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87-973 WHITE - CITV CLERK PINK - FINANCE COl1I1C11 n,�J CANARY - DEPARTMENT G I TY OF SA I NT PA U L X / �� BLUE . - MAVOR File NO. u • -� ' • Co n� l. es ution Presented By ` ReferrQd To Committee: Date Out of Committee By Date RESOLVED: That Application for a Class B Gambling License (Raffles, Paddlewheels, Tipboards, and Pulltabs) by Attucks-Brooks A.L. Post 606 at 976 Concordia be and the same is hereby denied for the following reason: 1. Failure to submit proper investigation fees. Failure to submit proper applications and renewal paperwork. COUIVC[LMEN Requested by Department of: Yeas Drew Nays �x� R�.`7`/�k9� � [n Favor N�cos�a scne,bei o Against BY Sonnen �°� ,1UL - W��son � �8� Form Appr d by City Attorne Adopted by Cou il: Date Certified Pass d C uncil Sec ary BY By A►pprov Mavor: Date � � � � Approve b Mayor for Submission to Council By PllBl.ISltED �U L 1 1 198 _ .> .. . - --,R---------.--�--�-r-•---F--�---�---�-.--------•�-_-- ---- �--------s- ✓ � - ��,-�73 ' ��u2 � �� Charitable Gamblin Control Board :•:��°��o;�.�.c� 9 FOR BOARD USE ONLY � '•� Room N-475 Griggs-Midway Building ` }'`, �� S21 UnIV@fSIL�/AV@IlU@ � LicenssNumber ':'• � St. Paul, Minnesota 55104-3383 PAID x:;• . - � - {612)642-0555 � AMT ��' • '�, CHECK# DATE GAMBLING UCENSE/kPpIICATION / .- . �, 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: ❑Class A — Fee S 100.00(Bingo,Raffles,Paddlewheels,Tipboards,Pull-tabs) �Class B — Fee S 50.00(Raffles,Paddlewheels,Tipboards,Pull-tabs) Makscheckapayabkto: ❑Class C — Fee S SO.00(BIf1 JO Only) Minnesota(�aritabls Caambing Cootrol Board ❑Class D — Fee S�25.00(Raffles only) 1 . . . ... ...._ �Yes ONo 1. Is this application for a renewal? If yes,give complete license number � - �� - `�-��or `OYes ONo 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) �� • es�No 3. Have Internal Controls been submitted previously?If no,please attach copy. 4. Ap licant(Official,legal name of or aniz tion) 5. Business Address of Organization �:: �TTl.�G'KS-'8 0 .�.�0 51" 6�6 6 oNGa 771 j9 � 6. City,State,Zip �. 7. Count 8. Business hone Number " � - ��• �,�/a /1�S,E � t�< ► �.}�,-/at��r.' . 9: Type of organizabon: ❑Fratemal eterans �Religious ❑Other nonprofit* y ' ^ ''�: 'If organization is an'bther nonprofit"organization,answer questions 10 through 13.If not,go tdquestion 14."Other no�profit"organizations must document its tax-exempt status. �Yes❑No 10. Is organization incor orated as a nonprofit organization?If yes,give number assigned to Articles or page and book number: Attach copy of certificat�. - ❑Yes�No 11. Are articles filed wiih the Secretary of State? . DYes�No 12. Are articles filed with the County? OYes O 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 o 14. Has license ever been denied,suspended or revoked?If yes,check all that a ly: � ❑Denied ❑Suspended ❑Revoked Givedate: 15_ Number of active members 16. Number of years in existence Note: If less than four years,attach - /6 Q , `Q evidence of three years �' existence. - ' 17. Name of Chief Ezecutive Officer '- , ,. � _ �, . 18. Name of treasurer or person who accounts for other revenues '� of the organization. ,�.�'o�Y �. , � a D D -��,�Y t.� �ss��- � Title Title F. �� " � C a �r,� ��'lJ,�-� Icl��9-HC E �J�Ft G��' - `� ` Business Phone Number Business Phone Number rr;' . . k•= ; � f � /� �� ..� I .�r' ,„,� .- / - n � f ' '"'�.-1 . ( j �l',� � �•_ � j .d_r'.� �y' ( '' �;.....) . (. � ._ .�`�;i '.i'� 1: r .1 �.t` �� /� �` . 19. Name of establishment where gambling will be 20. Street address(not P.O.Box Number) � ��ted � _ BRo��S P�sT E► g 6 Ca y a��/� - 21. City,State,Zip 22. County(where gambling premises is located) �� 5 T. ��. �� j��o �1 r��1l 5,,� CG-0001-02(8/86) White Copy-Board Canary-Applicant Pink-Local Governing Body , �s�` . ' ; �=-�_ �,3 - Gambling License Application Page 2 Type of Application: ❑Class A �Class B ❑Class C - ❑Class D �Yes�No 23. Is gambling premises located within city limits? - �lfes�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. es�No 25. Does organization own the gambling premises?If no,attach copy of the lease with terms of at least one year. � es�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 S � is not required for Class D applications. ❑Yes o 28. Do you plan on conducting bingo with this license?�f yes,give days and times of bingo occasions: ' Days Timea es ONo 29. Has the S 10,000 fidelity bond required by Minnesota Statutes 349.20 been obtained?Attach copy of bond. 3 . Insurance Company Name I � � b , 31. Bond Number � � . 32. Lessor Name � 33. Address 3,4. City,State,Zip :� , _ .:. . . ; _ . _-._: �,:< ��..��- .- -� 35. Gambling Manager Name 36. Address 37. City,State,Zip ' �.� �a � �'7"R��l.<. �� .J�►T Jdi��l- ..'��' -S��/ 38. Gambling Manager Business Phone 39. Date gambling manager became (� � � . "'� member of organization: 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 ; :;,,�;+:� �;-:�.-._ �actice. - "'-'��`-" _ BANK RECORDS AUTHORIZATION �'` =�y 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 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. Official,Legal Name of Organization 41. Signature Imust be signed by Chief Executive Officer) 0o S A�-1. ` _ P•s �6Q X ,� :r= ,�__ ,� -�- r� �.-.�::-j: Title of Signer Date� r' li " -- ' Yt:, � � �� -� 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 wi'th: � notice that this application will be reviewed by the Charitable Gambling Control Board and if approved by the board, wilF become effective 30 days from the date of receipt(noted below),unless a resolution of the local governing body is passed r which specifically disallows such activity and a copy of that resolution is received by the Charitable Gambling Control i;°:; . Board within 30 da s of the below noted date. ',-�-•. 42. Name of City or County(Local Goveming Body) If site is located within a township,item 43 must be completed,in �: .' addition to the county signature. �;.,�,: City of St. Pau't � Signature of person receiving application 43. Name of Township '�. x J. Garchedi � � ' (�' � � �, Title Date received(30 d�period Signature of person receiving application `�.; begins from this da 1 ;� _ � r}� `'/� X _;;� 44. Name of Person delivering application to Local Governing Body Title �;' � CG-0001-02 (8/861 White Copy-Board Ca�ary-Applicant Pink-Local Goveming Body ; ,. /; . �• 1 J � � .. `_i ., _..-'. :�•� •�/�_.�_�/ f '_J' �..�^..' --r,.."""w�-�.,_--� �