87-1426 WHITE - C�TV GLERK
PINK - FINANCE G I TY OF SA I NT PAU L Council /
CANARV - DEPARTMENT Flle NO. ��/��x"
BLUE - MAVOR
. Co ncil R olution �
; �
. . , ��,
Presented By
Referred_To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D.#45263) for a One Day Gambling Permit
(Bingo and Raffle) by the Missionary Sister of St. Peter Claver
at 507 Hall Avenue 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:
YeasDr@W Nays �
Nicosia
Rettman In Favor
Fei�ea�l
� Sonnen Q" Against BY
Weida
bvil�on Q
Adopted by Council: Date SEP ,i � �(7T Form prove by City Attorney
Certified Pas d ouncil Se tar BY
g�.
Approved 'Vlavor: Dat
� ��;T� — � '� Approved by Mayor for Submission to Council
By By
�F rtLirL.!a`�`s.:9 �'-� : 1 ;� I�J V! -
(;'f�✓l�'�
� . 1�:° �11401 �
�-i � ' DEPARTMENT � - - - - - -
CONTACT NA?IE
- "� PHONE � :
z- DATE .
AS3IGN � (See raverse side.):
_ Dapartme t Director Mayor (or Assistant)
_ Finanaa d �anagene�t Services Director � City Clerk � 9� �U �t��
_ Budge� D rector _
� City Att ey _
(Clip all locations for signature.)
V C 0 N C D Y (Pu,rpose/Ratio�ale)
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COST N D AC S C T D:
,� .
N V B G D:
(Mayor's s�i ture not required if under $10,000.)
Total t of Trans�ction: �L`Pt Activity Number: In.'�-
Funding S ce��
ATTACHI�tENTS: � (List and number all attachments.) -
ApP�`�` s
� �,
DA MINI T 'TI C f� I A-
_Yes No Rules, Regulations, Procedures, ar Budget Amendment required?
_Yes No If yes, are they or timetable attached?
D PAR T: CITY AT�'ORNEY REVIE6i
�Yes Councii xesolution requiredY &esalution required? ✓Yes _No
_Yes Insurance required? Insurance sufficient? ,rYes �No
_Yes �nsurance attached? .
� CITY OF ST. PAUL
� • ,� DEP.4RTi�'i1T OF rlidAl�3CE r1PID P-fAl1.'�G�'�P'�2:T Sr.'.�VICES (����Y�2�j
DIVISIOPJ OF LICIIIS:� �ND PE��ffT ADMIrr;IST3A120P�
Ii'FO�MATION ! �C,UI�� t,1ITH ?�°LICATION r OR �'i�MI i TO CCP�IDUCT GAi•�3LIi�G S�,SSIOP�; I;�t ST. PAUL
l. i•lame of Organization �TY '�I�.� ,� 2 S� t�►�n � l�
2. Address where Organization's regulax mestings are held Z6 S G e h,��,,, rv � V� C,
3. Day and time of ineetings n,,�, �(�,
!�. �ddress where Gambling Session c�rill be held ,�(�`7 Ha L(_ �v2,
5. Is aoplicant owner of property where Gambli� Session will be held? Yes_�`io
6. If leased, who is owner of property where Gamblin� Session =.aill be held?
51; : N1 a 1fi h e �,i`� G I��. �r,�-,
7. If leased, attach letter of permission to conduct Gamblin� Session, signed by lessor.
8. Name of officer maI�ng application S;�}-e v� �"�, � ev i S
�
9. Address o£ officer maFa.ng application ��S�� ���u T�p_ Date of birth ._t _�—I Z
10. Pdame of manager who will conduct Gambling Session (o �0 G�.o-�e� AV2�
11. Address of manager p h��,p� ���� h Date of 6irth �
12. In connection with what event is this Gambling Sessian being held?
t�� 1,1, ��sCt � �� ' � ��� o�,(,�
13• j�Ihat type of gambling device(s) will be used? °-aa� �°°� �ear� P.affle
1la.. Day, dates and hours this agplication is ior and nu�rber of sessions.
Day(s) � Dates j� --��_Hours �: y� �o s� °t� No. of Sessions �
15• T�TiIT prizes be paa.d in money o mercrandise?
s�.�,__
16. Is the applicant association organized under the laws of the State oi ��iinnesota?
17. How long has Organization been in existence? �,�; �s,�,a..r ��5 M�,s,.��,
lE. 4dhat is the purpose of tY:e Organi Zation? ��h� � r r �1n p (,�r� �}� ,� r _
19. Officers of the Organization
�1ame-Title Address Date of birth
��
sa�d � cZh.�,� � ��1 -- o� , �i
� ����iy��
20. vive na�es of oificers or a�y other persors paid for services to ths Organization.
,dame-Title :�ddress �ate of birth
21. In whose custody will records of Organization�s Gamblin� Sessions be kept?
:Tame :�,..wK�,� o�, "��i. ��,� v�,v-eA Address 2/S �,�.v�.��v� ��l-�
22. Attach a cony of your Orgazrization's membership roster and date each member joined.
23. A�tach the GambLing Session �fanager's bond.
2l�. �ttach a copy of the Department of the Treasur�, Internal ?evenue Service "Return of
Organization �cemvt from Income '"ax", Form 990.. (Chapter G19.Olt (I).)
25. Attach a copy of Department of the Treasusy, Internal Pevenue Sez�i.ce, ''Exemnt Or�an-
ization Business Income Tax", Form 9°OT. (Chapter �.19.04 (2). )
26. Attach the annual report required of charitable organizations by i4innesota Statutes,
Section 309.53. (Chapter ltl9.0l� (3). }
27. Hane you read and do you thoroughly understand the provisions of all laws� ordinances
and resulations governing the operation of Gamblin� Sessions?
28. Any chanF-es desired by the applicant association may be ma�e only Taith the consent of
the License Cairmcittee.
29. Has a.ny person(s ) participating in the operation of any o£ the gambling sessions cov-
ered by this license ever been convicted of a felony in the State of ijinnesota or in
a.�y other State or rederal Court? Yes No If answer is "�es", provide
names, addresses and birth-dates.
l� �j {�Q �
iJ1.o�e�; `J\,�Q,�o �"��, , M�l,;.�/YI,o�.�..A.Lt�/ -��� ��� �'I��1�✓(,��'
Organization �,Q;;;�.
gy .�;a�w n� ��..�.�.�s,�
(Officer-Title
and 1�1,e-�,s�:aV �l/►'�-e��n
(I�tanager in c",arge of Gamblin� Session
State of ;4innesota)
)SS
C ounty of R.ansey )
�; s�.r� << : }.��� and
being duly swor� sag that they a~e the petit�oners in the above a�plication; that �hey have
re�.d the foregoing petition and �rnow the contents thereof; that the same is true of treir
own ?snozlled�e. �,�� ,
Subscribed and sworn to before me tr.i� =
� day of��_c_,� 1° < � ;. _,���. KR�S?INH L. ;CHWHN�G� �
, ��'" NOiARY,ueuc-,n�rt�s'T?
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` p .�.: ,�y,� �nn,� �- �
�1 .�'1-k-�._ �,,i�:_.:i��-� ��� � .,� .. �.._. .,...,...:.v o
Notazy ?ublic,�_�,� Countv, 'rli.nnesota '."".�"�~M����•�-�r,
�•�y co�mission expires�,.,_.,� �� S�,
Building Depart:nent Approved Disapproced by
Fire Depart�-aent Approned Di.sa�proved by
Police Denartment :�pproved�isapproved--by
. �. � ;�`� ��'7-if���
�. .
Minnesota Charitable Gambling Control Board LAWFUL GAMBLING EXEMPTION
Room N475 Griggs-Midway Building FOR BOARD USE ONLY
1821 University Avenue
St. Paul,MN 55104-3383
�"'�� 16121642-0555
INSTRUCTIONS: 1. Submit request for exemption at teast 30 days prior to the occasion.
2. When compteting 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 Name Liceroe Nu�mer�M wronW a pevia�aN�ed�
�.�issionar,y Sisters of St ete !' t� vA
Addresa 7 5� C antury �ve �O. City,County,State.ZiP Code ' `+ �t`
;�t. :aul, :.r.. 55125 .�ash�r.� ,cn ;;ou..
Chief Executive Officer's Name Phone Number Manager's Name Phone Number
�ist�r .:.ary iie�is r�:?-�;�t��. �onald =. -_or��^ �?::_.;^�=.:
Type of Organization It Other Nonprofit Organization(Check One)
L� Fratemal D Veterans � IRS Designation
�] Religion ❑ Other Nonprofit Organization � Incorpo�ated with Secretary of State
❑ Affiliate of Parent Nonprofit Organization
Name of Premises Where Activity Will Occur Datelsl of Activity _
St. �i�tthe�Ns
�all ��7 Hall t�v� . �t. i%aul . ._. �5, ;)7 �ctor,�r ��, 1�;�'7
Premises Address
�
Games Yes No �y, ,� �€��rzes� � �ac� � ?�`� Profi��:
F �,M ; ,., ;
, �.: ...
.ti r� �. ,..„.. ....:�,, ,. �,,. . ->•.... ., ,.. . .
��
Bingo Y$cu � x ��a��' r�����`4���s+���� �� � ���°��A�t: � � *� �'
� ;,�+X i �> x_...-», ;,'�n �e " �
> � ' �
,,.�
,._....�.. . ,. ... ., .. ,..� .
.:
: ..
,y..t . , . �. ..,�.�s . -' . , ..
� +` ,� `mu" -�� � � ., � -1 � w'� -� �,,� :. �+�� K � c,�
Raffles Le s ,,������° ��� ��; ���� }���`���� �3�;�k x� i ����� � ���.
� ���, y�� °iR a�..w,. � .�'» �'+,S'� ::k� .A,.
�"``� �`��r'�`* �� � �' a a`����, � � �X�a��'�F �u`� w1°$ `�"�q
Paddlewheels �_ �������`�� ;r� � � � ��. n �.��x � Y
ai 0 �„��s������x� .�ey.,.,� s�,,�� �;. �,���, ;r .
� � ' �� s - . . ��' iail .';�
'°��� : �'37��� �A° �. x '�,: . - �� '�'> �,b
Tipboards ;10 ��,'��x��"���`����`� ��"���� '�'�� � � �� ��¢,; ��
�.,
, ;
„�„ � �>�,.� .., ;�-. -., a�. , ; . - .���. �.
�
Pull-Tabs ;lo ��„r � � ��, � , fi, �' :
�� ��
�..... : ��� �,; � ,
�wA�: ���=` �� o:�' V� � '
fi� .a��.'-�n < ( ���.
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����a ����a.r ,�����a� � � " � k t�'striluttb���9Ces&fl Nc�n_-
°�:x'� �"_, r. . .: _. . "�t ��'� 3� -��. ���.�''�,"s °t�cus
S� �� 4��a '6�' Y, �; �r,�,+� s
I affirm all information submitted to the Board is true, accu- �"��"'"tc�al�ft���a�i���ior�st�C��i�e�t�the:Boarcf=is
rate, and complete. ��a�'at�a�'�vc�i�t�,
� ? �3 a,�:
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x" 8 � G�`�4^°��'. �.,.,3 1 ,"h ��,)}
_. %e T S hi r;X.'V,' S�
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Chief Executive Officer Signature Date `�[1� " �'`" 6a4e�
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 Bo�ard 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
Na �of Local overning Botly(City or County) Township Name(Must be notified when County is the approving bady)
�l�y 0� $t. ?8U1
Sig ature of Person Receivin Application Signature of Person Receiving Applicatio�
3osepF� Carche�i
, �
rtie Date Received reie oete
� Lic2nse Insoector 9/3/L7
CG-00020-01 14/861 White—Board Canary—Board retums to Organization to keep
Pink—Organization Gold—City or County