87-1234 WHITE - CITV CLERK
PINK - FINANCE COU�ICII
CANARV - DEPARTMENT GITY OF SAINT PAUL File NO• �� -/���
BLUE - MAVOR
�
Council Resolution
��, �
Presented By ���
Referre Committee: Date
Out of ommittee By Date
RESOLVED: That Application (I.D.#18892) for the renewai of a Class B State
Gambling License (Raffles, Paddlewheels, Tipboards, and Pulltabs)
by Northend American Legion Post 474 Inc. at 72 W. Ivy be and the
same is hereby approved.
COUNCILMEN
Yeas Drc�W Nays Requested by Department of:
��,:;.�-_� �
Rettman [n Favor
Scheibel �
.�n Against By
Weida
wilson AUG 2 5 �$?
Form Approved by City Attorney
Adopted by Council: Date
Certified Pa•s y oun�e ry BY
By
prov y Mavor: Date 17G� — Appcoved by Mayor for Submission to Council
By
P���p 5 t� 1 z 1987
�� ����L� � �s�
, p� �
DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE p '�� � �'�
INTERDEPARTMENTAL REVIEW CHECRLIST
Applicant nc�l�"� �vne�i c���1n�4�6r���5��`�����e Address y�"�����,r �u .�
Businese Name �G.m� Home Phone ,�,�� - G'j ���-
Business Address W� Type of License(s)�n�,,�;,� l Q('�SS�
,
Business Phone �(�� - �i �1�3 �,]�-r,.�� �10..1m�.c,.� c.,. � -C� i a�'ILG C�c�a
Public Hearing Date ���r. .a�. �qg� License I.D. � l 5��� �
at 10:00 a.m. in the Co cil Chambers,
3rd Floor City Hall and Courthouse State Tax I.D. # n �!�
REVIEW DATE DATE INSPECTION
APPN REC'D VERFIED COMPUTER) COrlMENTS
�oved Not ed
Housing & Bldg �
Code Enforcement � � �. � ' ' C
I
Public Health �� � I
i/ � , i "
I
I
Fire Prevention � I � �
� 1 � I 1 �
�
�
Police � I � �
i
I
City Attorney �
I
�S � � �
� �
,
300 Foot Notice � \ � i
�
�
License Inspector's Comments:
I HAVE BEEN GIVEN A COPY OF TIiIS NOTIFICATION AND UNDERSTAND THAT MY ATTENDANCE AT
THE PUBLIC HEARING IS REQUIRID.
, , _ .,; _ , ._, . , y . . ,,. . _
, .. , • , , . ,
�
CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
New Officers:
Stockholders:
� �
�,,,,,,, ��=;�7- i�3� �
.��•a,��?�T��c'`,� Charitable Gambling Control Boa�d , FOR BOARD USE ONLY
:.65._- ._ p.J._� •) .
'J' �n� Room N-475 Griggs-Midway Building
- �� 1821 University Avenue LicenseNumber
��:� St. Paul, Minnesota 55104-3383
(612) 642-0555 AMT
�u�,�' '. CHECK#
DATE
GAMBLING LICENSE APPLICATION
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 5100.00 IBingo,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 Gambling Control Board
❑Class D — Fee 5 25.00(Raffles only)
DYes�No 1. Is this application for a renewal? if yes,give complete license number � - 0 - 0
❑Yes❑No 2. If this is not an application for a renewal,has or arnzation been licensed by the Board before? If yes,give base
license number(middle five digits) ��
�Yes ONo 3. Have Internal Controls been submitted previously?If no, please attach copy.
4. Applicant(Official,legal name of organization) 5. Business Address of Organization
, - . _ _� . _ . ,
6. City,State,Zip 7. County 8. Business Phone Number
' - . . - • _ . _ , 1 -� 1 _� - ,
' 9. Type of organization: ❑Fraternal ❑Veterans O Religious ❑Other nonprofit"
'If organization is an"other nonprofit"organization,answer questions 10 through 13.If not,go to question 14."Other nonprofit"organizations
must document its tax-exempt status.
�Yes ONo 10. Is organization incor orated as a nonprofit organization?If yes,give number assigned to Articles or page and
book number. Attach copy of certificate.
[�Yes❑No 1 1. Are articles filed with the Secretary of State?
❑Yes�No 12. Are articles filed with the County?
❑Yes�No 13. Is organization exempt trom Minnesota or Federal income tax?tf yes,please attach letter from IRS or Department of
Revenue declaring exemption or copy of 990 or 990T.
❑Yes�No 14. Has license ever been denied,suspended or revoked?If yes,check all that a ly:
❑Denied ❑Suspended ❑Revoked Give date: - -
15. Number of active members 16. Number of years in existence Note: If less than four years,attach
--- ; evidence of three years
, �`-, � - �"' existence.
17. Name of Chief Executive Officer 18. Name of treasurer or person who accounts for other revenues
- of the organization. - �
Title Title
� ,
- - � ;� . .- ---- � _ _ .� -.
� , --,` .
Business Phone Number Business Phone Number
1 ; _ 1 - `- � — '' , � • :� - ,... J --
19. Name of establishment where gamb�ing will be 20. Street address(not P.O. Box Number)
conducted —
_ - . -- __. _.� .. , , _... . i
21. City, State,Zip 22. County(where gambling premises is located)
. CG-0001-02 18/86) White Copy-Board Canary-Applicant Pink-Local Governing Body
:z� �>���-�a.��
� Gambling License Application Page 2
Type of Application: ❑Class A �Class B ❑Class C ❑Class D
.
�Yes ONo 23. Is gambling premises located within city limits?
,�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.
L;7Yes�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. �— �
❑Yes�1No 28. Do you plan on conducting bingo with this license?If yes,give days and times of bingo occasions:
Days Times
�Yes�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
. _ _ - _
�- - - .-; - , �.;
32. �essor Name 33. Address 34. City,State,Zip
r'i �� �� ,, ., �� - :.' % �/ -•1 - , —t t. �� _ (i�., ; ""/; 7
35.. Gambling Manager Name 36. Address 37. City,State,Zip
__ .r'.r` � : • ' " � i . � '—; .J t' ' `-;'..' ,
38. Gambling Manager Business Phone 39. Date gambling manager became
� ( ��` � , , . member of organization: ; j .:, .;�
:. . , - _ _ -; - � i`_ :,
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 unautho�ized 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, 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 Ocganization 41. Sigciature(must.be.signed by Chief Executive Officer)
� '� , /— ' . �( ,/'�'~_.��4•.� ��+`...i,.e.
Title of Signer Date �w C
• ._ v L�.y'L . — / !
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 with
�otice 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 Inoted below),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
�� addition to the county signature.
Si ature ers receiving application 43. Name of Township
X �
Title Date received(30 d eriod Signature of person receiving application
` begins� m his datel
X
4. ame of Per delive i aRpl' ion t cal overning Body Title
CG-0001-02 (8/86) White Copy-Board Canary-Applicant Pink-Local Governing Body
/0 c,/
, • ^ (���7 /�..J/
• - City of Saint Paul
. Departme�it o[ Finance and Management Services
Division of License and Yermit Registration
INFORMATION REQUIRED WITH APPLICATION FOR PER*1IT T.0 CONDUCT CHAR.ITABLE GAMBLING GAME IN
SAINT PAUL
1. Full and complete name of or�anization which is applying for license
/l/o� �,�c� ��ie vic�N ��/a�J �o.s�- � ? �
2. Address where games wiil be held 7 2 �, �v�/ ��UL �N SS1/�
Vumber Screec City Zip
3. Name of manager signing this application who will conduct, operate and manage
Gambling Games ���^�/Q�J � �/� f Z SI^ Date of Birth / Z - 3 - z /
(a) Length of time manager has been member oi apoiicanc orgar.ization / /� re,4i�S
4. Address of Manager s�� � �--�S.I Y' 5���} U �. 1 I/V SS �f1'� ��
Number Street City Zip
S. Day, dates, and hours this applicaticn is ror �- /p- $ ? �0 4 - /a - S �
6. Is the applicant or organization oroar_ized under the Iaws o= t�e State ot `�II�i? Y� 5
7. Date of incorporat�on ���L �- ��, ��j'�J
8. Date when registered with the State o= Mir.nesota
9. How long has orgar�ization been ia e:sistence? S6 �E�t}YS
10. How long has organization been in eYistence in St. 2aul? S G `�e R !^S
11. What is the purpose of the organ�zation? ����Y�IkS — �!9/lC��� � 7O!/�
�L o e.�L ��.�ra v n/� - S��i �o L s - V�� �•� y� -
12. Officers of applicant organization
���`fiy.�i1.��r/;/� � r
Name�hr�s 7�ahulct�"� Vame D�l�1N�cS S�"<<e.s
Address ��f /���'G't f�l��' Address � �% �/yfj�/����
ZNd
'r�t1��Mfl�4N�e Ir DOB Tit?e�/,c �okMqqJQ��cVDOB
vame `�H ��"i Le S Na�e /�c_°/U O �l.t/.Saill
Address �c� c'6 `'liJ��'/ [,f�j� ' :�ddress `� �-� � GCY�.UL°��3
CoHH.�A��-°r 3 r' ,
Title / /J±' v JC. DOB Litie (�i� �N/4��eY�JOB `�"^���
13. Give names of officers, or any ot:^.e: persons �no pa:d rer ser-:�ces ce t:�e or3an:zat{on.
Name �Q'1t;�- Vame ��¢
—r
Address ;;dd:e�s
Title __�'_e
(Attach separate sne•r- '.,- 'c�'_=_..r.�� ..__�s. '
.�. � C��'�� �_,� 3y
Z1. The proceeds oi the games will be disbursed after deducting prize layout costs and
operating expenses for the following purposes and uses:
L��� D n� b N'0 4 r� N S - �n � Lc� r�e �J 8 �v cJd�. - ���QVa u A�S
_ � � ao C � - I�efs �.o��n - I�ed-s C,� Mb - I� fs
h o s a i�-�a L -- ��,��n1 � ►e ax- - � s��,�LL -
2Z. Has the premises where the gzmes are co be held been certffied Eor occupanc}• by the
City oE Saint Pau1? �P C
23. Fias your orgar.�zat�on riled tedera'•_ Lor� 990—T' e S Ii answer is yes, please attach
a copy wit;� t;;is apol=cat�on. Ic answer is no , e:cplain why:
C�a�v �'�uc Lo s c�l -
�il}� changes CIES1*2C �'� ��2 d�D�'_Cc�C SSSOC?3C'_Oil ma� be j1dQ2 OR1V W1Cj1 t�i2 CORS2P.0 Oi CCt�'
City CounciL.
��. .G��/O/!� �0 5T� �-� �
Orgaz_zat:on
p p � ,
Date O ' � 'ls "7 By:,C � �
traaaga: in cna e cf gan2
�
� z
� � r � '-C � I I C r - _ �. � I O r.
r-r r, fJ ;-r j ` � , :0 r' � �_. C tir
rD t� -• � I I ,n r v 3 I � r-
� n = '� i ~• r � : r � Q
— = -� � � t0 r- — C � rn
�- 3 II = v �D rT rr t9 r+
� � •r. -- �. a _ �e M �
r � �I � , r° , � r' O 3 �
I � � i — r _ , —
, ,� I _ rt I (D ll1
y = �I � 71 :a = �r = = `G O
� ^
� � n 7r ;o _ ;�
f9 :'I '< i I � ~ � ' 'S 41 .
"O ^-7 ''D E � `G v..i .i
O t-� ,— � -:j ;: � �. � �
F-' ►S -- � � I I N
� � T �.. J1
r co n ' _ c � ;
n �o � - ' -
_ , � I � � ��,
� � � <� � -, ,, �
c) i� n ! _ ! ! ;y � ? y ^. � I
� _ rr I
� I . � ' n � �� 1 ,�
r�� � � ' � - � — I
� n i n � I_ r T R ;� � Iro
_ � -- _ _ � V i
� ~ n ^` i '� i� 1'� i
' __ � � 1 � 4 � "t '.� �
� � � � . � Q j �r� I
� '1
,
�• � �
� � �, ��-�� 3�/
_____� _______________________ AGEMDA ITEMS =_____—___=_—_______--_______—_--
ID#: C161 ] DATE REC.: C08/13/87] AGEMDA DATE: C00/00/00] ITEM #: C ]
SUBJECT: CRENEWAL OF CLASS B GAMBLING LICEMSE — MOkTHEND AMER. LEGIOM #474 ]
STAFF ASSIGNEn: CNONE ] SIG:CDREW ]OUT—CX] TO CLERK:C00l00/00]
ORIGIMATOR:CLICENSE DIV. ] COMTACT:C ]
ACTION:C ]
C 7
OkD1RES #:C ] FILE11:C00/04/00 ] LOC.:C ]
� � � � � � � � � a� � �c � �
FILE INFO: CRESOLUTIOM/CHEGKLISTlAPPLICpTION ]
C ]
C 7
______________________________________________________________________________
_ __ _ _ __ ____ ____ _ _ _ __ _ __
�_..�
-�,
, — r=
�; c.� rn
s�3 v
_:,-, ,�
� ,
. ,� _. ,
C.:J
. � -....J