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87-1250 WHITE - CITY CLERK PINK - FINANCE G I TY OF SA I NT PA U L Council BLUERV - MAVORTMENT Flle NO. �� /�n � Council Resolution ---� Presented By ' iJ � Referre Committee: Date � Out of Committee By Date RESOLVED: That Application (I.D.#10250) for renewal of a Class D State Gambling License by St. Casimer's School at 930 Geranium be and the same is hereby approved. COUNiCILMEN Requested by Department of: Yeas D�gW Nays � �a In Favor Rettman � Scheibel A gai n s t BY Sonnen Weida W1130ri A� 2� 1�87 Form Approved by City Attorney Adopted by Council: Date Certified Yass ouncil S tar BY By A►ppr e lVlavor: Date �� Approved by Mayor for Submission to Council By BY E �e�`.�'..:.�' •. _: ��±v� ��7/�5d C..tz.. `6� �31 �� • DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE INTERDEPARTMENTAL REVIEW CHECRLIST , c \ /� d!� Applicant �_ ��, r 5 .�C�h cx� � Hame Address �,p�� . l��e..rC��,r,a �,�,,,,�� Business Name SG_ Home Phone �j'1 C1 '' J�v�U �� Businese Address c[3O �� Yct .n a.a w. Type of License(s) �[�n�, � �a_ Business Phone `11� - C�3 Co5 - l.l, C a Public Hearing Date �� -�1 License I.D. # 1 Ua �-v at 10:00 a.m. in the Counc 1 Chambers, 3rd Floor City Hall and Courthouse -Sttt'i'e Tsx I.D. � ��P�- REVIEW DATE DATE INSPECTION APPN REC'D VERFIED COMPUTER CO1�Il�IENTS mved Not raved Housing & Bldg � Code Enf orcement n'!� � I Public Health � I/�i `�. I 1 i Fire Prevention � �(�- � � Police � �(� � � City Attorneq � I ENS � n �� 300 Foot Notice I n � � � License Inspector's Comments: I HAVE BEEN GIVEN A COPY OF THIS NOTIFICATION AND UNDERSTAND THAT MY ATTENDANCE AT THE PUBLIC HEARING IS REQUIRID. ., ,. CURRENT INFORMATION NEW INFORMATION Current Corporation Name: New Corporation Name: Current DBA: New DBA: Current Officers: Insurance: Bond: New Officers: Stockholders: ��>i.�o , , ,�,,,,,,,�,, °��'�� Charitable Gamblin Control Board - 6,�p�L6DUh0�?�� 9 FOR BOARD USE ONLY � Room N-475 Griggs-Midway Building 1821 Universit Avenue LicenseNumbe� _ � ,f f'.� y �: St. Paul, Minnesota 55104-3383 (612) 642-0555 qNjD �?�"I�" .. 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(Bingo,Raffles,Paddlewheels,Tipboards,Pull-tabs) �Ctass B — Fee S 50.00(Raffles,Paddlewheels,Tipboards, PUII-t2bS) Makecheckspayableto: �Class C — Fee S 50.00(Bingo only) Minnesota Charitable Gambflng Control Board �Class D — Fee S 25.00(Raffles only► ❑Yes f�No 1. Is this application for a renewal? If yes,give complete license number 0 - 0 - 0 �Yes ONo 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) �Yes�No 3. Have Internal Controls been submitted previously?If ho,please attach copy. 4. A�plicant(Of icial{legal name9f organization) 5. Business Address.of Organization Sf ��✓/�/�/L-✓ C�.QL G '�� ,��G/�/v1�/r� /!,s�+�:.-. 6. City, State,Zip 7 7. C°�nty 8. Business P ne Num/b�er 1.^- (J �G:-f�:.��,nJ/.'ill ��t(/e� 'r 5/G`i_,.� �Gf�'T%J e..`'� ( !�/'�r 1 J�j�'C',/�.1 9. Type of organization: ❑Fratemal ❑Veterans �Religious ❑Other nonprofi ' 'If organization is an"other nonprofit"organization,answer questions 10 through 13.If not,go to question 14."OthY.�nonprofiY'organizations must document its tax-exempt status. ❑Yes�No 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 from Minnesota or Federal income tax?If yes,please attach tetter 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 Givedate: - 15. Number of active members 16. Number of years in existence Note: If less than four years,attach � evidence of three years � G ;�.J j-� existence. 17. Name of Chief Executive Officer 18. Name of treasurer or person who accounts for other revenues /.�� __..�' ; i ,�" ,♦f of the organizatlon. --� , ( �� / ' �� I.. /G� /,�r�1i L.'�� /�!i� �r.�i�%�J .� l�/,1 �rt4//`�/ � f, Title ' Title i , ��f� �� /?�'•''`� /L �'j� : Business Phone Number Business Phone Number ` � _ ��,� , i i�� - :��';� , ��? , -7 ;<< -"`��,Y % 19. Name of establishment where gambling will be 20. Street address(not P.O. Box Numbe�l conduct�.d. /"� ' j �- j1,J/ji'i !`�'G"5 � G ��`� G �,i�� c::�/�_i.�-/;.� c..y�l 21. City,Stste,Zip 22. County(where gambling premises is Iocated) y� //f',�,,j�� j�r� f�� ' `l';�' f�`�'�.'��✓,f� l/� f � / CG-0001-02(8/86) White Copy-Board Canary-Applicant Pink-Local Governing Body �C��-/�25� �Gambling License Application Pa9e 2 Type of Application: ❑Class A ❑Class B OClass 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 applicatio�for each premises(except raffles)as a separate license is required for each premises. ❑Yes No 25. Does organization own the gambling premises? If no,attach copy of the lease with terms of at least one year. ❑Yes�IVo 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 S � , � „ is not required for Class D applications. ❑Yes�,lVo 28. Do you plan on conducting bingo with this license?If yes,give days and times of bingo occasions: Oays 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 ' /�G ' /'G - '' �� 3 s r Name � 33. Addre 34. City,State,Zi �f>�'j�l/!L �c �''.�G � =r�rcfG/i�1L'1U:yl � �i3tJ� 5��(�� 35.,Gambling Manager Name 36. Address _ 37. City,State,Zip � � ,�' �,� �t - - ,, r; �' �" /, � � -'.< :/ ;l � �� '`� ,� � .�i i : �1/ l i"t ,., r ;il � !�- — 38. Gambling Manager Business Phone 39. Date gambling manager became � ( , � ; � - ../ , �1 member of organization: — / `.� cf� 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, 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. Of ' ial„Legal Name of Org ' tion 41. Signature(must be signed by Chief Executive 0#icer) G;� �t�� -��.�G � _f. ;' r, x ,.,, �;r i :�r , '",� Ttle-ofi Si er /' • Date h ,; ,� ^ � J/ � r-7 �1�''F,��l� L� �%f'I�/7�5' '�'�-`:� '-� - � I � / � �' ACKNOWLEDGEMENT OF NOTICE BY COCAL�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(Loc}I Governing Body1 If site is located within a township,item 43 must be completed,in r; r-l ..�-/ ; , } addition to the county signature. , , � �7-f- -�-�r. �; J - Signat e o person re plica ' n 43. Name of Township � � � I�� ( ..r �� .-♦ Title �9'� � ` ate received(30 day period Signature of person receiving application --'T"" i begins from this date) � —j -,r -� „��,< ,�:�c�—!�`�`fti� (�i - � _,,r, �/ x 44. Name ot Person delivering application to Local Goveming Body Title CG-0001-02 (S/86) White Copy-Board Canary-Applicant Pink-Local Governing Body � � ��-��s� . , , � - ' ' Ci[y of Saint Paul • Department ot Finance and Management Services � Division of Lfcense and Permit Registration INFORMATION REQUIRED �.JITH APPLICATION FOR PERMIT TO CONDUCT CHAR.ITABLE GAMBLING GAME IN SAINT PAUL " l. Full and complete name of organfzation which is applying for license ��- ��n 3 s� �. _ 2. Address where games will be held 9� �c�L��LILdI'f �g�,��i ,J�J�I� � ��Yumber Streec Ci[y Zip 3. Name of manager signing this application who will conduct, operate and manage Gambling Games Date of Birth (a) Length of time manager has been member o= apol�cant organization 4. Address of Manager Number Street City Zi� 5. Day, dates, and hours this applicaticn is �or 6. Is the applicant or organization organized under the laws o: the State of �IIv? tG s 7. Date of incorporation N`A 8. Date when registered with the State ot `�:nnesota N�A 9. How long has organization been in esis tence? � G�j'�/►�//LS ,�'jNGG� /�4'a D1L �f�f�� 10. How Iong has organization been in eYiscence fn St. Pau1": c�E� � ,9 l I. What is the purpose of the organization? ��jtG G��"�G� y'�'gG�"fz- I2. Officers of applicant organization Name �FsNN/5 .�1'1 ' �il"N/Cf� vame �/2-• ✓/1�1�! ,�L�L� Address � sa 76 �T�I�s :�ddrzss /D�; ,;��L�}-y/vr'[ ?i - � T i t le /L�j�v2�r/L DO B �'�—�'�L � T i t?e ,v��;-o't/L DO B Name ��G,�jZ6i y�°,/?� vame Address ��'�/ ��GI'L/¢'/i�/Ur'1 �ad:ess Tit1e��jL�� DOB �'/ �'y� Titie DOB yy�I v 13. Give names of officers, or any ot:.er persons �rno ?ai3 `or serJices to _ae or3an��ation. Name Vame Address addre�s Title __�:e (�tttach sepa_-ate sne"- --,- '��===or=- •-�='-=• '. � � . , 14. Attached hereto is a list of names and addresses of all members of the organization. I5. In whose custody will organization's records be kept? Name �i/Y) • �/`�/U�C�/ Address /Q7�j ��y�s I6. Persons who will be conducting, assisting in conducting, or operating the games: Name ,��rVNlS �19rN�Gf'� Date of Birth ��- �—�'��a Address l D 7 (� ��'l 5 Name of Spouse �y� pf-j'L�j �`�/�}/U��,,f� Date of Birth 3'v� �� Dates when sucn person wi11 conduct, assist, or operate �� 2/5� ��,Sd"w��-L 19�7-��l Na�ae �j� � �-p C-�,�n,��-�► Date of Birth (fl— j �--�/,�j' A d d r e s s � � �-( � (p �-(!j�/�}yV � U�n,� Nane or Spouse ��} -�'µ�� .}��L�� Date of Birth (,� � a L.� —' ��_ Dates when suc`� person *ai'? ccr�cLCt, ass:st , or ooe_ate J� � 7 - � I7. Have ,�ou read a::d do �ou thoroughly understana the prov=s?ons oF aIl 1aws, ordinances, ar.d regulatio.,s �ove:--�in; _�e operat_en o� Cna�_Lab,e G2�D'i*_±; gumes? �1��J 18. Attached here�o on c:�e ce:n: �ur::�sFted b�� tne C�� o� St. Paul ?s a Financial Report which ite�izes a?1 receiacs, e_:�enses, ar_d aisbursemer.ts o� t?�e applicant organization as weil as ai� o.�anizat'_ons :�nc :.2ve :ecei-re� `unds �or tze preczd;ng caiendar year W11fC:1 �7dS tJ22:1 5=5nZ'j� �repa_Ted� SI1Q V2:'=�-�'� �.V /��_�j/^� • �'ame —1� �lo ��—��S . c�``� �� '1'I/[J ��B� �acress who is the �1��`�l�/Zt�.� e= the anplicant Organization. `lane oL Oi==ce I9. Operator o: pre�ises �rnere �ames �r�,= 'e �e:d: Name S� C,-�S//?9l/7fj ��/�`7t : �G�1G�. Bu�siness �ddress 9�� p�fiL.1�-y�/��'�''j Home Address q�J ��yV/U'Li•� 20. Amount of rer.t paid by a�p�i�anc Or�ani�acion ror re�t or che ha11; soecify a�ount paid per 4-hour se=�:cn �Jj�(„> � , � ��r��sd 21. The proceeds o� che ga�ses will be disbursed after deducting prize layout costs and operating e:cpenses for the iollowing purposes and uses: /U /9J�'�J`J3� ��CJ Q'7��1'L/Y'�P� L�/� C�� 5�/1'!//Z S CJ��'�L' - 22. Has the premises where che gzmes are to be held been certified for occupanc}• by the City oE Saint Paul? ��`j 23. Fias your orgar.�zation r�1ed cedera' �or:n 990-T'. �V Z� It answer is yes, please attac� a copy with tnis applicac�on. Ic answ•ar is no, e:cplain why: �/��- ��C�i�`7�' �9A�uiL�� Any changes desirec �•� cae a��l�cazc �ssociacion ma� be �ade only wich the conser.t of the City Councii. �-��i� �� • Orgaz'_zatlon i /, ; , , � �ate � �� By: �� t' a�z� in cnarge of game � � r- E = z I � :n r- _ ^. .�. -- c� cn :> > � rD '�G � I � C _ ,. � � I 7 r- � .� ' � !D (D � .. n � � .i , :0 ` ", �— � C: I I ;n rr rn � � � r. I � _ 't ; n -3 C ._. ;C I r* :� � n � '< 1 ^. � .� i ,< _ � � T` G �• _ rT - r- ^ O � :1 � (D r ... 7 '-�n �-- 3 1] C � v, :p rt r rD � -n n � •r. =I n. :n � � `a ; � � — I �, = 3 � � � v� m � `"' ,T � �o � rr E 3 � � i � i �. o I ;n ra � • � e �j I m a _. I ��- � � � o r' _ =� ! I ^ 1 � C - n � � n F' � 7 W �9 fD � � f� �A (9 :� '< � � = � '1� '�7 '-7 ro E �_ � .�� I � � l--� r'S � ^I C ,^.. � :7 I I 4'1 F. (9 ,^� � � ' � T. � CA I !A n ro � — � �D, � n ( � ^ fD �: � : r'r I � � � i _C i � :J � O �'t rr 17 i �, � � , _; i � I � :.� ,� `R I ^ _ � � � � — = _ � i � i I � :n � o r� I r' i9 < I i ; � � I I � � £ ^S ^t '� CA ' (O :7 � ( I � � � !7 C :;O � I � , —i .� r- 'Q " I I 7 �.?��y�1sa A G E N D_A___M_A T�E_R_I_A L_� COUNCIL ID�� /l�" --� DATE RECEIVED � AGENDA DATE AGENDA ITEM �6 SUBJECT � ' � ORIGINATOR CONTACT RESEARCH STAFF ASSIGVED DATE SENT TO CLERK COtNCIL ACTION MASTER FILE 2NF0 AVAILABLE ORD'IRESOL. �� DATE FILE CLOSED . '� � � ��.,.? � !�i p � . ' � •�_� .`�` � '�