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
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' •o,�o ��'�,;�`,Charitable':Gambling Con�ol Bo�d ,:. �'� � A��-�� :FOF�BFQ�►RD USE ONLY ��'' ��
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,� 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
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�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�°'�`�-, �:
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° ;"�'.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
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�;, 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 �� � •
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6 City,Stat�Zip 7: C nty . 8. Busi�ess Phone Number , `�
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� 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 �
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❑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�
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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
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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 ;�,��.
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� �: es ONo.,'23~_Is gamblin.g Premises locate�d w�i�ir�¢ty m s?; � , i ` ��� � .p� � •.s y ;• ,;
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. �:` ` �_ . 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
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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 _ '� � �` �� �`� -
.�� -� �� _ ,., _ �:
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35. Ga b�ngMan��er q,�e _ � 36. Address ; :.,� 37. >_C�ty State Zip � �_
�� �`. ..Lw� '' . .� F i'... .w ���..
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" 3 . ambl" anagerBu~ ssPhone � 39 V Date gambling manager became n�=-`� < :. ��� .�� �;,,;,
. .. ., ; . 4 . :`- member of orgarnzation: . � � .,:? �. ,�.� � ' � '
t ( ? . _ , � ,
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;: . . _ , ,: �. . .. .
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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) �
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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 ;�
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. . • 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.�.
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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.
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Orgar.�zat�on
Date gy; d�
ilAnage: in harge of game
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