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87-1183 WHITE - CITV CLERK PINK - FINANCE GITY OF SAINT PAUL Council CANARY - DEPARTMEN7 � BLUE -MAVOR File NO• �� // �� , Council Resolution -�� , , Presented By �� � � Referre Committee: Date Out of Committee By Date RESOLVED: That Application (I.D.#22360) for a Gambling Manager License by John Joubert for Westside Youth Hockey at 567 Stryker Avenue (Brown Derby) be and the same is hereby approved. COUNCILMEN Requested by Department of: Yeas Drew Nays �� �_ [n Favor Rettman Scheibel � _ Against BY Sonnen Weida WllsOn A'��, 1 2 .��7 Form Approv by City Attorney Adopted by Council: Date ku Certified Passe b o c' Secre BY By y� A►pprov y Mavor. Date AUG I `t R��� Approved Mayor for Submission to Council By P��S!!�D .�',�_!; i. � 1��7 �_ ' CI.Z . 1 [�l l�`.1 �(;����//�-3 � DTVISION OF LICENSE AND PERMIT ADMINISTRATION DATE � a � l <j-� INTERDEPARTMENTAL REVIEW CHECKLIST Applicant �,��..��-�S�c�,t�� r.,,�n d�-r�� Home Address �,3'� � .�� , G �Gl Bus ine s s Name ',�Y�,�n � • Home Phone ��a�-5 � 3�.p O�"l Business Address ,�j�0'"1 �t i �;,Q.� v Type of License(s) Business Phone a�`����( �U� J � �� � . Public Hearing Date 1a _ LicenseCl' .�`. at 10:00 a.m. in the Cou il Chambers, 1„��,�, 3rd F or City Hall and Courthouse State-�-r.D. #`���(�1 Oa - C��� DATE DATE INSPECTION APPN REC'D VERFIED (COMPUTER) COMMENTS �oved Not ed Housing & Bldg � 1 a f Code Enforcement ( I Public Health n 1 a i I I Fire Prevention �` � � � I Police � I Z-3 I � City Attorneq �� g,/ � y� l I ENS n� � • � 300 Foot Notice I � l� � � License Inspector's Comments: I HAVE BEEN GIVEN A COPY OF THIS NOTIFICATION AND UNDERSTAND THAT MY ATTENDANCE AT THE PUBLIC HEARING IS REQUIRED. CURRENT INFORMATION NEW INFORMATION Current Corporation Name': New Corporation Name: Current DBA: New DBA: Current Officers: Insurance: Bond: New Officers: Stockholders: , . G� ��,i�-3 t � - � � City of Saint Paul � � � Dep2rtment of Finance and Management Services Division of Lfcense and Permit Registration INFORMATION REQL'IRED WITH 9PPLICATION FOR PE?�MIT TO CONDUCT CHAR.ITABLE GAMBLING GAME IN SAINT PAUL 1. Full and complete name of or�anization which is applying for license • �J�J QS� �� 2 Qc.�.��, �Oc_��'- 2. Address where games will be held �.�� ���"��t.�, ���av.� �� �S�O� Number Streec City Zio 3. Name of manager signing this application who wiil conduct, operate and manage Gambling Games ���r� ���rT Date oE Birt:� L{� (a) Length of time manager has been member oi app�icant organization 2 c,�p,_„S 4. Address of Manager ��� � - ����-�- �� �-A� �n ��10� Number Street Ci�y Zip 5. Day, dates, and hours this applicaticn is for �pQ,(\ -�, * ��n�, , �p.L�v� . 6. Is the applicant or organization organized under t'�e Iaws o: t�e Stat� o� �LN? � / 7. j Date o= incor�oratior. �c�, l g— ��'j 7/ �� 8. Date when registerzd with the State or M:anesoca « � � 9: How long has organization been ir. e:cistence? t�o �¢..r� � S 10. How long has organization heen in eYisteace �n St. Pau1^ 1� �Q.�-� S 11. What is the purpose of the o:gan;zation? ��^y`��, �,���.�5 C ��C��) 12. Officers of applicant organization Name �Z, �.�J1�\O\.c a va�e ��C�r�-T ` � � �c.�c� ( L^r� �.St . Address ��` � �o�4�sZ., Address Tit1e��2.tiS��T DGB T�.C�e ��L�. ��-S . DOB Name �.2�t1 � M fa�� Yame v�C.�'�\ — ZZ�� ����-��� Address �Z� ���� :�dd:ess w� �"-� . Title � �s2.t�Su�J� DOB Tit�e�C��\�c� DQB 13. Give names of officers, or any ot^.er pe-sor.s :�nc ?a:d :or ser-*ices to cae o.gan�_2t'_on. �ame Vame Address ;�dc;e:s Title _��Ie (��ttach sep•arate sna�r -_,- '-c�=-=....__ ._�_e�• � . : . �,r=���i�� . • � . 21. The proceeds o: the gar�es will be disbursed after deducting prize Iayout costs and operating expenses for the following purposes and uses: � �(�GC�Q C� `\CZ._ �t�r�iL, � , � � .7��Q ��. �o�..� IV\n �A�,,._s- �--�cx.��. �.��c���o n C��a._� ��, n o .,,`� � �� v� � \ � 2Z_ Has the premises where che games ara co be held been certified for occupanc}• by the City oE Saint Paul? ��,p Z3_ Fias �our orgar.�zation �iled :ec=ra! �or� 990—T? �Q I� answer is yes, piease attacn a cap� w:c;� t;,is apoiicacion. _c answzr is no , e:cplain why: �Y1 �� C�S� o� �Mt��ko 11 . Any changPS de51L2C J� i.�@ aJ��=CG1L :.SSOC�aC_Oil IItc� }JE J1dQe OL11V 4i1Ctl tii2 CORS2LlC OI �R� City Counc�l. T �� � �oc�.¢�y Or�aZ'_za ior. \ Date �yC �v���, g 1 By: �Saaa e: in char or ;ase � ro � ? 'y "'�)�• i� �? � :v r �- � i o r — n _ •1 •AMnnM�ns � � ^ � _ � � I �= � _ � ,� .•-. � � �. n � �. — � i � -� T rD ? r I O rn n f� .� C i � " :D rr _ rt� F-+ .. 1 _ _ :l1 r�- � � I ~ � I � � � -In , � �... � � , ^ J � I .^7. 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