By I %' Referred To Commi . Date Out of Committee By Date RESOLVED: That Application (I.D.#48025) for the renewal of a Class C State Gambling License by the American Legion Post 449 at 408 Main Street be and the same is hereby approved. COUNCILMEN Requested by Department of: Yeas preW Nays Nicosia ln Favor Rettman Scheibei � Sonnen __ Agal(ISt BY Tw�wse� Wilson Adopted by Council: Date �/ � — c�� Form Approv by City Attorney Certified Y• •s b uncil S t BY By- Appro by Mavor: Date _�. MAY 7 - 1987 Approve y Mayor for Submission to Council Bv - - — BY ��;+�,t'�F.s t't!i�'`,`, J. . I:1C�1 !.u�:�.''�� t��',�-:��ZO`'�" `-.'_.wv.r vaTx.x�.' xiv ' 73"w{l,JN',�s` � `" �'Sf?* c. P ,.,.J.�i � �.t"� � a�..r �*ES- : �..d � s . ''�.��a�•�� :�.�+ �,� �, r �. � �, <�. � i � . .: C",3,,.x R��� �F��;. J � ` '�4, -#i4>'�'Y'`''.'I�'� 't �{ .� f�' �� �}:�- '� � `���" J "}'a � tj .f ^� �z.'S`.��'it'4��n- ?�`+ . h` �. .._3ai.�'�.A� ``� !�.�� ���7, !y ft �, ��. � y 3 }�� i ,; , .:� %�fe��- �� s° �s � �a~ v�.; ��a*;Y s . �. i �,,t �°� �`:� r a s � � �. �•,� r', i t e>�„ � � ' •o,�o ��'�,;�`,Charitable':Gambling Con�ol Bo�d ,:. �'� � A��-�� :FOF�BFQ�►RD USE ONLY ��'' �� .� ; �� � �'� Room N-475 Griggs-�Vlid�v Buildmg . � " ��� .� _ z-;' � �; ?,� v -ti. k .r F ��"� ` ;f�+'4�t�^ ���`L�CEn�9Nut11b � q� x�, t ��� .1821 UrnversityAVen e �;��� � r � �{s 3 , , ;4�, � � `'��-. ,�. Y.. < . S �t k�+��� Y �`' �i � F yi�y.�aL a;� '� M,. � St.Paul, Minnesota 55'�-� 3383�r � � � '�� .. �� ��� .�< .� �� .�� � �: � �,���_ �• "'�.r t�� � . t �� � :, ; �,�' :(612)642=0555� r��"' "� ,�3 �� w � � �, � .� : PAID ,���' � � A� � - �,� ; t� � ��-x �,�j a4MT, �= w #� »-ry : �„ . � ,. < ��.�",. �` � : �� CHEC�C .�� �.. � ,�< ,;? �,. ��& +:y��'�� a �� � �Y � { �t � ay � "SS�.�',�".1�ro^t ;J4k`� � ��^^k Yk•- .YSt�.. '� . � �.�. .. � ,"��s�� "�i` � ':+, 'f�� r�". '� "� .,e'.D�t ��,.��'�����`t��r'* iJAT " r R ' �' +�r ��#� ��> o ,a-wE �`# �?f �.:.ti r � -`��`� � ��-ts r . 2 ; ��. � �;-.�,���GAMBLING ICENSE-:�A �I .-:�T`ION� �. �i ��- ,� ;:, � j ; ,� ���3 Y. ` ti" ��; �� � �'��-� ,�',�.� � y�°�c. ���' `+�" a. "-s C r: x,,,x�-� �.7� . a � �� y ��;,y ',,,��'. 1 y.t y. . 1 � ,P ��- �{ } � .a'� '�K y.�y.t f�j,� �l.u,� � � ��„�^z.���,�:�� � ' � ?; ��"�i H,�. . �� �� r �. �.. � -' S t ,:.e sr �{ � ,�?� S �r �i`r �� r� �+° t",t r r+ �,c�, �.7Yr .��� UCTIONS'�. . •v..ti.-L�.. x ..r! ::.� : �� T2 � `t �` . i � � Y f �!._�' �bvt k �:�A 7'YPeor,pnnt�n ink'' 4�� ��i, �� ��:,.r�� .�r:: . ,��'��" �:� ���`��,Y,� ��`�'�a ,.. � � ��' � `k` � a ° '. � c i�,+ ,� >t, '4,�k ..�,.,��C.�.�5 w�. z��'`�".� ,� B Take"compl�ted��Qlication to�ocal governmg,body,oli�am;signature\and.dai ;o ��I;cQp,�e ; Ve�1.copy.Ap;p(icant,kee s,�1 ,r �r,� ;=.�� '.copy.and se���s.o��inal to�he�bove addresS �it�i:a"`�cCieck �� ;a���s�; �����' ' ` -'' ���?�� �,�'��,���� ; . � C, Incomplete epplications;�jrill�ie.retu�ned , �,��ti „�w �Y"f�q '� .,�,,� �; ��� .� �".� ��; `:,�'�xh�°'�`�-, �: f- r,. �,�..t: .e..-. r Y' "�rr�M.: ,�A>r. .�.:• r, i�'. k :s - .. . . r . �,.: ° ;"�'.TYPe:of Application�� `'`; ak� �;�����,,r ; , � �:, } � �. � ��;;� � ° �z' �� „ � s = , A • " ' ' � � � r �� ,. ,�� � M' .F.eel4jit .r,z ;��� `"r t�a : OClass A - Fee S 100.00(Bingo,Raffles,Paddlewheeis,�Tipb�oards,Pull-tabs) ,; ��- 3 � � v ,� lass d ;Fee;� ��50.Q0(Raffles,,Peddlewheel,s;Tpboa�ds;Pull utabs)''� �� ����! ��.��'� x�b -�'`�}'�:'�;.�', ��w �`' ' . ,�Isss C ,`Fe' :60.Ob'IBing only) �`'�'�� ', -i"�y`;� •��`` � .r :`�� •� �Min'ns�aceCtia eb `O!"'b!"g.�on�ot9.,o��rd �:'�� ;r' 4-y {. . ° ; . �����r:�'. �#�?Q.�s''� 5����#J '�N�� �.. � i. . . ` .: , ; , ,. . , , ,. > . , � 'f-c � ���. � � . c� �;, Yes ONo ;1 �Is th�s appiication;for a renewa(1-��If yes,give`complete license-numb�r� = ` J µ� ;. ,.�. __ _ ` ���,;` 4. �'� es,�]No��rr2 '�1f t�is is`not an application forss�enewal �has or arnzatfon be�.$n�'�ia�rl�e�iby�th, . e before es;�give base� �;�``��r. 7;.3Sf} n?ch . t� ��V; .:: A :q,. , • �,�_.., + .. a . ..�w + ��r'°x *�Y3.'�'";,S'�`�°6'��e'.t. 'rN�^2�;�'i"'��'�.:21 ;'a�.ti� r� �s�w � .">r a.. � ,-�;;. � �,Jice�se numb r(middle five digitsl, � - J.�,��:g.,�;���, �;�;�.�'���:,�; �,s.�::..� r,��, ..•�,� �� ❑Yes ONo 3 Haveante�na iControis been su6mitted previously?If no,please attach�copy. : '�F��-n d�'p; ` : , ,• � �: -=�Applicant(Official,leg�:ria e g�organization ;. �: 5. Busin.ess Add�ess:of Orgarnzation �� � • , . :: �.. �"' t.�t^' .:� ' �'i i�'�C� � r. t a ' �G �` 7 �.�f� �b t� ' , i9 6 City,Stat�Zip 7: C nty . 8. Busi�ess Phone Number , `� ����� .�<.,,t � '� �����! Y f �. . .../��.3�.� G( . r ��at. �(� •.a/'w.� �� �e,' d ?� � �.� � 9. 'Typeoforganization:� OF�aternal .,��/eteran��t3Religiaus��r , therponp'rb�if�'`��4 �'. '" - 2s: = � •If organization is an"other;nonprofiY'organization,`answe�questions 10 through 13.If not,go to questiort 14."Other nonprotit'',organizations, Y'� . �-must document its'tax-exeinpt status. , '` ` '.,' ' : ° ... ;' ` . , : . _ .� OYes�No . 10. Isorganization incor orated as a nonprofit organization7 If yes,gwe number assigned to Articles or page and � ':�book number:` ,. ,'Qttach cop`y,of c�rtificate �� :'' ,. ';�' � �,"�.�,. �� = es�No ''11:'•Are`a[ticles filed.with tFie Secretary"of State7 y `�+' -� {"� x�,• es ONo 12. Are articles filed with the Countyl ��,;� "��� , es�No 13. Is organization exempt from Minnesota or Federal income tax?Ifyes,please attach letter from IRS orDepartment o� �' � Revenue declaring exemption"orcopy of 990 or 990T. :'.,{�(�� "�..�'°"` . :; x , ���-i,,, „ ��``>�,�_ ,� U/�z.�'.; � . �Yes�110 14. Has;license ever been denied,suspend�d or reVoked7 lf yes,checK all that'a �ly � .. . ,, � . _ .. ,. , � :�r -. :-, . . -_ , :; . , ,, ❑Denied ❑Suspended ORevoked Givedater - ` 15. Number of active members 16. Number of years in existence Note :If less than four years,attach �; ,:� , ; � � - , �` ewdence of three years 4� . i, ;��:_. �'.�.,/s" r -�� .:�..,.�� '_�A "�"���: ��`lL ��j��'S�~������"�"���j C�°�;'c��ir1C.P,r .,�u�. �� '�^v. ��� � 17::aName of Chief Executive Officer. � ;' 18�Name of treasurer o�r person wFio accounts for othe�reve�ues J �i , .� of the organization +` k�a� �fi �°- r y � � ,,.g.�_ " ,.Y';, i� '' �' �Title°. � Title' �, � t�� . ' • . � * 7 1� 1 � '. i , �� £Y , . .�, i F� ! t�`: .`... j wi "1 � / s 4, � i ,.�.y.- 4�)7e�,'�t'X� �i $�'�aa�":Y"., �+ d1 M�4 � � ° �� t: �. :�$f • y< ^'t'.�a" f i a 1' .a.� 'Hkn�1 sb �. 'iF,'��' �, �._.a�� Y�t�x2�o � ����,�p9 I �',f e �-�i�r ; y� ��� .:�..+"'"tu�• '�� r+�.� �,,,, ?'�Y - •v: `{ t. �� r. t� � � � � �1�: . �I - Business Phone Number �L � ��s� - � � Business P�or�e Nukn�er'� . ; ; r �Y"` " h,,'`n.,'� : �; ��� � ,T: ' . K.r ' � n�r�. g � �,y'. r� b���„ �, .r �. L�� t sr bj ¢ f �y ( +�vy".°� t y 1 a _ F "�`�� +'. 6; �t :� p S� L `� ��+? , . , . ' w' .. . 4 t, r - !. 1 ( ! �J � �� �� `i .� •�� h I�rz°5�����' �i�l.�� i/"$��.y�• 1 ir.� �J,k 4�Z.'�l�, `t .A�� : +... � _ 4' k ,,. . .�. �:[ a � P a t.�», i;w Ma. . !m%�.� -I,y. �+( �+�c� x ' �x ,�,.,,� ,`; 2Q S�'re� addr�s ;(not `;g = .,u. �er, �"F� "`` %, ; �`4 F� 19 'Name of establishment where gambling�vill be,��-�, �-- ; � 1 ` Y ,yry(`,�'�,at��"� t - ��i.K dJ+�� },k Y ��G,�' fF� �b , f'conducted �:�• �,�l�f' f-y" � % �� �, ��'•�� €� '�K_.k �. V l�~ � � �i4�i R} 5�k M T.� � } . �� ..,...F ; ! ,�y F �'�d�t'� �� -���" i�k'r - � ` . - �r�''�"� •+' w s� '�� :�w�5 R'�°r��'��'�X�S /+♦ c♦a« $ G�l i 9 "'S�d� `' ' W7 iL ' M*��. f ' v '# A 7 S A a� Y, 6�j 2� V�y�ly�7lC�lel Z�p� , r �7.;i' 4^C F�' �L' y.,O•�77 �1�n9 Q� isesls ocated)�s���"� �!%AP �� 4 *��)4d"'±C �Y .�-� . � ,i �.i� 1sF '., a"� : ti;��'�,.� `t;t��: dct'4��F .�. � ,� '� '�"r:,ia ?,.� v' `1'�' .`t 9 '��i�.�... ,� �� w '� ..'SY�' v sf� '�A �..: -�h � �A`' _� �'".,/���`..�" y�* �� i ,b,� 1 �� .�t�. - i '� '`�3 ..� - F ., .�^ Y'... „ t ,' �� �i.;qr � M-' � dc r �y�:. �{ CG-0001 02{8/86) , � � ¢ �~ WhiteCop� ,a >�� �'�'`° �Can�ry�A � pve�rl��� +, 1 t � -r'l..§§ k'r�a. ' y T.� . � � f 4 ir �4 3� Z . 1 ..� � } SK,}�� i y J' .. � ��. ��,, 4�T£ 4'�n'� a;k+ �f�,. >N e.... �+ 'r�r'� ��Si'��..: +� �,'"� .�_t,i e_ �. '�rr R�.�c `�,�' � * a},. ..�p`� a} 'f� � Y-� �a�` � � 'Y,:a �`y�"`: �, �E� ,�, �`.,;��r�,,' � l � .�a : 'r � t r�� `�c:� � � 1 ..v' e�'i�.�-a b °' �, ck . ,y `''��; I. .,�. � . YI y� .iA�` t �.Ff., . 'L, `Ny �p.�} g�tP6rt: Y 't ti � .' a ��.. ` a^w 'v, .£;,�... g�a,; � �. �,� d'i ,5�. ���*� a wro?3� �a ��' s `� '�,, k�� ` x,�;,,Ky}°... � e � vi a�.q��l,k.H. g.� .. �-+�e-'✓�c���l'r�'� t S�K�''�`� � <�,. "f?p"3'�,` :�4 �e�I;��y'#R31.'�- _ .._.._...._... __�W 4 . .. . .� .s. '�x ...�L._'iy�+.T13fF.�:�s.}",��w.. �� ..- e. .���.r x+d`., ...+��a�'"�a'�-. �3f�� t � � ,r � �, � �x � �:Y' 3"�x�'``�r�' 3 �:� e �° � �� � .�� . i T;x '�'� "> Y 1 ' � R.. �'�t�..., �"' . "� � ��'3�F�`,i'�+'tc*.3� � z�R >��� 4�:;Y -�, ; � � ¢ �� {�.,ti �1-Jp � - '.. az�'� ;` �t?"�h �' �_ .� 4��<�gt � �pd. r¢r .. ,r �.'���'!'� � ���{�'s��- � �.,+a tte' � i y+ 1 � �4�+.��n%.**s a �� i.;. # .,�3,� � ��; o-�' .. �. � " . .�' P 3� � a x iC�. 'i �,�"�3r c J ,»- '_?m'Rt ,...F . t '�°�� �W aA e 2 a.� q,.n. . j � � � 1'��� i t+i.� � N s� n � � a �� is ^�,.. , �t �.:rx i°"`id�'s:ta '' i'F�;.���`4 j �'�,r 2 �14����Y � a • � � ,�#»'��''tis,� y . 3"b"' u r fr��� LL: Ga�bling License Application . � CI`�ss B. lass C � OClass,D � r�` x �,a ' � ' d ° � ;� � ���'�� TYPe of Application � ❑Class A ' Q.�� �, ,.�t� �,�,� , > , � �;k � � �x� , ,: a"��`� t ;�,��. �* �s-�•;.•:: ..r ;_• _ .:-. �_;> '� � � t r ��,� x.�Y a� . e � y �'�e �v� � 1 11 It d z.t-•�h '�t 4 a� , * r' . ., :� � � �: es ONo.,'23~_Is gamblin.g Premises locate�d w�i�ir�¢ty m s?; � , i ` ��� � .p� � •.s y ;• ,; ��,r:,' ' . ... . _. � .� , �� " ,.. . �:` ` �_ . esC7No '24. Are all,gambling'activities conduct�tl�t�the.premise�,listed m`�#19yofFth�srapplication7lf hot�CO,fnp.@te a�eparate . , :�, � : � `'applicaiiCn for each pre ises`(excep f�f�IQS),�as,ase arate lice.. �e;�s .q�ir�d fpr each premises �, �, • ��� � rvb't r:.y ..�, � �. � ,M k a .?n � ``}° � �` se:,wRh terms t�f�at � e�ear.„ :yx�. `: - es o ��;�25:Does orgeniiation own th g��t61i�J pr@'�nlses?,[�11o;`ettach cop � e,,,l@ _ �y,w. 'F c 3•'b�x ' m" '�`" ' ,� R 27 Arrtts�nt ofi Mo, nt= : � ❑Yes❑ o '26. :Does the organizat�on leaseytl�e�nfite '�emi5es2�If hp,,BtteCh��;;sk��c o � 3 $ � M1,` �,�F , , t s' � '� the premises indicaUng vit�a;,p'�itiQr,�ts bemg leasedr y4'lease dnd�S�C C� � � �r� . . . ��n�a '4`i ` , a � s: a i���' ,� �,'S�aM 3 5%. ,. ;�' r , .�; ... . �. .:. .. �� rC�:. �"a _� �..__ ..� - -is not required for Class;D.�pp(cations ,�� �. ,,. _ _ � - � � � es�No 28. Do you plan on conducting bmgo with�hiS license?If yes give days a�d times of bingo occasions ;` r 4 i .'� :a � � s � i � ,. �p�' Times s. ;� � .�,�,�'� .� .a, a» t�'' t d�.t,� -� y 1 � / � � .�/�0�1�1�S!]Q V F�,. W' s �,;'���d ���� r;:t "tN�t��{`i� �� R�=e.� i 5 ��k� �'`� �{'�'f �., �a. �:;� e,:.� .� '.t�,`x�$,�,,'+����r 1"i�.^'���4��,y$ � � y . . . . �}_ �e ,f3'^+��a .� >7 � i es�No 29. Has the S 10,000 fidelity bond requiredby Minnesota Statutes 349 20 been obtained7 Attach cop�i`of bond. � 30. Insurance Company Name } ��` 31. Bo d Number r,; , �; � �kLh� �" .r.R � �' F����� �i _��Yr �i/}������ � �>y 3�� ddres� , '�� r « t�' a r ,� �K 3 Lessor: ame =� „, � ` � r _ '� � �` �� �`� - .�� -� �� _ ,., _ �: P ,' i 35. Ga b�ngMan��er q,�e _ � 36. Address ; :.,� 37. >_C�ty State Zip � �_ �� �`. ..Lw� '' . .� F i'... .w ���.. � .����e__ . ;: �..� �_ .� � . . ., t �3 i : _� . . � i4>� �o . ) �. " 3 . ambl" anagerBu~ ssPhone � 39 V Date gambling manager became n�=-`� < :. ��� .�� �;,,;, . .. ., ; . 4 . :`- member of orgarnzation: . � � .,:? �. ,�.� � ' � ' t ( ? . _ , � , . ` �.;;:.�.��. � . � ;: . . _ , ,: �. . .. . . � :s y ,: , GAMBLING SITE AUTHORIZATION ;° ';• ` � ' ' � � �' .By my signature below,lo�al law enforcement officers or agents of the Board are hereby authorized to enter upon the site,; at any time, gambfing is being conducted,to obserVe the gambling and to enforce the law for any unauthonzed game or; L , • . �� , i {�,,�-•,��y ;" practice. ,�,K��r�,�.,;,.�,.�w.4�•:.z� .�.,.w� "R`•*t�rx�s17 it�.t�» �t{�� ; > ,, . 1 ` , ���, ,BANK RECQRDS AUTHORI�lATION�' " By my signature below,the Board is hereby authorized to inspect the bank records of the Gener�l Gartiblirlg�,Bank Account ,Y : whenever necessary to fulfill requirements of current gambling`rules and law . �- � � , .� ' , :: � . �• �� 'OATH � � , . -, ' s � �,!� „ ' . ..-�.`"`�* ,� - ; .� � f £' I hereby declare that ' � � - � ° _-� " .: 1:' I have read this application and all mformation submitted to the Boar�l, �-{ � Z AI�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. 1 will familiarize myself with the laws of the State of Minnesota respectinglgambling and rules of the Board and agree, if licensed,to abide b those laws and�ules, includin amendments thereta '„ ^ = �-40. Official,Legal Nam of Organiza ion 41. Sign ture(must be sign by C ie Executive Officer) � .�� �. S ' ���� a ` X � � Title of Signe[�,,- � , Dat�x ,,�� �r - � '- ' 1 ,� � �} .� `� �:� Y� �� ���'�-�� .� �" '�:'� '�'y � �� r ...;. '..""- a . �tt'.. t'.� y*- x . '.''�,� � `.i. �� , : ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY' `' ' , ' ` � I hereby acknowledge receipt of a copy of this application. By acknowledging receipt, I admit havmg 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 receipt(not o bhatWe olut on is re ieived b t the Char table�Gambling Control .� � �� .�'`which s ecificall disallows such activity and a copy : y �:�s , u{ , , �: .- � ; Board t hin'30 da s of the below;noted date °� � 3�r�' "` " ' ' � w'` . ` '� ' 42. Name of City or County(Loc Gov rning Body) If site is located within a township,item 43 must be completed;in ;� r.: � � � addition to the county signature ' � � � ��k y �, ::� ��� � y r; v�9 � �•� .. , � .�,.�; ! r � .. - . ': .... ' : ' .. .. .� �,` .��� . �_ � ` ',Srt �. � �: �` -�1� � ` ..: � ..v� . � ,� .e y � ,� s ,ik�.. *� � .,Signat of perso �receiving applicati n �`' x�>,�, 43: Name of Tov��ship 4� u�:���;����`�'�'�� �&�,����q � �.�,.�� ��.' �. � - { �.'- �7+,r1�� � }50.t r �t;iY'S�" iy'k7� r'�`�i� ° �` � £.r'�'.�s - C ` � d�'�%s �� `.� �'� 4�>�r E % � ,�� t"k$sa�. 0.,�"Y w.< M��.� i �� . , ,�� t e: � <<.�. � -:-+x `&�'�'''S"'^ �iek;'r� .��'� .. di``. .��y, . � i. ._� � �Q: e�x �7�� � .. . . .. ;.n �;.. . � �:. i:: a , a° �-#1 '�K�"r� R . a v MP ��,, , �e . � • �. Date rece�ved 130 ay perFod, :k ,_ ��g�ature of per on ecQiyir�g applic�bo��j a, �� ��`��a��Y`���;�S��,� F t ''i�,= trC�a ). ,3 �. x ""r 3iv�:`• 'N.�.�- b � �y�.s:� k'!��pP 3 s'''� ;y x � �'`f"it" �; 3 i�.� (� . � � : begmsf�q��,h��8�e��' �� 6p�'��rr �LS� l ���,� '�'�, '��fKt�.f tws.:. �. � ;,�_' �� �: " - �. . s. v4 � �1 s �, *I� t ti__:��' '�nie} t a . . _ . .� y- .. ��T �i . � .. ! t-" : ,� , � �rw � r , :�>_ ;. G , � ' elivenn 'a hca#ion"to Locai (���B * .44 Namebf�Person _ 9 PP o e ody 7if��� � � , ������ � r� � ;ffi'"` ,�^r`8�s�'°-i� u '�, `�-�s `��'� � `�; �'x. ��e� ". w -�+�t-�'�'+�', „ � r ��� . ._ .. : .. t �-°�.�" v . � . � � _J . . . � . y r r =""? "`� � �'�� Canery App�;�l C�8 t �`'�°`� r� ��;�' i(1k Local Go�iiemi�g B " ;� -•-CG 0001-02 (8/86) �, � White Copy 6oerd .,.� �.�r �x � � ,�� }r � �� � �' � ��<� T R f ��� i >{ �j 'r�, ��`�r :"��,: 7 � . ;, `r .� Y .,k �' �-:s `' #,�*� '�r'"` �x � s � ��w� ` - , c ;, � �..r ,u , i^ Y� ..�1 � .�7r��y�� .t*7w4.Y � .. �. ¢ � � :�'S°i « . . ' �a `r . . , f� . ��. �' l '" ' � ..A, . " �:..�;�v...,. .,: : `..1�._' .'^$2+�.1.'FY r ..�".�K�4.t..� .��.?f„�,:��� - a ;.,� � n R€ '� .g L'� y§,7� � j�,, i � .:'�S �" ..�.��'U�', . ..�._ _.,.. .. ... � ' ' . ��� _. ...,, h �. .�._ . ��. `� �.'��.�1�`+��`�'�'_�,�E�.�k�'v'"'F.`.:M.. v, "'se�� � _ . . . .,`* , . !���_�,3�. . . • City of Saint Paul U` . Department of Finance and Management Services Division of License and�Permit Registration INFORMATION REQUIRED WITH APPLICP.TION FOR PERMIT TO CONDOCT CHAR.ITABLE GAMBLING GAME IN SAINT PAUL 1. Full and complete name of or�anization which is applying for license .�,���1 C.l�It� L EG-%o/1� Po 5'T ��� � a -s T,t�� e� S�/i��/� 2. Address where games will be held �p g �'f/�j� ST �G�� �/a� Number treet City � Zip 3. Name of manager signing this application who will conduct, operate and manage Gambling Games , �-`j����' Date of Birth /�— g ��� , (a) Length of time manager has been member of applicant organization /'S 4. Address of Manager ��R/ ��n������ �� �JJ��/��/ �'s%a� Number S[reet City Zip S. Day, dates, and hours this application is for �1P�y�es ��,�� =3—�7 — �—o?—�� �;•30-�%3, 6. Is the applicant or organization organized under the laws o: the State of �Qd? E'5 7. Date of incorporation � /�,9 ��'c/ 8. Date when registered with the State of Minnesota �j/� ��l� r 9. How long has organization been in esistence? �����/ � 10. How long has organization heen in existence in St. Paul? `�- /y 3 11. What is the purpose of the organization? ���,� ,(� , � Jy� � _�i'��5�- ��f�C�� I „�_ 12. Officers of applicant organization . � . Name ����-�,/ Sn�(�.��` Vame �~•� Address ,���! �ine�ao� �� Ad3ress ;�-�� �. ��, Title �,y�Q a er' DOB � �Q—/�/ Title(v�,,,�,,,.,Q��p1ti DOB a- d 6 . � Name ' Name Address i��9 ���,�,�,��..t„f Address TiCle � n,..�� � DOB �_y'�� Title , �OB � 13. Give names of officers, or any otaer persons �aho paid for services tc the or2anization. Name Name Address Add:ess Title T��?e (Attach separate snee' . .�. 3CQ��=0P.3;. .^.���es. '. }, , , ! �. � •� ' ���b�,�, 14. Attached hereto is a list of names and addresses of all members of the organization. �* 15. In whose custody will organization's records be kept? Name � �/ sn�l�.Ql� Address /a jj / �j� �c��ooP D� � � 16. .Persons who will be conducting, assisting in conducting, or operating the games: Name T�-��/ s'� I/.Y,o./' � C� �,,> Date of Birth c�R-�/ Address _ /,� fj� �j/1 4Joad�f ��i Name of Spouse Date of Birth 9_/p � ��, Dates when such person will conduct, assist, or operate �)��j. Q,��r- �'/DU�Is Name ��/J S ��� �o -���,- �7`�t�'/4$��)___ Date of Birth 4ddress _ L{7 Gf � ) l,n ��� L� Name of Spouse �� � Date of Birth �J � . Dates when such person *ai1? concuct, assjst, or ope=ate � e����, ����, p `, _ 17. Have you read and do ;�ou thoroughly unde:stand the provisions of all laws, ordinances, and regulations governing t;;e operat:on ot Char�tab�e Gambling games? �/��' 18. Attached hereto on the fo rL+. furzished bv the Cft� o� St. Paul is a Financial Report which ite:nizes a11 receipcs,• e:cpezses, and disbursements of the applicant organization as well as a�I orgar.=zat'ons whc ha*�e rece;ved `unds ror the preceding calendar year which has been s:3r.ed, gregared, and ve_i?ied by �J � Name oZ� , S s`/a.� Address who is the o� the aoplicant Organization. ?1 e ot Off=�e 19. Operator of premises whe*e ,e,ames a�11 be held: Name _ 13L/ T) ,�/ S �F� . B�tsiness Address L�o }� �yf/.�L,��j Home Address 20. Amount of ren[ paid by applicanc Organication �or rent o� the hall; specify amount paid per 4-hour session ,� /oS,v U � ., . � ' � �7-1.3�- 21. The proceeds of the games will be disbursed after deducting prize layout costs and operating expenses for the following purposes and uses: l /�A .Y�l1���� �,�"l��a A�e_. � /�✓Lr��r�t�C�/.�1.�. . � r 22. Nas the premises where the games are to bE held been certified for occupancy by the City of Saint Paul.? ��s 23. Has your or3anization riled rederal form 990-T? �L If answer is yes, plesse attach a copy with this applicacion. Ir answer is no, explain why: , � � d�L!-�`�; Any changes desirec ov tne 3*�JD��can� �ssociat�on may be made onl;: with the consent of the City Council. --���L�G ��°�,D� Orgar.�zat�on Date gy; d� ilAnage: in harge of game c .� rr � � -'� � :n � r. �- C� �n C� �Sl � ;D `G y� , :9 (D N • � ,'! n, T� I v , :0 rr '-t !y C C.i ']1 (9 � ^ � J] !-r � (D � � r' �'] � � "" f'r (D J n y '< I n r► ^J y ^ `G G r�• rT rr p � 3 cv C � • :� �' �o '— � G O �-n r ;D G `G �o rr r (D Y� rn "� � � � v � r^ I R ^'° ' �'I "'1 .� � � fT !D !A � � iJ 7 � E � � � ,D I � y :� I C (!f rD � X � r �-t lD G'1 tn ,n c.. rr '7 1i� � � � � `G O � � I "` r* F (D � 0.1 r. " :n i -t � I fn m IL (1: I .^. J Z Q� fD 'Jl '�G ' fD E � ��v ''d z1 I ^I ( rr ,� O h� r� O J y ?: (n h-� �-S � �^ � J , �-n � I pf � F� fD A I y � �' �D � . n �o � I � � m n � i �I I -�, n c) r� !9 � � i� � rt rr y S (9 � j , rt � (0 —' R �i !D � �� fL I �'' � � � (D _. rh 9 i � � !9 � rt r, j. ... � i � � � � 'a -� O (D 9 I T I - � ;�C rr � � I r- I I r I y I I E � J v u� � �n � I ,-. � o �v f-- .. � , r-, �n .. � '� �