87-1237 WHI7E - CiTV CLERK
PINK - FINANCE CO�I/1C11 �J
CANARV - DEPARTMENT G I TY OF SA I NT PAU L /�/�3�
BLUE - MAVOR . FIl@ NO.
�
Council Resolution _
;��� ���
Presented By
Refer d o Committee: Date
Out o ommittee By Date
RESOLVED: That Application (I.D.�16396) for a Gambling Location License - A
applied for by Arnold Kampa DBA Ted's Rec at 1084 W, Larpenteur
be and the same is hereby approved.
COUNCILMEN Requested by Department of:
Yeas Drew Nays
Nicosia
Rettman In Favor
Scheibel
Sonnen � Against BY
Weida
Wilson
Adopted by Council: Date AUG 2 � 1987 Form Appro ed y City Attorney
Certified Pa s cil Sec r BY
By �"`,'
A►p ved y avor: Date �� �� Approved Mayor for Submission to Council
By BY
P(�.ISH�.D S��=P 12 1987
C .��. �I �,1�-� y �X � 5��
� , �D�IVISION OF LICENSE AND PERMIT ADMINISTRATION DATE '�� 2`6 � 5[�,
INTERDEPARTMENTAL REVIEW CHECKLIST �/�"�7���-3� "
/7
Applicant �R�j�� ��,,�,�cJ Home Address _�j�5 w . �����r��.w
B ine s Name��[�.� Home Phone - �
us s S� • � ��
Business Address lC�C(�{(�J� ��"�a�� Type of License(s) � �j•n► l.�h�V�.��t�v�
Business Phone '��{� - �-�'�► ?, ,�Y Q.,� q'
Public Hearing Date License I.D. � L(n?j �( �.P
at 10:00 a.m. in the Cou il C ambers,
3rd Floor City Hall and Courthouse State Tax I.D. #
REVIEW DATE DATE INSPECTION
APPN REC'D VERFIED COMPUTER COMMENTS
�OVed NOt ed
Housing & Bldg �
Code Enforcement '� �Zy � - '
Public Health � I 2� I ' -
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Fire Prevention f
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Police � �
r-1 a� + . L
,
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City Attorney �
I
ENS �
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300 Foot Notice
� � z� h A-
License Inspector's Comments:
I HAVE BEEN GIVEN A COPY OF TIiIS NOTIFICATION AND UNDERSTAND THAT MY ATTENDANCE AT
THE PUBLIC HEARING IS REQUIRID.
_. , .�. ,,. . . . , .
: . . .._.. . , .. . , . , ,
9
ro •
CiJRRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
New Officers:
r ;
Stockholders:
��� �;t--�7-t.�3 �
1
�Lpplication No. Date Recsived By
L
, ` CITY OF SAINT PAUL, MINNESOTA
CHARITABLE GAMBLING LOCATZON
Directions: This form must be filled out with a typewriter or by printing in ink by the
sole owner, by each partner, by each person who has interest in excess of
5� in the corporation and/or association in which the name of the license
will be issued.
THIS APPLICATION IS SUBJECT TO REVIEW BY TAE PUBLIC
— �_ � , - -
1. Application for (name of license) _� �"/� � �� �_
2. Located at (address) �l/��� L J ���5��� '�--
3. Name under which business is operated ��, (� ,� � �-
4. True Name ' ����Ii ��Jf��Jt � J� Phone ��` ti � �'_j'
(First) (Middle) (Maiden (Last)
5. Date of Birth �`,a'S 1��.L Place of Birth `��� ������12�
(Month, Day, Year)
6. Home Address , j�� �J !'�,.��tr�-t�l---� /�/�'�� Home Phone �7�`�;"'�"�`��'�
7. Have you ever been convicted of any gambling violations? /��)
8. List licenses which you currently hold at this location. ��f���i��`��
�
��^'� `,i�L7""t,— �('�� .%'�``� ���� ��/r/?//��/ �� L,'`
9. SUBMIT A SITE PLAN WHERE THE GAMBLING BOOTH WILL BE LOCATED
ANY FALSIFICATION OF ANSWERS GIVEN OR MATERIAL SUBMITTED WILL RESULT IN DENIAL OF THIS
APPLICATION.
I hereby state under oath that I have answered all of the above questions, and that the
information contained therein is true and correct to the best of my knowledge and belief.
I hereby state further under oath that I have received no money or other considerations,
directly, or indirectly, in connection with this license, from any person by way of loan,
gift, contzibution or otherwise, other than already disclosed in the application which I
have herewith submitted. _
��^ ?State of Minnesota ) ,�/ : �
) ss ,.'
County of Ramsey ) ' ,, ` � ' , �
� �� ; ,
Subscribed and sworn to before me this % �(,�.. � :. . ��� ��-�
� (9'�gnature of App13c nt)
�� day of 19 �
�
,
K� � � �
�i� �.�u� ,�. �;�.�� �c��� BARBARA l. BERG
�� NOTARY PUBLIC -MINNESOTA
Notar y Public, Ramse y unt y, Minnesota `�� NENMEPIW COUNTY
� My Commission Expires May 15.1990 '
My Com�ission expires ��,� �S, ►� 9 O r I
X
�-�,-,�.�;
_______________________________ AGENI�A ITEMS =_______--_______-____________-��
ID# C157 ! 7 DATE REC.: C08/12/87] AGENDA DATE: C00/00/00] ITEM #: C ]
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SUBJ�CT CGAMB�LIM13 LOCAYION LICEMSE-A AF'PLICATIQN - TEL1'S REC • ]
STAFF AS5IGhIED: C ] SIG:C ]OUT-C ] TO CLERK:C00/00/00J
ORIGIMATOR:CLICEhISE 11IV. ] COMTACT:C ]
ACTION:t , ]
C � ]
ORD/RES #:C ] FILED:C00/00/00 ] LOC.:C ]
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FILE INFO: CRESOLUTION/CHECKLIST/AFPLICATION ]
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