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87-1417 WHITE - CITV CLERK PINK - FINANCE GITY OF SAINT PAUL Council � ,. BLUERV - MAPd'RTMENT File NO. � ��/� � Cou cil Re lution . , Presented By Referred To Committee: Date .- Out of Committee By Date 1 .�. RESOLVED: That Application (I.D.#61153) for a One Day City of St. Paul Gambling Permit (Bingo, Raffles, Pulltabs and Paddlewheels) applied for by the Church of St. Pascal Baylon at 1757 Conway on October 4, 1987, between the hours of 1:00 P.M, and 5:00 P.M, be and the same is hereby approved. COU[�1C[LMEN Requested by Department of: Yeas D�,eW Nays rJicosia � In Favor Rettman Scheibel � Against BY Sonnen weiaa $EP � g 1987 6Vi1sOA Form Approv by 'ty A ney Adopted by Council: Date Certified Yass d cil Secr ry BY ss� � ��J � n 1��7 Approved Mayor for Submission to Council A►pprove b avor: Date i: � By BY �`'tio�iLy�:s"�':' a�:1i�� 7 - ��7 �1 • • � DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE INTERDEYARTMENTAL REVIEW CHECRLIST Applicant C`�t�rC�C�� cJ�� C(�1 t��(?�"1 Home Address �S-1 �ortc...� Business Name �.yrP Home Phone '� �J � " �J�a� Business Address �_l '� � � v 7.`yp � � h � e of License(s) d+'+e.- -�e. . Business Phoae �!��- �� e�m��_, `�;�ur�� .`z---.r��- c �J1�..a�Q. Public Hearing Date J •oZ-�I f License I.D. # �o(1 ��3 at 10:00 a.m. in the Cou cil Chambers, 3rd Floor City Hall and Courthouse State Tax I.D. # Y��Or REVIEW DATE DATE INSPECTION ' APPN REC'D VERFIID COMPUTER COMMENTS �DVed Not ed Housing & Bldg � Code Enforcement �IZ� � I(� � I Public Health � � � �� , �� Fire Prevention � u� a--` � I I Police � n�� ' � City Attorney � I �S I `n\n� � � 300 Foot Notice I � P� ► License Inspector's Comments: I HAVE BEEN GIVEN A COPY OF THIS NOTIFICATION AND UNDERSTAND THAT MY ATTENDANCE AT THE PUBLIC HEARING IS REQUIRID. . , . . . . . )��Sl' . - .� .... . . . _ . . . .. . . . . . . . - .� ,� .....d . • , � - � r CURRENT INFORMATION NEW INFORMATION Current Corporation Name: New Corpal�ration Name: Current DBA: New DBA: Current Officers: Insurance: Bond: New Officers: Stockholders: CIT? OF ST. PALTL /�� y/' ' , ' D:P.4P�TP•��:'JT OF FI?vr12;CE �ID ASAiIAC�i��P!T jy'_�.VICLS l� � DIVZSIOii OF LICEIdS�. !'�ND PEi?��T ADrLIP?ISm��orr I21�'OF�;ATICN ?yC.UI:� ��iITH Ar°LIC;�TION FOR P'�_',iZI�T TO CCr�IDUCT GAi�'�3IS_1G S�,SSZOt' Ii•; ST. P�UL l. P�ame of �7rganization Church of St. Pascal Baylon 2. Address where Organization's regular meetings are held 1757 Conway Ave,: .St. Pau1,MN 3. Day and time of :neetings Fall Festival (1 day) , Sun, Cct 4, 1987 - 12: 00-6:OOpm !�. Address where Gambling Session will. be held 1757 Conway Ave . , St . Faul , MN 5. Is auplicant owner of property Tahere Ganblin€ Session �aill be held' X °es `10 6. If leased, Who is owner of.property r;here Gamblin� Session T�rill be held? 7. If leased, attach letter of permission to conduct Gar�blin� Session, signed by lessor. 8. Name of officer m�ng application John M. H�fStede, Pastor 9. Address of officer maksng application 1757 Conway Ave,StPaulDate of birth 10. Ptame of manager who will conduct Gambling Session Jim Chastek 11. Address of manager 68 Darlene St . , St. Paul, MN 5511� Date of birth 12. In connection with what event is this Gambling Session beir� held? Fall Festival (1 d� 13• ��`hat type of gai*ibling device(s) will be used? Paddlewheel X '?�.pboard F.af'fIe X 1.la.. �ay, dates and hours this application is for and number of sessions. � � - �..y . . Sunday Gct 4, 1987 12:00-6:OOpmp�o. of Sessions 1 Day(s) Dates Hours 15• '�1i11 prizes be paid in money or merchanctise? Money � � 16. Is the a�plicant association organi.zed under the laws of the State of ��:innesota? Yes 17. How long 'r.as Crganization been in existence? 41 years l�. r�v'hat is the purpose of the Or�anization? Reli�ious con�regation & �rade scrool 19. Officers of the Organization - P3ame-Title Address Date of birth � .1wvVt.�.�tn;,Mn.+.w�,ti-r.,,,-.n..:.;: .. . , �r+h}� �jnhn Rnanh. PY'GS � : 2�- S»mmit Av�o� �t P�,Lti� R�v John M Hofstede, �V-P 1757 Conway Ave, St. Paul Marv Healv. Secv 1757 Conwav Ave, St . Paul �ohn F,'�h;�P�� 757 Ganwa_y Ave_. �t _ P�111 icev. Michael G � Connell 226 Summit, S t . Paul G�- �-;_,� � 20. 'Give �na.r�es of officers or any other persons paid for serv�ces to the Organizatlon. ' ;dame-Title Aadress �ate of birtr none 21: In whose custody will records of Qrganization's Gambling Sessions be kept? Name Rev. John M. Hofstede Address 1757 Conway Ave. , St . Faul, MN 22. Attach a copy of your Organization's membersr.ip roster and date each member joined. 23. Attach the Gambling Session �iana.ger's bond. 2lt. Attach a copy of the Dep�rtment of the Treasuiy,- Internal ?evenue Servi.ce "Return of Urganization �xempt from Incoine Taac", Form 990.. (Ch2pter f�19.OL: (1).) 25. Attach a co�� of Department of the Treasury, Internal Pevenue Service, "�xemnt Qr�an- ization Busines� Income Taxrr, Form 990T. (Chapter l�19.0�. (2). } 26. Attacr� the annual report required of charitable organizations by i4innesota Statutes, Section 309.53. (Chapter l�19.0�. (3). ) 27. F:ave you read and do you thoroughlv understand the provisions of all laws, ordinances and regulations governing the operation of Gamblin�; Sessions? y es 28. Ar�y cha.nF-es desired by the applicant association may be mac�e only *,�rith the consent of the License Committee. 29. Has any person(s ) paxticipating in the operation of any of the gambling sessions cov- ered by this License ever been convicted of a felony in the State of i°Iinnesota or in ar�y other State or Federal Court? Yes PJo X If answer is "yes", provide names, addresses and birth-dates. . , Church of St. Pascal Baylon Orga 'zation Bp � ; - - i�-v� f cer-Title and �/"`�i�� (A1a.nag r in cr,ar�e of CambLin� Session) State of i4innesota) )SS County of Ransey � � d j�T and �/�'�'j�� Ci��1�"i� being duly orn sa� that they are the petitioners in the above a�plication; that �hey have read the foregoing petition and Trnow the contents thereof; that the same is t,rue of t'.:eir ac,m knowled�e. Subscribed �nd sworn to before me thi� v � �� day of � V(7�S i 19� ALBERT B.OLSON • —� NOTARY PUBIIC—M�NNESOTA ,, RAMSEY COUNTY Notary b1ic, Countv, �Li:ines �Y�^m.ExpiresAPri�12.1988 . 2•fy co�smission expires • Buildir� Depart:nent rlpproved Disapproved by Fire Dep artnent A�proved ?isapproved by Police Department Approved--'�isapproved—'—by ��.,...... �-"`� t � Minnesota Charitable Gambiing Control Board LAWFUL GAMBLING EXEMPTION , ��,. +, . � , Room N475 Griggs-Midway Building -. FOR soaR�use oN�Y ` 1821 University Avenue � 7 —�L�/J - = St. Paul,MN 55104-3383 ,_�� ';�� (6121642-0555 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. Organization Neme �^��^b°'�ff�"^�^�'°'a��^�� '..::urc.• .:' t. . ascal :�:a��l�r. .--��i4F��-�UI � 2"fVl�a:'. Address City,County,State,Zip Code 1"l�� _. ,.�w� �vf :±. �.�wl , "?a::-SE" �'.:l - ;r. .� Chief Executive Officer's Name Phone Number Manager's Name Phone Number �;�'V _ _.. - . .:i��tFQ@ �7�— :� ��°.E� ' ;-'�uS:E',� -�-r —z� Type of Organi2ation " If Other Nonprofit Organization ICheck One) ❑ Fraternal O Veterans ❑ IRS Designation � Religion ❑ Other Nonprofit Organization ❑ Incorporated with Secretary of State ❑ Affiliate of Parent Nonprofit Organization Name of Premises Where Activity Will Occur Datels)of Activity i,..,.:7't.'.. ' .�* . . c:SC t: _. . �� ,!: Premises Address ::_ r�:i . . .. _ ! '�>� , �. . _ au? , .. �5�:�r Games Yes No Gross Receipts Value of Prizes Expenses Profit Bingo ;,� � Raffles .� : Paddlewheels �; Tipboards ;� Pull-Tabs Use of Profit Distributor From Whom Gambling Equipment Acquired Distributor's License No. I affirm all information submitted to the Board is true, accu- I affirm all financial information submitted to the Board is rate, and complete. true, accurate, and complete. �, , . ,-. _ , _, `. ., :., ; �., � _ f�� . : .. � Chief Executive Officer Signature Date Chief Executive Officer Signature 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 Board and will become effective 30 days from the date of receipt (noted belowl by the City or County, unless a reso�ution 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 Na e of Local Governi y ICity or County) Township Name IMust be notified when County is the approving body) ignature of rson Receivi g Applic 'on Signature of Person Receiving Applicatio� �.� • Data Reeeived Title Date . �S a CG-00020-01 �4/861 W te—Board Canary—Board returns to Organization to keep Pink—Organization Gold—City or County