87-1316 WHITE - CITV CLERK
PINK - FINANCE G I TY OF SA I NT PA U L Council � _ J�� � �
CANARV - DEPARTMENT �
�-BIUE - MAVOR File NO.
�
Council Resolution
Presented By ��
Referre o Committee: -- Date
Out of Committee By Date
RESOLVED: That Application (I.D.#18441) for a Class B State Gambling License
(Pulltabs and Tipboards) by East Twins Babe Ruth at 733 Pierce
Butler Route DBA Butler Station be and the same is hereby approved.
COUNCILMEN Requested by Department of:
Yeas Nays t
Drew �!?
Nlcosia ln Favor
Rettman
Scheibel �- Against BY
Sonnen
Weida SEP - g 1987 Form Approv y Atto ey
Adopted by � Date
Certified Pas �y ouncil Sec r BY
By, » �
A►pprov y Mavor: D — Approved by Mayor for Submission to Council
/
B BY
P °��S � ':��J� �. � ����
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� DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE �� ��, ��2(9� �'�
INTERDEPARTMENTAL REVIEW CHECRLIST
Applicant n c . ��,,.�o D�."'�;�L, Home Address 1a.5� ��Q�n��
Business Name �- ,� Home Phone '��7 C.4 —(..¢ �p?�
Business Address �;����,����_.._�., Type of License(s) � � ��� «I�.
Business Phone � �{aCj � D��1,5 ,��1 � ��o-�-�Ca['��CS�
Public Hearing Date License I.D. � ����
at 10:00 a.m. in the ou cil ambers,
3rd Floor City Hall and Courthouse State Tax I.D. # 1� (p-
REVIEW DATE DATE INSPECTION
APPN REC'D VERFIED COMPUTER COI�IENTS
boved NOt ed
Housing & Bldg f
Code Enforcement � ' I � h I � �
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Public Health � �
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Fire Prevention �I � � � )�, 4
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Police
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City Attorney �
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ENS �
✓� I� �
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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.
. .. .-.... ..v: , . ,. ..-,...: , . .,_ . . . . . .
GORRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Ngme:
Current DBA: � New DBA:
Current Officers: Insurance:
Bond:
New Officers:
Stockholders:
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„�n,���
�• ��� /� Charitable Gamblin Control Board
�¢tO�LED�yO��'J 9 FOR BOARD USE ONLY
°�'�'•�n° Room N-475 Griggs-Midway Building
- :� 1821 University Avenue ��°°°°°N°mb°�
- St. Paul, Minnesota 55104-3383 PAID
(612) 642-0555 AMT
�'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:
OClass A - Fee S 100.00(Bingo,Raffles,Paddlewheels,Tipboards,Pull-tabs)
CTClass B - Fee S 50.00(Raffles, Paddlewheels,Tipboards, Pull-tabs) Makecheckspayableto:
❑Class C - Fee S 50.00(Bingo only) Minnesota Charitable GambRng Control Board
❑Class D - Fee S 25.00(Raffles only)
❑Yes�No 1. Is this application tor a renewal? If yes,give complete license number � - 0 - 0
�J,Yes❑No 2. If this is not an application for a renewal,has or anization been�icensed by the Board before? If yes,give base
license number(middle five digits) � ���
❑Yes�llVo 3. Have Internal Controls been submitted previously?If no,please attach copy.
4. Applicant(Official,legal name of organization) 5. Business Address of Organization .
— � T - - , _ � ;( �-; ,� � ;} 4 0 � ;�a - ;:,r i�'��
6. City, State,Zip 7. County � 8. Business Phone Number
� ,
�-t, r1 � i- - ( ^!' � '�%�_j` r_ l(;; �.
9. Type of organization: ❑Fraternal ❑Veterans ❑Religious C�Other nonprofit*
'If organization is an"other nonprofiY'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
book number. ` - ' � t ' Attach copy of certificate.
�Yes ONo 1 1. Are articles filed with the Secretary of State?
�Yes❑No 12. Are articles filed with the County?
DYes❑No 13. Is organization exempt from Minnesota o�Federal income taxl If yes,please attach letter from IRS or Department of
Revenue declaring exemption or copy of 990 or 990T.
OYes�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 fou�years,attach
� �� evidence of three years
l �: �,�� existence.
•�' �:
17. Name of Chief Executive Officer 18. Name of treasurer or person who accounts fo�other revenues
of the organization.
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Tit�� Title '
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Business Phone Number �_ ? �.--- Business Phone Number
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19. Name of establishment whe�e gambling will be 20. Street address(not P.O.Box Number)
conducted --. �
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21. City,State,Zip 22. County(where gambling premises is located)
�' _ ��
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CG-0001-02 18/861 White Copy-Board Canary-Applicant Pink-Local Governing Body
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• Gambli�g�license Application Page 2
Type of Application: 0 Class A �Class B ❑Class C ❑Class D
DYes�No 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.
❑Yes mNo 25. Does organization own the gambling premises?If no,attach copy of the lease with terms of at least one year.
DYes�No 26. Does the organization lease the entire premises?If no,attach a sketch of 27. Amount of Monthly Rent
the premises indicating what portion is being leased.A lease and sketch $
is not required for Class D applications. ' '� ` ►'�
DYes�No 28. Do you plan on conducting bingo with this license?If yes,give days and times of bingo occasions:
Days Times
C�1Yes O 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
.,
,--,` ;� -f ,.i .,/-• �' j,'^i?• :,=��F';r� ��"�
32 Lessor Name 33./ Address �, ) ;,� , .( 34. City, State,Zip
. ��� °� � r ,% J I !if x��` 1�� �L/f'/l_C'� /�`�f f��J' �� ��f•1 ^'� �'7�� .
` 35. Gambling Manager Name 36. Address 37. Cit'y,_State Zip
. . � _ l .. . ; .. !' ! ' / � �"�J• % - //: ! f'"ft i
38. Gambling Manager Business Phone 39. Date gambling manager became
( ,: : � - member of organization: � !�f ,% !��;"1.�: �
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 Generat 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 Organization 41. Si�nature(must be sigr�ed►a�Chief Executive Officer)
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Title of Signer ' ' Date �, � --' '�
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� 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
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 receipi 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.
� , M .. _.:'�_ . _ ._
Signature of pe�son receiving application 43. Name of Township
X `, _r � -� � �l ..
Titlej ~ � Date received(30 day period Signature of person receiving application
begins from this date)
, i _ '1 X
44. Name of Person delivering application to Local Goveming Body Title
�_.- ! -- '`— �_._..1-
CG-0001-02 (8/86) White Copy-Board Canary-Applicant Pink-Local Governing Body