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87-639 WNITE - C�TV CIERK PINK - FINANCE G I TY O F SA I NT PA U L Council CANARV - DE�ARTMENT u BI.UE - MAVOR File 1\0.�� � Counci R�e ol ' ,--�� 1 Presented By Referred To Com ittee: Date Out of Committee By Date RESOLVED: That Application (I.D.#44768) for a Class B State Charitable Gambling License applied for by Sylvan Booster Club, Inc. at 1141 Rice Street (Kuby's Place) be and the same is hereby approved. COUNCILMEN Requested by Department of: Yeas Drew Nays � Nicosia (R Fevo[ Rettman Scheibel Sonnen � __ Against BY �iacco. .. Wilson Adopted by Council: Date �1AY �' - 1987 Form Appro by City ttorne Certified Y s-ed b Council Se ta BY By� I�pp by Ylavor: Da e �`���Y � Y � Approve Mayor for Submission to Council y — gY ��$�li:4Y1� {�ii'l�� L � 1�lV 1 • ' City of Saint Paul ��7_ �3y' � , Departmetlt oE Finance and Management Services Division of License and Yermit Registration RMATION RE UIRED WITH APPLICATION FOR PERMIT TO CONDUCT CHARITABLE GAMBLING GAME IN AINT PAUL 1. Full and complete name of orRanization which is applying for license _ s `�L Y(�-,� �onS7�",�/�' �� L�. ��`✓��-'. 2. Address where games will be held _ _ f� �� �l C�� �f'�i�U�- ..�. l� � f--�-- Number Street City Zip 3. Name of manager signing this application who wil]. conduct, operate and manage Gambling Games �� � ;-,, , f ���,; , f Date of Birth ��� _�.,L' ; ���_ ��? • __/ / . (a) Length of time manager has been member of applicant organization %�' �„ ,; 4. Address of Manager �; � � � !`�� � i' ,� /j /% . / > � !: ; Number Street City 7.ip S. Day, dates, and hours this application is for "�� - �" � `�� ��'��j /�Pj �'%��'1 � /v;��J 6. Is the applicant or organization organized under the laws of the State �f I�L'V? _--�,�,� 7. Date of incorporati�n _ :���2.� �� M 8. Date when registered with the State of Minnesota 3 � � 5��� � 9. How long has organization been in e:cistence? ,.�j ) `� ,,-a 10. How long has organization heen in e:cistence in St. Paul? v� 7 % �� � 11. What is- the purpose of the organization? "'j�/'�- 1''!(;.��tc� ��, r� .�l' 1:" 't 'A��: ��; i;� :'ih:.�'. ��:Jrt��.�. I�F� + r �'�::� r:;E'f F -j �ri�� ; b� �: �� L� G f �t t�C a �! ��, �� E %•i c 1: � �. , � -� j �A,.�: 4,, , �i i'iC� 1%.ti�V '�"Fi�� l C i /)�, j'Gf�I�t;r��� ,� > 12. Officers of applicant organization Name •=i E�v r� �'�S .�, /��f�t>S Name ����a i��,) FI �-� �Sr-- ��c'���,�-� Address _' �/ /_�/y��:/i S�'% Address �J �. ��S����� Title ���5� �EK,' f DOB � �':27 "�/ Title ��C_r�'�+�'�-�('�' DOB %j - /�-� / Name J��3��/� r. G5 C/c�n/Z��� Name � � � Address �, f . �dS� Ea �11� Address Title _����-�SG'��� DOB /-z-S�"--�r' Title DOB 13. Give names of officers, or any other persons who paid for services to the organization. Name Name Address Address Title Title (Attach separate Stlz�'* FO: addit_or.si ^a�es. �� � x ��- (��� _ 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 �f a� � �'(� � ZSc��,�� Address �7�i�C,.S�,fIJ,�. , S`i'�l��rl.�iMt1. S,S%/ 7 16. Persons who will be conducting, assisting in conducting, or operating the games: , Name _ �.G•i-� ..i i ►��L I��' �-� K �'�Z�-� r�Il Date of Birth 3 _��� —c.� `I Address _ �j � j- ���;�. �.��� , Name of Spouse _ ��c.��2_c � ) Date of Birth Dates when such person will conduct , assist, or operate Name ,�c�t-��._ `�-`��Jr_r{-�./ Date of Birth � � -���' -�, � Address ( � � ( �,� K Name of Spouse `_ � �'�,� �- �" lJ.� t � Date of Birth �-� ' � J ' �-,� Dates when such person will conduct, assist , or ope-ate 17. Have you read and do ,�ou thoroughly understand the provisions of a11 laws, ordinances, and regulations governing the operation of Charitable Gambling games? j�� � 18. Attached hereto on the form furnished by the City of St. Paul is a Financial Report which itemizes all receipts, e:{penses, and disbursements of the applicant organization as well as all organizations who have received funds for the preceding calendar year which has been signed, prepared, and verified by c�� �'�-i'/� �, 'ZSc��,}L,�� Name �i �� ��a.:�� ��/ �, St-�R-vL /h nJ. SS'// � Address who is the •�f��'��SU���S� of the applicant Organization. Name of Office 19. Operator of premises wnere games will be held: Name ��l�� L.0 :�, �F-� �- � �.� '�`�' ��, Business Address I�� � Y S -- /� 7/ /'j�r�.� �t 5�' r�� j���� �`��f� Home Address .� �� n �I�hl�,� /�f/� �, a-1'-;�jg.,UL�j�RJ �S%l � 20. Amount of rent paid by applicant Organi�ation for rent of the hall; specify amount paid per 4-hour seGsion �;on)� � � r � (� �7��� ,� proceeds of the games will be disbursed after deducting prize layout costs and operating expenses for the following purposes and uses: ��-�-� L�f� �� �� � �l � l �r�dv�1 L? 22. Nas the premises where the games are to be held been certified for occupancy by the City of Saint Paul? Y�.,�, 23. Has your organization filed federal form 990—T? � If answer is yes, please attach a copy with this application. IF answer is no, explain why: �J� ���� �1i �r �� �� �`�-` /i�� ��� J�1RS �i-YJLI� i � f�il' �.'�i�- /��/'�_ � /j �'c�1/:b� f;L (1��� l:�f- r !��? ,n Y� F,,;;,,;_,d,.�; ,,,., ,�����, Any changes desired bv the applicant �ssociation may be made only wich the consent of the City Council. 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