87-1418 WHITE - C�TV CLERK
PINK - FINANGE GITY OF SAINT PALTL Council � 7 /
CANARV - DEPARTMENT
BLUE - MAY.OR �� FIIe NO• �
� Co cil R olution - �r,
� ,
_
Presented By
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D.#31646) for a One Day Gambling Permit (Bingo,
Raffles, Paddlewheels, Tipboards, and Pulltabs) by the Church of
St. Casimer at 930 E. Geranium on October 4, 1987, between the hours
of,1:00 P.M. and 5:00 P.M, be and the same is hereby approved.
COUNCILMEN Requested by Department of:
Yeas Drew Nays
Nicosia � [n Favor
Rettman
Scheibel � Against BY
Sonnen
W�ida
G�TilsOri SEP 2 g 1987 Form Approved ity orney
Adopted by Council: Date
Certified Pass d C ci( Secr y BY
sy�
�� r �,
t�ppr v d y Mavor: Dat -
^�' �` � Approved by or for Submission to Council
g By
� �_
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, -
P�7 -i�i�
DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE
INTERDEPARTMENTAL REVIEW CHECRLIST
Applicant (� h�,irC�'1 C��- �7t, . l (,�S�Y�I.�� Home Address ��� 4 . �1 Qn�;_,,� � �,..,„,�
��p�.,� er�n
Business Name �,��v Home Phone _ -��c� -Q 3 co 5
Business Address �l 30 � . _�Qnrz �m�.�,,.,� 1'yp� of License(s) ,ti,° ,
Business Phone `'"�''l� - 03(s�.5� � -4-0. £
- �
Public Hearing Date �, License I.D. # 3 ((��-(�
at 10:00 a.m. in the Co ncil C m ers,
3rd Floor City Hall and Courthouse State Tax I.D. #
REVIEW DATE DATE INSPECTION
APPN REC'D VERFIED COMPUTER COrIlKENTS
�oved NOt ed
Housing & Bldg �
Code Enforcement G�' � . •
�
Public Health �
� � a ' - � .
�
Fire Prevention 4
�1 �� � � � � � _ �
rn� �
�
Police �
C' �
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f
City Attorney �
I
ENS �
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300 Foot Notice f
I
� !�' 1
License Inspector's Comments:
I HAVE BEEN GIVEN A COPY OF TIiIS NOTIFICATION AND UNDERSTAND THAT MY ATTENDANCE AT
THE PUBLIC HEARING IS REQUIRID.
� � �
CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Nsme:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
� New Officers:
Stockholders:
� .•, � . �� �_,- �y��.
. ���. � � Minnesota Charitable Gambling Control Board LAWFUL GAMBLING EXEMPTION
- Room N475 Griggs-Midway Building FOR BOARD USE ONLY
, 1821.University Avenue.
- - St. P'�f'ul,MN 55104-3383
'������� (612)642-0555
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.
organizationName Church af St. Castmi r - ����������
Address City,County,State,Zip Code
qy4 c. Geranlem SL. Paui, �ta�sa„ ��!`I ��ti:�
Chief Executive Officer's Name Phone Number Manager's Nmne Phone Number
Fr. Tori tieysr, uMl l;�-u�G� Narion Stinson �/"f�J��s�.
Type of Organization If Other Nonptofit Organization(Check Onel
❑ F�aternal ❑ Veterans ❑ IRS Designation
�l Religion ❑.Other Nonprofit Organization ❑ Incorparated with Secretary of State ,
, ,. -- - - - � affiliate of Parent Nonprofit O�ga�ization
Name of Premises Where Activity Will Occur Datels)of Activity
St. Casinir school hall
Premises Address
930 �. 6eranium, St. r'aul t�J/�/u7
Games Yes No �k�,�tos�RBeeiptsa ° Vs1u�o�F`rizes E'icpe�ses. Profit� '
..�:
Bingo X ��,.
Raffles x � �
� �
Paddlewheels. x ���� � .a�; ����
Tipboards x ��� �;, >. �'�°�,'
. S".H?:'.... �
Pull-Tabs X Yr
: r
.._ _ ���
,�'�, �=s � : � ��
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� � � ��,�"' ���� �.:.a �.���, > ;�,.- ,: '
.
,
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4��.,
, �
�,�pm� �qy� Distributor's Licertse fYa..
Oiatcit�tlit�r�Fo�YTho� A
� iew� -�d ,�`�`a���F
a,`
I affirm all information submitted to the Board is true, accu- [.a#fir��at�'fnancisG=infar.matior�Fsubmitted ta>the Board:is
rate, and complete. tr��„aecucate.,ancLcqm{stete� . ;� �
. . - - , � ,/3/87 � � �
Chiet Executive Officer Signature Date Ckiief Ezaeut�eOffice�Signatare Date�
ACKNOWLEDGMENT OF NOTICE BY LOCAL GOVERNING BODY
I hereby acknowiedge 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 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(Must be notified when County is the approving body)
Ci v f ^�
' Signature of Person Receiving Application Signature ot Person Receiving Application �
Joseph C3rch2di r _
Title Date Recaived Title Oace
Lic�nse I�s�ector 9/3/�7
CG-00020-01 14/86) White—Board Canary—Board returns to Organizatio�to keep
Pi�k—Organization Gold—City a County
.r • •• v��� v� ...�. 7"t'.i.+ � j� �—' /I ! a�
' • :J:�:�'+.Lw:�...i i V.—' ��^it:.l.:. _�� li=s::t�::.':`��.'�.�.:'!' :.::._:�''.^.,... �.i� Q
yI�S10:1 Or ��%:iS� :�i.�i ?:r:u"ST �t������1�O:t
I=�'QR�ATICN �CT3I� :��IT_H t�.PDLIC�TIi.�1 rQR ?^it:,.'T'•" TG CC?�sDLCT Gni�?��G SGJSICt� I:: ST. ?�•'JL
1. .:a�.�� oi V r��..ra�i+6Ti�VI1 ,S�T Cf�-S 1 �'Yl 1(� C��(eCt1
2. 9ddress whe� �anization's reg�.ilar nestings ars held ��� G • ,�?E�f��?Ll {y(
3. La� ar.c ti.e of :�eetin�s �Ll l�TE��'y -
�
��. Adc�:sss c.;here CamblinP Sessioa :ai�? i�e he2d /3� C (�`�Z��[U{�
5. Is �r.�ca.-:� owr:er o.f propert� �3rer� �a+.-:bl��� �essien wi�'_ re he_�'�_?es '�To
5. I� lsasec, :�;'r.o ;s o�aner oi pro�ert� �r;'r.srs Gn�,bl.in�- Sessio� ��ri:ll �e re?.d^:
7. If leased, at�ac: letter of per�ission to conduct Gar.ibli^f Session, s�g�ed by lessor.
�. �lame of oflicer ^�a�i� applica�icn FiQ �Y�'1 /��E7�
9. r�dc�ess of oiiicer maIri.ng applica�ion ��y L.�-72,�3.f>/��ate of birt:� 4� 3�
10. ::ane oi rana.Fer �rho will conduct Caircbling Session ��4� �����
��. �ddz�ss of r,.�T�er �3�' G�"T�'���'1�/ �ate of ��h � 6 �g`
12. In con.rection with �rhat eveat is th=s GambL.ng Session be�r:g neld?_
��4r� ��%'' ��� . . _. �._, .
-----. __. ._ . _:. .
I3• 6�Jhat ty�pe oi ga�bL2ng device(s) �ri.11 be used? Paddlewr�el�'?'ipboarc� � P.aff'Ie�i
I�. :�a�, da.tes and hours this aapLcztion is �or and number of sessions.
Da�(s) � Dates l� � �7 u�urs ��" � T'o. of Sessicns
?['. :di?1 prizes be oaid in none� or �erc?^.anc.'ise? /J�'p,C�
16. Is th@ 3DD�:.cant association o:r�nize� under the lz�rs o` t�:e State oi :�:i.�?r.esota?�
17. hoGr long .".as Cr�.anization been in exisZe.^.ce? m@��' T"�,� �4���
1�. '•y'r.at is the our�ose of the Oraariization? �cZ� �L1�1S
I9. Of��cers oi �he Organization
ilame-Title Addrsss �aiz of bi.�"th
��4 ,�� /??���2- ^f���2 �3� E ��-�21�-.Ut�.�i �/�/3�
�� ��°�2a ��so�,� ���'� _9�� � �Ye�e��-� ��r����Z..
. , , .
� �-�i�i�
" ?=• �i•re :�:�s o:' ei°=cers or �,; otaer �e=sors �a:�' =or sez^^ces LJ L�e Ow-�T.=2&L:�.OI:.
_•ia�.e�:.t�e �dd:ess �ate oi �ir�r
Zi. I� Wf.O�° C1IStCG�j :v'1� :'OCO�±S OZ' �I'�3I21ZS�iCS1�5 ::^�.*I^��^F. Sess_ons �° �o`J�?
.�ame �.�/�c0� ST�J�'"'-�a� �dc'.re s s ���( � (���II.L�
22. �t�ac� a copy oi �our G�g2r�i.zation's members'r�p roster and date eac:� me�nher joined.
23. 4�tac'r. tne Ganbl,i*� �ession :•ana�er�s eond.
2�:. it�2.C�' 3 COD3' Oi �::8 Lep�Tt��er_t OI t.B `T':°SSLL^'� lnte_^^al. �evenue :@'_"�'�_C° �t:��il7L'_^. OI'
n.T?3i']7.23t.:.CP. ;XE,'P.!Lit, �=OL: j.:iCOi.":B `�r3X«� i0�'?1 q,r'�. ��ti:Z.^,�@S' �114.:J� �!J 1
�5. �t�3Cr 2. COD� 02' i2!,J2I't~ent OI �I12 i''_'O2.SU.I'�'� I:�2Z':12..1 �.°•%@_^.L1Q �@^V;.C°� �}"'�e:�t Grpan-
ization �usiness �ncome '"ax", Li or^� 990T. (C'r_ap+er !�l?.0�.� (2). i
26. :�ttach the annual re�ort required of cr�aritahle organizations by ��.ir:nesota :,tatutes,
Section 309.53. (Chapter 1t19.OL (3). )
27. �Fiave fou read anc do vou tho^ou�hl� un�erstar_d the �rov_sior.s o�' a11 Ia�rs, ordiaances
and re�ulations �cvernin� the operation oi CanbiinF Sessions?
Zc. �� cta.*i:�es des�red by �re appi_cant assec�at��r_ nay ne mace only c,�t:� t;�e co^sent o�
t!^�e License Coimrcittee. �
� •
Zq: iias ar.� person(s) pa.�ticipat�g in the operation of an� o� tre ga.�blir.� sessior:s cov-
ered bp tr,�.s 1ic�nse ever been con�cted oi a ielon in tre State of :�is.aesoza or in
��-- �y- a� other� �tate or :iederai Court? Yes � .�lo�. Ii ar_swer is "?es", �rovide
names, addresses and birth-�tes.
SI�'•(� �� J2 C�CI/�c�
Gr�aniza�ior.j
_ .. _ �p �72�s�'
(Offic�r-?'itle,
a�d
(I!an�zr �n c:as-�.e o_' Camblinr Sessior;
Sta�a of :�ii�esota)
%S�
�our.t r of ?�r.se3 )
(�L+n C� ��-�: ���Sc��r. and
be�ng duly sworrs sa� that t:ey s:,= t.'�e pet�t'_oners _n �r,e above a�pLcation; �hat �:ev have
:"QC� �:@ ?OY'8�01IIg p@t±.t].OLl 2IIL� '�lOW �he COIIt2At5. ��SZ'°Of� LI13+,. '":.r2 53IR@ yS '_S° O" :i:g'Z'
o:�r� '{no�rledFe.
a .�1 s
:.ubscr=bed and swar!z yo bei�rs �e t'�.is �"�.. �RISTINA L. SCFiNiE1NLEA �
,� :,.
_�j d3� OS'. �� �o�'� ���� NOTARY PUBLIC-MI�!MESOTA �
��� \ ��..F' DAKQTA C!'i�A!;7' S
°Kn� l—,". `� .Cc-.� � � �:,'�c,,,,�,; _ : _�^� ;
, ` - - - ►�wwy�,v�n�, . . . ..:o
:;ota�,, ?ub�c.� a. c-�-t-z--.._-�;QUntv, �•Lnnesota
:•:J ccsuni.ssion Pr�i=es q �
! �u�lcir� ^enax��ent :���roved Disa�nroved by �
-i:e �e�arL;..ent �D�roved �isa�p.oved ��
� ?olice �eoart�enL iDproved--7isa�raved-�;y