87-1301 �MHITE - CITY CLERK
PINK . - FINANCE G I TY O F SA I NT PAIT L Council ���/�Q/,
CANARY - DEPARTMENT
BLUE - MAVOR , Flle NO.
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Council Resolution -
Presented By � ��
Refe ed To Committee: Date
Out o ommittee By Date
RESOLVED: That Application (I.D.#17126) for the renewal of a Class B
State Gambling License by Rice Street Post 3877 Veterans of
Foreign Wars at 1138 Rice Street be and the same is hereby approved.
COUNCILMEN Requested by Department of:
Yeas Drew Nays �
i3i�osia [n Favor
Rettman �J
Scheibel ��
Against BY
5onnen
]uioaa�Y�i
Wi1SOCl SEP — $ �98� Form Approv by City Attorney
Adopted by Council: Date
Certified Pass d y ncil Secr ry BY
By, �
A►p AAavor: Dat �9�7 Approved y Mayor for Submission to Council
B BY
P��s,� ��`��' 1 9 1987
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DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE
INTERDEPARTMENTAL REVIEW CHECRLIST
Applicant�;«� ��5�. 3�"l� Hame Address �13� �.�S� •
Business Name �,�-�p� �� p� �Y_p��„ �,� Home Phone �� - �� O�
Business Address ��3� t�;c� S{ , Type of License(s) U(CLSS�j �J'�-t,�s-�
Business Phone .���j— ��O� `'�.�„���,�,v�c� Q .,.v �t�.�ha.�.J�
Public Hearing Dat License I.D. # ���a1�p
at 10:00 a.m. in the Co ncil Chambers, �.�.cx.�,.a,._
3rd Floor Citq Hall and Courthouse State Ta�c I.D. #� j� �jQ�Cj OOa
REVIEW DATE DATE INSPECTION
APPN REC'D VERFIED (COMPUTER CO1rIl�IENTS
NOt ed
Housing & Bldg �
Code Enforcement �( y� �1�i
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Public Health �
5� I �--, ,,,, �� �
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Fire Prevention �
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Police �
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City Attorney �5 + Z� �
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300 Foot Notice I
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License Inspector's Comments: �QC�
I HAVE BEEN GIVEN A COPY OF THIS NOTIFICATION AND UNDERSTAND THAT MY ATTENDANCE AT
THE PUBLIC HEARING IS REQUIRED.
- r•
CIIRRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
New Officera:
Stockholders:
. , ���-�a �
. .
.; . .
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14. Attached hereto is a list of names and addresses of all members of the organization. `'�,
15. In whose custody will organization's records be kept? (�\
Nam: 1/0��-�� G � " /!�c P t 1� (/t'4�3�?7 Address //�� �fi 1 C e -s� �`S// 7
- _�=�
16. Persons who will be conducting, assisting in conducting, or operating the games:
Ivame PA��(Nt JC�f�(N Date of Birth QvEF `'zl
Address $� � SY�Y�fK S% SI� ��U� M�NN �1%��7
Name ot Spouse �jEµ,Qi I�dfLlrl _ Date of Birth c vt/1 �,l
Dates when such person wfll conduct, assist, or operate FR7��1S �¢Nd SvN0�4YS
Name I(AREN Na�M6G�G I177 G�4�rl��' Si� r/�4v/ ,���17 Date of Birth o��'QX!
address JcS�fdlNt NnNT�'%'�E�t� ll,�`/ ,4C6Ch,t�Gk fJ P�v� �J`l/7 G''"rR�I
Nane or Soouse �aT�J A�C w�0awt Date of Birth
Dates wZen suc7 perso:! *a�L1 concLCt, ass:st, or ope_ate SATvRO�fyS •�Nb F��osyf
17. Have you read ar.d do vou thor�ughly understand the provisions oE aIi laws, ordinances,
d�d regulatior.s ?OVe='t{^F� Ci1e ODAL'3C:OI1 OL Cha�:.Ca�J:e GB�Di'_:1� ��m2S� ��/- S
18. Attached here�o en t�e £o�:*.: �ur::�shed '�v tF�e Cit.� o� Sc. paul is �a Financial Report
which it�mizes aL'_ rece:ats, e:cpenses, ar.d disoursemeacs oi cae apolicant organization
�; we11 as a�i ergar.izat:ons ane na�re �ece=red `unds =or t:�e pr_cediag calendar year
Wllf C.`1 �7d5 been 5-7.^E'-7 � �r27g�ed� �IIQ �1�'-=��E:['+ ��7 Q6N.�¢�D tO�1�
�ame
� � Lr/' GR�4NG-� AvC S/ P�1vG M/NN- S f fl7 -
:�adr_ss
who is the r-� w;$��1�G /�'1�3N�9�GG'� o= tne applicant Organization.
vame o� 0�=ic.e
19. Operator of prem=5es wner° ,zames �r�i: �e �eLd:
Name DONi}Ll� �Q��
B�tsiness Address 113 � �I�L Sl RCL r Si p�'v� MINNEJa%�f �S�/7
Home Address �'�' w- 0/%4it(G�� .41/C. . ST �-4vL M�tirrrrfo1-� 5�l17
2Q. Ar.tount of rent naia by a?p��csnL Gr3ani�acion cor re.^.t o� cne tta11; speciFy amount
paid per 4-hcur se.=.s:on /�/'(' /1�`�
. � , ,
` ' • City of Saint Paul
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. Departmecit oE Finance and Management Services
Division of License and Permit Registration
INFORMATION REQUIRFD WITH APPLICATION F�R PERMIT TO CONDUCT CHAR.ITABLE GAMBLING GAME IN
SAINT PAUL '
i. Full and c:omplete name of or�anization which is applying for license /�/CL S//Ptt r
V, %_ w. posi 3577
2. Address where games will be held I13� /?��E fjI16ET S�- P.��� 5j//7
Number Streec City Zip
3. Name of manager signing this application who will coaduct, operate and manage �
Gambling Games QQN,lCQ �Q�� Date of Birth fj/�//JL ,2� /9�.�
(a) Length of time manager has been member o= applicant organization /y 7,5
4. Address o= Manager �� �w cir QRAN�� Avr. S/; P,qUG .5 S�/l7
Number Screet City Zip
SuNO-�y NQON — IO:Bc pn
5. Day, dates, and hours this application is ior FR,�y S�¢jv�p�1Y 11�0� R•i`/— /=�� 9�`f.
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6. Is the applicant or organization organized nnder the Ia:rs o= t�e State or LIN? e-S
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7. Date of incorporation /�[�{2�� r2 0 � � � �
a /
8. Date when registered with the State ot Mianesota �j�n � , �t� / �/��v
9. How long has organization heen in e:cistence? ` � � �
10. How long has organization been in esiscence in St. Paul" l � ��
11. What is the purpose oi the otganization? ��/�� C p` 1/'efPr��tis
-� e s .� �o c a.( �p��-y,�rr v n G �� � 1'
I2. Officers of appiicant organization .
Name �(J` l { �! � � � �v 4 �i �°�� va�e �i4 h-t t S �f4-��
Address /.� ��-�(/fi f'�lvL� �h ��e � �ddress �(,�, �CJ��f'�
Title �d„t,,,,�,�,�P� DOB Title,�/Z VtC P C CM�r!• ��B
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Name D,g� � � �,Q v „r� � Name fJ eKQ��n P �. /�/C K (J.f
Address �� �`?f9-i2�e,S :�dd�.ess ��p � �j/�C,S�Pit l�
Title ��L rl C P L v:rrw►. DOB Titie �U/�/2/��°.tr/I�s�-S�/�DOB
13. Give names of officers, or any ot:,er persons Nno oa:d �or ser:�ces ce the ar3ani�ation.
Name vame
Address �ddr°�s
Title --�=2
�Attach 52'�S:'dC2 s;zeFr� -_ - ac:.-==.,,--- .._�_s . '
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21. The proceeds or che gacaes wfll be disbursed after deducting prize layout costs and
operating expenses for the following purposes and uses:
��1 l�l���/�'�/`'P D rL yl�N/Z� 19-1�/d.v�' — s'y0/�TS , — /2!t c< <S Chod�
/ T �[� �
� �'l o f/¢I�L..S � S � D v K �J G / v//T�S r � v/����2
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2T. Nas the premises where the oames are to be held been certified for occupancy by the
City or Saint ?aul? �c..°S
23. Fias vour orgar.�zacion Li1ed tedera' for:n 990-T' � I� answer is yes, please attaci
a cop;� w�c:� t�,is applicacion. Ic answar is ao , e:cplain why:
Any changes desirec b,% tie a�glic�:�c :.ssoc�a�=on ma� be �a.de on1;r wicn the consenC o� tile
Ci�y Counc=l.
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Orgaz_zat�on
D a t e �(o By: /� Gr.a�-� f C��
ttaa ger in arge oi game
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�`�"^��; Charitable Gambling Control Board
ii • QtO��[DUhO,�' �O '`, FOR BOARD USE ONLY
: ��'��n' � Room N-475 Griggs-Midway Building
` :� 1821 University Avenue ��seNumber
� St. Paul, Minnesota 55104-3383 , A�p
` _ (612) 642-0555 ; �-��`
��e�' .` CHECK#
i `. DATE
� GAMBLING LICENSE APPLICATION
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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 S 100.00(Bingo, Raffles,Paddlewheels,Tipboards,Pull-tabs)
` 2`�Class B — Fee S 50.00 IRaffles,Paddlewheels,Tipboards,Pull-tabs) Makecheckspayableto:
j ❑Class C — Fee S 50.00(Bingo only) Minnesota Cha�itable Gambling Control Board
�. ❑Class D — Fee S 25.00(Raffles only)
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LIYes❑No 1. Is ihis application for a renewal? If yes,give complete license number t' � '
❑Yes❑No 2. If this is not an application for a renewal, has organization been licensed by the Board before? If yes,give base
F license number(middle five digits) � �
� �Yes❑No 3. Have Internal Controls been submitted previously?If no,please attach copy.
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� 4. Applicant IOfficial,�legal name of organizationl�,_. 5. Business Address of Organization
� (., r'•_ �� ,,� ',- ' 1 ; r. ,,J ; � y � 7 j ! : i .ti`t! :: ;•`r.':-':
� 6. Cit�State,Zip ._ 7. County 8 Business Phone Number
, i ;�� �;�.. �, .�,', ;v;..� , �' �l7 /,',�r-�: - � 1 G ) t��:,�, :>/:�5�
9. Type of organization: ❑Fraternal L�Veterans �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�No 10. Is organization incor orated as a nonprofit organization?If yes,give number assigned to Articles or page and
t book number: Attach copyof certificate.
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� ❑Yes�No 1 1. Are articles filed with the Secretary of State?
� ❑YesONo 12. Are articles filed with the County?
E ❑Yes 0 No 13. Is organization exempt from Minnesota or Federal income tax?If yes,please attach letter from IRS or Department of
i Revenue declaring exemption or copy of 990 or 990T.
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6Yes�No 14. Has license ever been denied,suspended or revoked?If yes,check all that a iy:
C�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
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!.r , `"1 - . •'� �� existence.
� 17. Name of Chief Executive Officer 18. Name of treasurer or person who accounts for other revenues
of the organization.
'-v� ,. . �,���; �: ,� �.'' ._ 'l ,�',.�,� ''r n-r c /`�!1 ` ,�i-1 j
Title Title
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� Business Phone Number Business Phone Number
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19. Name of establishment where gambling will be 20. Street address(not P.O.Box Number)
conducted . - - - , , � _ _ _
P ,� ; _._ '; ,�L C` t//= :✓ !-p i<`;��7? '1 �% � ti` 'C ..r f%;';� • f
21. City,State,Zip 22. County(where gambling premises is located)
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CG-0001-02(8/861 White Copy-Board Canary-Applicant Pink-Local Governing Body
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