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87-1201 WHITE - CITV CIERK � PINK - FINANCE GITY OF SAINT PAUL Council CANARV - DEPARTMEN7 ,�/� BLUE - MAVOR . F1Ie NO• � `1 � Council Resolution �, .---� �.,�,.� �,_ , Presented By --' Referre Committee: -. Date Out of Co ittee By Date RESOLVED: That Application (I.D.#62868) for a State Gambling License (Class A - Bingo, Raffles, Paddlewheels, Tipboards, arid Pulltabs) by Rosette's Inc. at 1494 North Dale be and the same is hereby approved. COUNC[LMEN Yeas Drew Nays Requested by Department of: Nicosia �_ In Favor Rettman � Scheibel Against BY Sonnen Weida � AUG 1 � 1987 Form Approv by City Attorney Adopted by Council: Date Certified Pa. y ouncil S ar BY By , A►pprove iVlavor: Date � � � Approve Mayor for Submission to Council By f��:�� 9 198� �. �a iL `� l 311�� /-/�°� ' DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE INTERDEPARTMENTAL REVIEW CHECRLIST v Applicant��cy� ,fJ--4-,c_ f Home Address 1�� C�� Business Name �� Home Phone �� -�,3 ct 1S Business Address ��-�c� 1�_c�_��- � Type of License(s) ��U� c,c,L� on �V �� Business Phone ��1 - � .3�'/ 7' ` l C�SS r-� S�t�-- \'�►-Y.b ��.QQ_ � Public Hearing Date � License I.D. # /�a�((� � at 10:00 a.m. in the Coun 1 C ambers, 3rd Floor City Hall and Courthouse State Tax I.D. # °� �� S REVIEW DATE DATE PECTION APPN REC'D VERFIID (COMPUTER COI�IlKENTS raved Not raved Housing & Bldg � Code Enforcement ►'��(� � I Public Health I �1 '� I I ► I Fire Prevention 4 � nl � � � Police � 1 � �� City Attorney � ! I ENS � � � � i � 300 Foot Notice I 1�1 �'k 1 i License Inspector's Comments: I HAVE BEEN GIVEN A COPY OF THIS NOTIFICATION AND UNDERSTAND THAT MY ATTENDANCE AT THE PUBLIC HEARING IS REQUIRID. ..... . r r {.:..�e..a . � .a. . . .. . .. 4 . - . � � ' � � .. .. . - . • p CURRENT INFORMATION NEW INFORMATION Current Corporation Name: New Corporatioa Name: Current DBA: New DBA: Current Officers: Insurance: Bond: . New Officers: Stockholders: ,��,,,,.G � ,��-,��i , :..b,o;�o�„�Ti;�� Charitable Gambling Control Board FOR BOARD USE ONLY °��'��y� Room N-475 Griggs-Midway Building License Number . q 1821 University Avenue St. Paul, Minnesota 55104-3383 AMT 1612) 642-0555 ��'�.. CHECK# DATE GAMBLING LICENSE APPLICATION INSTRUCTIONS: A. Type or p�int in ink. B. Take completed application to local governing body,obtain signature and date on all copies, and teave 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 S100.00(Bingo, Raffles, Paddlewheels,Tipboards, Pull-tabs) ❑Class B - Fee S 50.00(Raffles,Paddlewheels,Tipboards, Pull-tabs) Makecheckspayableto: ❑Class C - Fee S 50.00(Bingo only) Minnesota Charitable Gambk�g Conuol Board ❑Class D - Fee S 25.00(Raffles only) ❑Yes�No 1: Is this application for a renewal? If yes,give complete license number 0 - 0 - 0 �Yes C�No 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) " DYes�No 3. Have Internal Controls been submitted previously?If no,please attach copy. � 4. Applicant(Official,legal name of organization) 5. Business Address of Organization ��}J�:.L C��J• .�_li{.• lj� i 11'.`a.a�1.1��1 ��i�i'.�.�:L 6. City, State,Zip 7. County 8. Business Phone Number � ?a�u? :•[i�n��sot� �5iG3 >�a.:is��T � �i� � 4o9-43y� 9. Type of organization: ❑Fraternal ❑Veterans ❑Religious QOther nonprofit' 'If organization is an"other nonprofiY'organization,answer questions 10 through 13.If not,go to question 14."Other nonprofiY'organizations must document its tax-exempt status. ;E3�fes 0 No 10. Is organization i�cor orated as a nonprofit organization?If yes,give number assigned to Articles or page and book number: �1�u 3�4 Attach copy of certificate. �];Yes�No 1 1. Are articles filed with the Secretary of State? :C3.'YesONo 12. Are articles filed with the County? `C:kYes❑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 QNo 14. Has license ever been denied,suspended or revoked?If yes,check all that a ly: ODenied ❑Suspended ❑Revoked Givedate: - - 15. Number of active members 16. Number of years in existence Note: If less than four years,attach evidence of three years •,� existence. :�/'��; .J`.l ,� 17. Name of Chief Executive Officer 18. Name of treasurer or person who accounts for other revenues of the organization. - � � , -�;:z�;�on ' ' r _ ilZ_. I: <i. .� .1�'':i _i;i?iCi3 Title Title �us_�:;:.��a ;`�tarza�-�� :"raasur�r Business Phone Number Business Phone Number � ( �.)L�: � �iC)��-Es,}�^;� ( il ! ? � ?7 ��'i5�7(i 19. Name of establishment where gambling will be 20. Street address(not P.O.Box Number) conducted ��ii i�3�.� f ,f � .�0�}t'I .1��.t3 .itr�?:` 21. City,State,Zip 22. County Iwhere gambling premises is located) 6, i':IFl�. �'_i°:O�3 1 t i .�i�laF37 CG-0001-02 IS/86) White Copy-Board Canary-Applicant Pink-Local Gover�ing Body C� �7-,�o, , • Gambling License Application Page 2 Type of Application: C3 Class A ❑Class B ❑Class C ❑Class D :�Yes❑No 23. Is gambling premises located within city limits? ;L�Yes�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. DYes�No 25. Does organization own the gambling premises?If no,attach copy of the lease with terms of at least one year. ❑Yes�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 g is not required for Class D applications. �'�.v(? sBYes❑No 28. Do you pla�on conducting bingo with this license? If yes,give days and times of bingo occasions: Days Times :C`_It:.�:." ' : 't.-i. : .a'.1 - �l i �": ?'s't�(? \ :�QYes❑No 29. Has the S 10,000 fidelity bond required by Minnesota Statutes 349.20 been obtained?Attach copy of bond. 30. Insurance Company Name 31. Bond Number �iNSt�=r� �s_ ��' - �i:c;�r -�ci7� 32. Lessor Name 33. Address 34. City, State,Zip . 1(1�'.:_.� :t,"'.i_ ?t>'�=? i i f��"�� i�.L t� i��• S t• ��Ll� y 1'!:� .1�' � / 35. Gambling Manager Name 36. Address 37. City,State,Zip a i 3 t�� l:.A .J J C: 'r ''u Ci!7 v i �ji :,�� .@.L� �� • i3 t "��LE i i i ti ,.)�.�l.� 38. Gambling Manager Business Phone 39. Date gambling manager became ( : , _ , -... member of organization: A _ r-; � .� ,, -,�� fi 1 "� ) �;�.� :, ... 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 practice. BANK RECORDS AUTHORIZATION By 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, accu�ate 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. �Sigqatur�(must be signed�by Chief Executive Officer) i�':S�'i.' '' i X( i--�{.�z...�.v:��.�z`�'�,� Title of Signer Date =% .iU5; _ '.i: Il: " .��r � , ;,-'. ACKNOWIEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY I hereby acknowledge receipt of a copy of this application. By acknowledging receipt, I admit having been served with notice that this application will be reviewed by the Charitable Gambling Control Board and if approved by the board, will become effective 30 days from the date of receipt(noted belowl, unless a resolution of the local governing body is passed which specifically disallows such activity and a copy of that resolution is received by the Charitable Gambling Control Board within 30 da s of the below noted date. 42. Name of City or County(Local Governing Body) If site is located within a township,item 43 must be completed,in �4 ,•, addition to the county signature. '`:_,. � . �: Signature of person receiving application 43. Name of Township X � _..r . Title �;� ' Date received(30 day period Signature of person receiving application • begins from this date) ; . � � ,..4 X 44. Name ot Person delivering application to Local Governing Body Title .i 1 i 7 .::1.L';. t+.::1:;<�'1 CG-0001-02 (8/86) White Copy-Board Canary-Applicant Pink-Local Goveming Body ...__.__. __. ._._ _.. _. _ . . _. ._ ._._ _ .. . ____'1 - . �?� �j-�:�ar , . � ` � City of Saint Paul • Department of Finance and Management Services Division of License and Yermit Registration INFORMATION REQUIRED WITH APPLICATION FC�R PERMIT TO CONDUCT CHAR.ITABLE GAMBLI?VG GAME IN SAINT PAUL 1. Full and complete name ot or�anization which is applying for license Rosettes , Inc . 2. Address where games wi11 be held 1494 North Dale Street St . Paul 55117 Vumber Streec City Zip 3. Name of manager signfng this application who will conduct, operate and manage Gambling Ga�es Marv Chris Johnson Date of Birth 12-18-58 (a) Length of time manager has been member of applicant organization $ vears 4. Address of Manager _�19 Galtier Street St . Paul 55103 Number Screet Cicy Zip 5. Day, dates, and hours thfs applicaticn is :or Mondav 7 • 30 - 11 • 30vm, vear round 6. Is the applicant or organization organized under the Iaws �= t�e State or �R�T? yes 7. Date of incorporation 4-20-65 8. Date when registered with the State oi.�iir.aesoca 4-20-65 9. How long has organization been in exisce�ce? 25 ye ar s 10. How Iong has organization been in eYistence in St. Paul? 25 years 1I. What is the purpose of the organ=zation? To encourage & promote a marching �oup ; to further & enhance the social & cultural development of the members of �he marching„_��oup : to foster & imnrove through social intercourse community spirit and loyalty to the City of Saint Paul . 12. Officers of appiicant orgar.ization Name Arlene Widmer v�e Marva Rae In�ebretson Address 1 54 i ndal Address 1552 Woodbridge #310 Maplewood , MN 55119 St . Paul , MN 55117 Title president DaB 5-21-45 T=r'-eVice President ��B 3-8-50 vame Jim Beikler Name Kathv Maher Address 459 G i fi h :�ddress 951 Bellows St . Paul , MN 55106 West St . Paul , MN 55118 Title TrPaGUrPr D�B h-29-fil T��=z S rP rPtar� �oB 11 -26-57 are 13. Give nanes of officers, or any ot:^.er ?ersons �zo pa_d ior ser-�:ces to tze organi�at:on. ##SEE ATTACHED LIST OF BINGO WORKERS## ti'ame Vame Address :;ddre�s Title __�'_e (Attach Sep2:'dC2 sce�_ -.,- acc___.,,.__ ..__�s . ' �-��-,a�� 14. Attached hereto is a list of names and addressas of all members of the organization. 15. In whose custody will organization`s records be kept? Organization - Jim Beikler 459 Griffith St . St . Paul 55106 Name Bingo - Mary Chris Johnson Address 619 Galtier St . St . Paul 55103 16. Persons who will be conducting, assistin� in conducting, or operating the games: Name Brian A. Johnson Date of Birth 12-6-56 Address 619 Galtier Street , St . Paul , MN 55103 Name of Spouse Marv Chris Johnson Date of Birth 12-18-58 Dates when such person will conduct, assist, or operate wee kl y Name Arlene Widmer Date of Birth 5-21-45 Address 1254 Firndale , Maplewood , MN 55119 Nane o* Soouse Ken Widmer Date of Birth Dates w�en suc:� persor_ *ai1l concect, ass:st , or ope=ate weekly 17. Have �ou read a^,c ao ;rou charaughly understand the provisions of alI 1aws, ordinances, and regulatior:s ;ove:�f::; the operat:en cr Cha��*_ab'e Gaab?i.ng �ames? yes 18. Attached hereco o,. t`�e for�! fur::Lshea �,r tF�e C�ty o� St. PaLl is a Financial Report which it�*�izes aIl receiats, e:c�ens2s, and e?sbursemencs a� c�e applicant organization as we?1 as a;' o:�ar,�za�'_ons :rne :-iave _ece�-red _unds tor tae areced'ag calendar year whfcn ?�as bee:� s'saed, _ repared, ar.d V2':=;�� r N/A tiame :14Q=aC5 who is che o= tze applicant 0*ganization. `lame Or Oir=Ce 19. Operator oi prem:ses �rne-e 2ames :r�1; be `�e�d: �Iame sdeal Hall Business Add:ess 1494 North Dale Street St Paul , MN 55117 Home Address 20. Amounc of rer.t paid by a�p�:;:�n� OrgS:7I�3Lion ror *eat o: �he ha_Z; speciiy amount paid per 4-hour se��cn $175 . 00