87-1047 WHITE - CITV GLERK
PINK - FINANCE GITY OF SAINT PAUL Council
CANARV - DEPARTMENT FIIC NO. �� ���
BLUE - MAVOR
�
Coun ' Resolution
Presented By , ��
Referred Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D. #52242) for a City of St. Paul Gambling Permit
(Pulltabs) by the North End Business Club Inc. at Rice & Sycamore
and Rice & Front for July 29, 1987, be�tween the hours of 4:00 PM �
and 8:00 P�1, be and the same is hereby approved.
COUNCILMEN
Yeas Drew Nays Requested by Department of:
Nicosia �_ [n Favor
Rettman
Scheibel � _ A gai n s t BY
�e
,s�:�.�
Weida
WilSOri JuL 2 � '�7 Form Appro e by City Att rney
Adopted by Council: Date
Cerlified Pas e b ouncil Se e y BY
By
Approved iVlavor: Date J�L 2 7 �8� Approv d y Mayor for Submission to Council
By BY
Pl�.�s�D nU� i i987
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Minnesota Charitable Gambling Control Board LAWFUL GAMBLING EXEMPTION
. Room N475 Griggs-Midway Building FoR BoaRO use oN�Y
1821 University Avenue
- St. Paul,MN 551043383
��••���� (6121642-0555
INSTRUCTIONS: 1. Submit request for exemption at least 30 days prior to the occasion.
2. When completing form,do not complete shaded areas.
3. Give the gold copy to the City or County. Send the remaining copies to the Board. The copies will be
returned with an exemption number added to the form.When your activity is concluded;complete the
PLEASE TYPE financial information, sign and date the form, and return to the Board within 30 days.
- Organizati n Name Licx�se Number Of currently or previa,sly Iicensed)
o t!� ��D us �5S �L�.c� f NG
Address � �t� Cit�C{o.u�y,St�`Zi fCgde � ��j'�
RA
�i7 �•�•
C ef Executive Officer's Nam Phone Number Manager's Name Phone Number
�REC.-�. . �i�E EN h� �{8�--�j�..5 � E_oy� � �R C�c�h'1
Type of Organization If Other Nonprofit Organization(Check One)
❑ Fraternal ❑ Veterans ❑ IRS Designation
❑ Religion �Other Nonprofit Organization ❑ Incorporated with Secretary of State
❑ Affiliate of Parent Nonprofit Organization
Name of Premises Where Activity Will Occur Datelsl of Activity
Premises Address
Games Yes No �Gross Receipts � �;Vatue 6f Prizes.. . Expenses Profit
;�;
� �
Bingo �'
3
3 �
Raffles �` ' `�
� � �
Paddlewheels � ��`' 3� : s �
� �,F: � � � : .
- ..
.: �. :.
, ,-:.;.�:
Tipboards x � �
�.
Pull-Tabs
tJs�s�Pta4(t �
.�����, :
� :�
�����,����Eq��pqi�r�� �, distcibutoc's License:Na.
y��«"�r. � �'�'r' �� � ''
I affirm all information submitted to the Board is true, accu- [;affiFrrr=.at�financia[ i�focrrTatior� submitted to:the Baard is
rate,a complete. fi�uewacAc.wrat�,a�sdeampl�te...
- /� �
Chief Executive Offi r gnature Date Chief Exet�tiu�F?ffieecSignature Oete
ACKNOWLEDGMENT OF NOTICE BY LOCAL GOVERNING BODY
I hereby acknowledge receipt of a copy of this application.By acknowtedging receipt, I admit having been served with notice
that this application will be reviewed by the Charitable Gambling Control Bo�ard and will become effective 30 days from the
date of receipt (noted below) by the City or County, unless a resolution of the local governing body is passed which specifi-
cally disallows such activity and a copy of that resolution is received by the Charitable Gambling Contral Board within 30
days of the below noted date.
CITY OR COUNTY TOWNSHIP
Name of 4oca1 Gove�ing Body 1 ity or C ty) Township Name IMust be notified when County is the approving bodyl
�
Signa ne o Perso�R eivin icat on Signature of Person Receiving Application
• �
Ti e Date Received Title Date
_�._r__
CG-00020-01 141861 White—Board Canary—Board returns to Organization to keep
Pink—Organization Gold—City or County
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;.�� ' - �:rl.c�Tl�:fT C^ F`Ii'x::C:; .�� Ii.'�:;�C:.P:c,I:T SL:c�C�S�: .
, �•• :::' :`. . . �IVISIOti OF :S�EIJS'c �Ii�JD Ps�^u�T''`�DMI�II.ST:"�1�O:J �.. � .
,
I3dr�F!ATION ��UI.� Z�lITB AP°LIC�ITIC;1 FOR PT'F��i TO CCt•IDUC: GAi�3T�I?�G SESSI�Jt: Iid ST. P�TJL
North End Business Club Inc. "
1. ::a��e of ��roar3zai�on '
2. Address where �anization's re�ular meetings are held - 1638 Rice street
3. Dsy azid tiL7e Of .�te°Lin�S �� First Wednesday.Each Month--Noon
!:. AdcL�ess where Gamblinp Session taill. he held see attached ;
5. Is applicant ouraer o.f property *rl�''@'_'9 Ga�^bli:.� Session will� re helC' x °es '?o
6. `If leased, :•rro is owner of prcoertp wrsre Gamblin� Session *,a3:11 ne held^ `
see �attached . . . - ' . •.
. 7. If leased, attach letter of perni.ssion to conduct Gar.iblir.� Session,� signed by lessor.
. � Gregory M. .Sheehan
E. llame of ofiicer maI�ng applicaticn � -
1215 Rice Street ' � � 1/27/51
9. Address of officer maldng application Date of birth .
. . .. �,. . . :r•. . . .
10..• Piaae .of raanager.who�H3.11 conduct Gamblir� Session Lloyd Bergum ' � .
Il.`.�'addTe§s �of manager ' 960 Western , Date of �irth 12/16/24
I2. In connection W3.th what event is this Gambling Session beiag held?
• . � .. . . . _ • • . � - . .. . .. ,
' ; == ' ..` 'Rice Street Festival . " ' ."`
:Y � . ' . :, ) . . ..... . . '
-':.;• . .. . . . '
. .... . '. '. � . . . ... .. ....... . ..._.. .
13. What type of garabl3.ng device(s) wi11 be used? Paddlewr.eel � '` Tipboard :� P.affle
1.l1. __ Dap, dates and hours this a licati is�_for and number of sess�ons.
. ..�__.. . - .
Da s �- �ai�e�" Nours t;o. of Sessions
Y� )
_. �. .,_ . ,. . Mone
="<•15•-,'TrJi1l..prizes be paid in money or merchandise? _. Y.r-. ..., -:� .._._ .
16. _.:Is�tre at�plicant association or�anized under the laws o� the State of I�iinnesota? yes
17. How long has Crganization been in existence? �6 Years .
1@. �v13a.t is tr.e pt�pose of the Or�anization? community development
.�..---:--:
19. :� Officers of the Organization " ' �"` '�""
PJame-Title Address Jate of'birth
, ,. _ � .
Greg Sheehan, President 1215 Rice Street 1/27/51
Lloyd Bergum, Vice Pres. 960 Western 12/16/24
Linda Bergum, Tresurer - � � 960 Western 2/20/49 ,
Lil Linder, Seeretary 275•Wheelock Parkway - -
2Q. uive �acies of oFficers or ans o�her persor.s ?aid for sez�v;.ces, to the Or�ar.izatior.. �
tiame-Title ,: ,"'' � �ddress . ' �ate vf birth � �
r �
�
. . . i.�!. . • . . � . . . ♦ . .
,. . . ..f. � . , . . . . - . . � ., .
2I. I� wrose'custcdy •ai.11'`records oi Organizaticn's Ganblin€ Sess�ons te �eot?
�.___.._.�.:. . .�.,_.�, _. _. �..,.,
idgme� Lloyd Bergum ` " �" � Acic'.ress 960 Western
.,.. _...,... ._,.
;�
22. »Attach a copy of your`Crganization's membersr�p roster and date each member �ained.
� 23. A�tach the;Gar�bZin� Session i•fanaFer's bond. . , ....: , ;,., ,
2l�. �lttac� a copy of �he ::epartment of the Treasux^,►, Inter:ial .'.ener�ue Se�ce "2etUrn of
�' `"" "" Organization .racempt �rom Incor�e ^_'ax", Form 990. (Chapter u19.01�. (I).)
�� 25.'��Attach�a copy of iepart;.ient of tne Treasur,�, Internal ?evenue Service, "�Yemnt Qrpan-
, -� ization Business Income T_ax", Form 990T. (Chapter !�1?.0l� .(2).}
26. kttach the annuaZ report required of cr.aritable organizations by i3nnesota Statutes,
,. ���;�Section 309.53. (Chapter 419.Q� (3.). )
•� ,
` 27.'�"I:ave you read�and do you thorouE*hl� understand the provisions o�' all Ia�rs� ordinances
and re�ulations��overnin� the operation of GamhlinF �essions? yes
,.,.. -_�, _
:� 28.���1�y cNan.r•es desired by the applicant associa�ion may he -made only ursth the consent of
.. .
.:�__.....-the. License Committee. - - _.... ...__,
� -
"�'29:" Fias an�r person(s} participatir.g in the operation of any�of tHe �aribling sessions cov-
ered by this license ever been convicted of a felony in tre State of �iinnesota or in
"'�"""""""any other State 'or Federal Court? Yes � Pio �x . If°answer is "fes", provide
names, addrssses and birth-da.tes. . _ . <, .
A� , North End.Business Club, INC
Gr�anization
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,. �,;� .. ' , � . - and O�-
�� ����� . (I•tan , r in c�-.ar of Camblin� Session
State of 1•iinaesota) "-t' �� � _ _
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�ounty..°f. �?seY _�h... ,� � � . _
ana
�be3n� duly sworn sa� that they a:�e the petit;eners in the above a�plication; that �Fey havs
rsad the foregoing petition and .'mow the contents. thereof; tliat the same is +z^se of t�:eir
�•m kno�,rled�e. • . . ' _
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� Building �Jepart:�ent Approved" �. � Disaaproved � by --� • . ` `
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� Police Jepartr.►ent Approved--7isaporoved-�y
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° City of Saint Paui � `
, Department of Finance and Management Services �
' License and Permit Division � ���a
203 City Hal1
St. Paul, Minnesota 55102-298-5056 .J
APPLICATION FOR LICENSE
CASH CHECK CLASS NO. �New�. Renew
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, Date - 19 '� �r
Code No. Title of License + � � � �� /
From � 19 U.,�0 1,/ 19
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AppllcantlCompany Name
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100 �y siness Name �
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Business Address � /' Pho�e No.
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100 Maii to Address �� Phone No.
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100 � �'�
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ManapeNOwner•Name
- 100
100 AlanagerlGwner•Home Address Phone No.
4098 Applicatfon Fee 2, 50
Recefved the Sum of 100
S .� a� ManagerlOwner-City,State&Zip Code
100 Totai 100
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License Ins'eCt�r �y.T� _ (Signature of Appiicant
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Bond:
Company Name Policy No. Expiretion Date
Insurance:
Company Name Poiicy No. Expiration Date
M[nnesota State Identification No. Social Security No.
Vehicle Information:
Serlal Number Plate Number
Other:
THIS IS A RECEIPT FOR APPLICATION
THIS IS NOT A UCENSE TO OPERATE.Your application for license will either be granted,or rejected subject to the provisions of the zontng
ordinance and compietion of the inspections by the Health, Fire,Zoning and/or License Inspectors.
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$15.00 CHARGE FOR ALL RETURNEO CHECKS
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NORTH END
RICE ST . FESTIVA
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CO-SPONSORS
N0. END IMPROVEMENT CLUB • N0. END BUSINESS CIUB
P. 0. BOX 7014
ST. PAUL, MINN. 55117 'o
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RICE ST . FESTIVAL
CO-SPONSORS
N0. END IMPROYEMEHT CIUB • N0. END BUSINESS CIUB
P. 0. BOX 7014
ST. PAUL, MINN. 55117 �'o
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DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE J'I � i�j� g�
INTERDEPARTMENTAL REVIEW CHECRLIST
Applicant ����� �c.c.S� n�-s�11�.��c �Hame Address ��
Bus ine s s Name rY.�„�n._. Home Phone "�`]- �`7.5
Business Address � �j (.J.�.�v,.� r�l� . Type of License(s) �n�v,� ,C�� �QI1;Yn�_,
Business Phone ��� �(fo�� '� �,Z�l �S��l � �Cs, L 5 �cc�.rn.r�rc� �ccr c�va� .
Public Hearing Date License I.D. # `�j,���'�
at 10:00 a.m. in the ou il hambers,
3rd Floor City Hall and ourthouse State Tax I.D. # �� �
REVIEW DATE DATE INSPECTION
APPN REC'D VERFIED COMPUTER CO1�II�IENTS
�oved Not raved
Housing & Bldg �
Code Enforcement � I� �
1
Public Health �
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Fire Prevention �
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Police I �
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City Attorney �
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300 Foot Notice � 1 � I
1 �
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License Inspector's Comment •
I HAVE BEEN GIVEN A COPY OF THIS NOTIFICATION AND UNDERSTAND THAT MY ATTENDANCE AT
THE PUBLIC HEARING IS REQUIRED.
CURRENT INFOR1�tATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
New Officers:
Stockholders:
_ - - � ' ' C%�-��-��"��
A_G �_�I_D :A__M_A_T_E_R_I_A_L_S
COUNCIL ID�� ��� DATE RECEIVED ' � �
AGENDA DATE AGENDA ITEM ��
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SUBJECT � ��2z�-�-��`" �- .�-�7�
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ORIGINATOR , � -, _ CONTACT �" '
,�— - .� s-o s
RESEARCH STAFF ASSIGNED �' DATE SENT TO CLERK '�'.��
. -7-
COUNCIL ACTION
MASTER FILE INFO AVAILABLE � � ' � ' �
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ORD'/RESOL. �� � DATE FILE CLOSED
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