87-1264 WHITE - CITV CLERK
PINK - FINANCE G I TY O F SA I NT PA U L Council /
CANqRV - OEPARTMENT File NO. ��_ ��r �
BLUE - MAVOR
�
ouncil Resolution �
���:� _�=;
Presented By
Referred T Committee: Date
Out of Com ' tee By Date
RESOLVED: That Application (I.D.#52489) for a One Day City of St. Paul Gambling
Permit applied for by the Nativity of Our Lord Church at 1900
Stanford on September 19, 1987, between the hours of 2:00 P.M, and
6:00 P,M, be and the same is hereby approved.
COUIVCILMEN Requested by Department of:
Yeas Drew Nays
Nicosia � In Favor
Rettman �
Scheibel Against BY
Sonnen
Weida
WilsOn �P �, � �al Form Approved City Attor
Adopted by Council: Date
Certified Pas e uncil Sec ry BY
By
� � � p � Approved b Ma or for Submission to Council
A►pprov y Mavor. Date �
B BY
PU�.i`'.�f� ��s' � ;', �9$�
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C Il. D( �' l`�� �� ��' ` � ��"f� c,
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• ,DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE x�(� � 4"�
INTERDEPARTMENTAL REVIEW CHECKLIST
1 � 05
Applicant �-}-( (G�,�e Address °I5
Business Name ��j��YrlS� Home Phone 3"�1� ' 3oLda
Business Address � Type of License(s) -
Business Phone - 6� Yn't�, �v� �
��� ,L GL. �7
Public Hearing Date " � License .D. #
at 10:00 a.m. in the Cou cil am ers,
3rd Floor City Hall and Courthouse State Tax I.D. # 11 `.�}-
REVIEW DATE DATE INSPECTION
APPN REC'D VERFIED COMPUTER CO1rIl�IENTS
�oved Not ed
Housing & Bldg i
Code Enforcement �
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Public Health I
I
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I
Fire Prevention �
n � �
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Police �
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City Attorney �
I
ENS �
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300 Foot Notice I
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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 REQUIRID.
. ,. ,- b t. .. ,,;� .4., �.
CURRENT INFORMATION NEW INFORMATION
� Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
New Officers:
Stockholders:
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2. �dc:ess �rhe�e Gr�arizaticn's r� �::ar meetin�s ars "e?d � �/(1S
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5. T� 1°3Sc''Q� ;•ir'J =S rn,�mer O� _^vZ"'�°S'�J ;ir°T'° '.�.t3I"i�`�ir_f. Sess:cr. ',d;_� f;P :':Q�,a:'
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7. If leased, attach letter of per^�ssi n to ccnduct Ganbl�n� Session, s_gr_ed by ?essor.
�. `iare of oificer �aI�:?g app�catica A�►�� �; / '/` �J I/ �
9. hdd:ess of of�icer �na�-.�ng application ��g .5 � � �) �� Date of birth � �^ �
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1C. i:a:�e c_ s�a:zaee� wro �rill cor.duct �a.cr;oiing Session��) �K rn �, �� �-
�1. iGdre�s ci ^a:.ager / �9� �Y� �1�8/ � V�/1Ir�P S�dS �ate ol ;.�r��5 / - T
12. In cor.nection with.wha� ever_� is tr�.s Gam�lir_� Sessicr_ oe_^� :^.eid?
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13• T��'rat type of gar.:blinF devyee(s} c�r±11 be useci? Paddletir'r_eel�"'i�board P.a�r`_'le�
�. �a�, da�es arr+.d hours Lr.:s appl�cation is 'or anc zu.�:ber or sess;ons. ,
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Da�(s) � �ates -�V)._ � -(�"�Quours ?'o. o� Sessiens
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I�. ',ili �r_zes ce paid ;n mons� or :�erchar.dise? m,bl'�
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17. :oGr long has Cr_ar.i�atior. '�e=n i_^. e�c:�ster.ce? S
l�. '�;nzt is �he p�:,.�ose af t�:e Grrani zat�on? �trYc�4'1`� S As �1 �N d �151 N
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19. Of�=cers o: t'r.e Organization
+arce-Title �ddress �ate of birZ�
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� 1'�?�le 1 i tIP. t�tQCli 9 S$ 1'd�2 0= "{,.�': '
?I.. �^ �vr058 V::S�Ct1y' S�T'�Il -'°CO�.^-5 O� CZ'� ,:ZST.1C.^.1S r2.Ti.^,1iII:" .`.�SSiQP_S �e k@D��
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22. ��tach a ccpy of your Crga.ni�ation's membersY�.ip ros�er and date eaca r�ember joir.ed.
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23. i��ac.". �:ie Gzr,chli� Sessior. :�ana.Fer's bc:.d.
L��. :���BC� a CCF,tj' C� t::@ �2D2��:12P.� C� Lr� `rZ'°SS';."�'� 1.^.:2^.^.cl .'.e�enue %2?'V'±C° r��?.@�U?"^ O:
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2�. �L�3C�: 2. CODy' Of L2D�L�16II� Oi �i@ 1:"°3SL:..'^'� T:1L�?'�Si =°�l8^til? �e^�r_ce, ��"�:e^'�L Ci=P3Ii-
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ization �usir.ess Income '"a:c", Forn 9o0T. (C'r_a�ter �:19.OL ;2). �
C.�.`. :�+�BC i �t:2 3i1*'iL13� T'@rOI'� I'°CLI�I^BC.a. 02 C.3T'1t2C•ZP. OT'c82:1Zot10L1S tDV ;�inne�ota Jt3�11t?S�
Sec��o:� 3�°.�3. (Chapter L19.�L �3). ) �
27. Fizve �ou read ar:d do veu tho�ouF-hl� �.ui�'erstar.�? the �rov_sior.s o�'�1 larrs, crdiaanc�s
ar.c rert.�lat�on� �over^�n� �he operation o= Ga.i^hlin�- �essions'. �S
G�. c.: ' C�?.�^S S @5=r � �h � � ±� prl .^l2,-y' . 1^...0 �' �t.,;i �r° CC:?5 '� c
y '? r ed b,� .e �^�DZ-C2:. 25S�,C;.2 � ^o a g Or�„ :v� P..�.t 0:
th� I:icer_se �.,or.imi+tee.
29. i_as ar.� persor.(s) p�t�cipa��-� in t'r.e opers�ior, of ar.� o� �`:e �a:-^hli^� se�s�or_s co�-
°�@_^. �3T tf18 i�c�nse EVe: been COZIL�C�@C 02 a =e?on 1A tr2 State Of +.lIL^.@SOL3 O� lri
°...'1;J other St2�2 CT' i@G�QI'3y COti.:t? t`@S �i0�. li Z*iSri2� 1S 1��T@W��� �rovi�'e
r.a*r.es, adciresses and birth-da�es.
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beir.� �ui� swor*� sa�� L'r.a;, t'r.ey ��-= Lhe pet�t'_cners ?r. �:�e 2COt2 ar.�l�cation; �hat ;,he,: hav�
Z'°�Gs �::e iOT'@�Ol^€ pet�tion 3I1C1 T�C•rt �:18 conta_nts �:_ereof; Lii3� �l"i@ S2Pt@ 1S `u° ^_° t�2�Z'
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t�� :a� :Ji�-��' '-�J�� �,�.�' iCRISTINA L �
' � . NOTARY PUBUG-MINNESOTA
�( C -� OAKOTA COUN7Y
��t'—'°�c�1 'X�`��^-- MY COhMuI.�XPIRES JAN. 2. 1992
;+Ot�' �Z1��iC����-IC�t;�� .�•OLl=it�T� :1�II@SOta_ Y r
:�:;� cor..�-i:�ssior. Pr�i_es � qc �
?�.il�r.�: ^epax�-ent dporoved �isa��roved ��
?i:e �e��rt�:.ent �pp:cvea ?isa�praped �;r
°o1=ce �e�s:tr..er.t ;pproved—��sar�rov?d-�:p
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Minnesota Charitable Gambling Control Board LAWFUL GAMBLING EXEMPTION
'� '' Room N475 Gri s-Midwa Buildin
99 Y 9 FOR BOARD USE ONLY
1821 University Avenue
- St. Paul,MN 55104-3383
�•�������� 1612) 642-0555
�n> . . , ..
INSTRUCTIONS: 1. Submit request for exemption at least 30 days prior to the occasion.
2. When completing form, do not complete shaded areas.
3. Give the gold copy to the City or County. Send the remaining copies to the Board. The copies will be
returned with an exemption number added to the form.When your activity is concluded;complete the
PLEASE TYPE financial information, sign and date the form, and return to the Board within 30 days.
Organizanon Name � } ' � _� ' • ; l.ic�+e Number Ilf currcwN a qreviau�v�icensedl;
a t . .,i,,, J f J -�•,,,,R '��. �f .. � -�'l i 'r �-�+'� r !� '� /'1 f'.� �-> 1� �'� %1% ! < �
Address , t � C�ty County State;Zip Code tr � . �� � ��
f !� ' ,"r�1 1��f t '3 �� ��I . i � t�(� j. t �S ,�r.. "t:.��.t �f..�^� � r ,�.,_,,.. •
Chief Executwe Officer's Name Phope Number y.y . Manager's Name ,.�� ',�' ,�� Phone Number � :
y,.� _,.�_. , t � ;', �,� i d: ,1;' � ':ij �:: _..F , . j` 1 -_L..' '+ ' � - � �'r '`>1
` , . �; ; ��� . t � ; . , . ; • ' W �. �_
Type of Organization \ If Other Nonprofit Organization(Check Onel � l, ;' y; ;;r� ;�
❑ Fraternal ❑ Veterans ❑ IRS Designation %'� � �- �G� ='.'' � �(1
r-:.
- � Religion ❑ Other No�profit Organization � Incorporated with Secretary of State � J
' ' ❑ Affiliate�of Pa�ent Nonprofit Organization
Name of Premises Where Activity WilYOccur � r' f % �r � Date(s)of Actrvity
`� -; � ;}_ / � 1���� ;l� � , �, L:_ i , �� � ,_,
�',1 � i ,/� r� ., + � i'. ° r: �,c4, '. y f` !, /; , �
Premises Ad�ress ��j"�. � = V - ,:. � J�-�
4 ��
'�'` 1,i �1�1 �"ir��'_�tr�rJ ? �/F� i ;�' �. 1 .'
,:
Games Yes No Gross Receipts Value of Prizes Expenses Profit
Bingo �
Raffles
Paddlewheels �
Tipboards
Pull-Tabs }�
/ '
Usetuf Profit •
Qis4aibutor FrorteVYhom;Gambfing EqvipmenYAsquiced-= : ' Disrributor's Gcense Na. "
I afficm all information submitted to the Board is true, accu- I,affi�rn �tt'financiat information;<:submitted to the Board is
,' ; : rate; and complete. true�aceurate anct!complete�
�! ' ., , ``� I ! — t; ...,d
. ! . ,+,� �
ChiefExecutiveOfficerSignature Date Chie�FaceeutiveOffieecSignature : Date
ACKNOWLEDGMENT 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 Baard and will become effective 30 days from the
date of receipt (noted below) by the City or County, unless a resolution of the local governing body is passed which specifi-
cally disallows such activity and a copy of that resolution is received by the Charitable Gambling Control Board within 30
days of the below noted date. .
CITY OR COUNTY TOWNSHIP
, Name of local Governing Body,(City or County) Township Name IMust be notified when County is the approving bodyl
`/'t �_' ` {' '
l�-��"`_ `--� � "�l- 4�
Signature f Person Beceiving Application � Signature of Person Receiving Application
� :
j�_.�. . � � • t� 1��l C. � -� "t �� ,1 .
Tit } • Date eceived Title Date
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CG-00020-01 14/861 Vr/hite—Board Canary—Board returns to Organization to keep
Pi�k—Organization Gold—City or County
��-�-,���
___--_______..����=�T==-==__--_= AGENDA ITEMS _________________________________
__ __ ____ _ __ __ _ _ ____ __ _ _
IU C1`4 ] DATE REC.: C08/12/87] AGENDA DATE: COOJ00/04] ITEM #: C ]
SUFSJECT: CONE-LtAY GAMBLING PERpiIT AFRLICATIOM - NATTVI7Y OF OUR LORD CHURCH ]
/
STAFF ASSIGMEI�: C ] SIG:C ]OUT-C ] TO CLEkK:-E8�f6Bf@83 �� 3
O�iIGIMATOR:CLICEhISE DIV. ] CONTACT:C ]
ACTION:C 7
C 7
ORD/RES #:C ] FILEU:C00/00/00 ] LOC.:C 7
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FILE INFO: CRESOLUTION/CHECKLIST/IMFORMATION SHEET/EXEMPTION REQUEST ]
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