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 (
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Public Health n 1 a i
I
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Fire Prevention �` �
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Police � I Z-3 I
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City Attorneq �� g,/ �
y� l
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ENS n� �
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300 Foot Notice I
� l� �
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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.
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