87-1449 WHITE - GITV'CLQRK
PINK • - FINANCE�� C I TY OF SA I NT PAUL Council
CANARV - DEPARTNENT . ��J���
BLUE - MAVOR � Flle NO. �
�
Co ncil solution
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Presented By . `
Referreid To Committee: -Date
Out of Committee By Date
RESOLVED�: That Application (I.D.#84487) for a One Day City of St. Paul
Gambling Permit (Bingo, Raffles, and Pulltabs) by the Church of
St. Mary's at 261 E. 8th Street on October 11, 1987, between the
hours of 11:00 A.M, and 3:00 P.M, be and the same is hereby approved.
COUNCILMEN Requested by Department of:
Yeas Drew Nays
�� � In Favor
Rettman /,
Scheibel V Against BY
�
�
WllsOn F' p Form ro d b Attorne
Adopted by Council: Date ��T — '"? �o� pp y Y
Cerlified P-s d by Council S retary BY �
By
Approv Nlavar: Date �r� � e`� ���! Approved by Mayor for Submission to Council
By BY
�� 0 C T 17 1987
; ����9
1�° Q11402 �
� DEPARTMENT � - - - - - - _�
' , ' l _corrrnc� � ,
'2q�- — PHONE �
� DATE
ASS J � R SOUTING ORDER: (Sse rev�rse side.)
_ Depart nt Director �.Mayor (or Assistant)
_ Financ end Management Services Director � Gity Clerk ( / � -� -� �7�
Budget irgctor " _
� City A oraeq _
0 (Clip all locations for signature.)
W � C D ? (Purpose/Rationale)
'�� � ��s�ri d�e:r re.�c�►re v►-,�.�s w� ll. I�. w1�.,w�--a
� l��. boc� Ce�� �o��.�� w< <� h.� �e��
�` � r - �� obl�. ���-,5 . � � ��)
i�S � ��� �� �
COS ND C D:
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N V CHARGE 0 D T D:
(Mayor's si nature not required if under $10�000.)
Total Am t of Traasgction: {n ' 1� Activity Number: �,, �
Funding urce: � '�
AT'TACHMENTS (List and nwnber all attachments.)
���`' �` �'i°
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' DIi_ ST 0 DU S ��� ..
_Yes No Rules, Regulations, Procedures, or Budget Amendment required? �
4Yes No If yes, are they or timetable attached?
,
DE ARTMENT VI W CITY ATTORNEY REVIEFi
�Yes . Council resolution required? Resolution required? ✓Yes _No
,�,YYes o In�urance required? Insurance sufficient? ,_Yes _No
i'Yes o Insurance attached?
: . o�- r.�� ,
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. \� .. -���U�ly
, � I Minnesota Charitable Gambling Control Board LAWFUL GAMBLING EXEMPTION
'���'' ,��:ki;oom N475 Gri s-Midwa Buildin
99 Y 9 FOR BOARD USE ONLY
I 1821 University Avenue _
- - St. Paul,MN 551043383
.:.....;��. �(612)642-0555
INSTRUCTION$: 1. Submit request for exemption at least 30 days p�ior to the occasian. ,
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 1 . financial information,sign and date the form,and return to the Board within 30 days.
Organization Name - �e��ff�W a c�e�1'����
Ci1l.F1'C"• v ' 'J�' �SF]�'�,' r �" r It �
Address � City,County,State,Zip Code
�
��3 r:. =;t;s ��r�et = t. •,,t: -,. ,�� . . ,.�,
Chief Executive Officef's Name Phone Number Manager's Name Phone Number
� ~i.• �l.iJ�:i<�Z5' �.VZ.ZC�c ��ZL�-� � . L� � � �!, :t. `ic ��. t:�' :t:•.l!?'!` . —
Type of Organization I . If Other Nonprofit Organization(Check Onel
❑ Fraternal i ❑ Veterans O IRS Designation
� Religion i O Other Nonprofit Organizatian ❑ Incorporated with Secretary of State
. " ❑ Affiliate of Parent Nonprofit Organization
�.,-�_.,_Name.of.E'iemiseslNh9reActiviW:WiII,E�ccw.-:__ ..�x_-..�. _�-. :_ ._,,._,.,v,_.-- . ..,.::— •. ,;... __ __.__ _ _�_. - ---- . DatelslofActivity
' t:,:t u i-,r :� S C. :'?a r�i c;;. 5 t. :�a t�
Premises Address
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25i �:. .=t':;I St. �'='_. ,_i , ~ , _ ,
Games � Yes No °,�oss Receip� �al��o�Ptize�, °. Eicpe�rse� `Prafit
Bingo � ���`
X s tr
Raffles ' '�°
�,... �;
�_.
� x
Paddlewheels �� s� t �' ,�� �£,: �'
�,�'
� � � � �,"�a ` ,� � �
� m �x
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Tipboards . � �� �<
� , . � . . ��t k:-, k Y:D
. . ��. � � � �:
Pull-Tabs y t �`-��, �„� �� � � �- �'""`� :�:
`` K::
. . ��� M� e ``w $ �
�, ;F a�E'"'a``�.,*�.k§'�,�`s't� ��� � s
.. .n �
DisVibutoc•"s Eicense No.
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Et�Ftcur�Yrt 4��+�V�!�-"•
�y�� � � a.�r �:
I affirm all infor ation submitted to the Board is true, accu- :t-affic��at�:#i�a��is�u�farEna#ia�submitted.ta th�;.Boa€cf'is
rate' an omplete. / - true�a�ra�t��artrt:co�piefie:
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ChiefExecutiveOfficer ignature -j Date �ie�ExacutiveUH'�cer�grtaturx• Date>
%�ACKNOWLEDGMENT OF NOTICE BY LOCAL GOVERNING BODY
f hereby acknowl�dge�eceipt of a copy of.this application. By acknowledging receipt, I admit having been served with notice
that this applicat n will be reviewed by the Charitable Gambiing Control Baard and will become effective 30 days from the
date of receipt (nbted below►by the City or County, unless a resolution of the local governing body is passed which specifi-
cally disallows s4ch activity and a copy of that resolution is received by the Charitable Gambling Control Board within 30
days of the belovy noted date.
CITY OR COUNTY TOWNSHIP
Name of Local Govemi�c�Body ICity or County) ,r-� Township.Name(Must be notified when County is the approving bodyl
Signature af Person Recejving Applicatiorr Signature of Person Receiving Application
:� _l ,,� _`.
- -
Titte� � ' Date Received Title Date
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CG-00020-01 14/861 White—Board Canary—Board returns to Organization ta keep
Pi�k—Organization Gold—City or County
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. ' CITY OF ST. PAtTL � =� �35�t�
DEPS��T?�"»+T OF rII3r1�;CE AIID P�lA;1�G�IEt?T SE'�VICES �G��l�f��
� , � DI`IISIO�J Or LICEI•15�, �ND �"RI�LCT ADMI�?IST:'�A�OPt
, _�
IT_1r Ot,�4ATIC�! �C.UI� ?•1ITH ^�7DLICaTTOrr r o� �::��T TO CC"�IDUCT G�:��3ISiTG SESSIOPd I.•? ST. p�UL
1. .dame ojf Organization
2. Addresl�s where Organization's regulax meeti.ngs are held �./o� ��tq� ��— �
3. Day anld time of ineeti.n�s � � j/1/��e p ��,
4. Addres� where Gamblin� Session :aill he held 2�D� �Q�� � �d� .
5. Is anp�.icant owner of property where Ganblin� Session Hrill be held'�Yes `Io
6. If lea�ed, who is owner of pronert� Nhere Gamblin� Session T„rill be held'
i. If iea�ed, attiac:� letter oi permission to conduct Gar.iblir.� Session, s�gned by lessor.
8. Name o� officer maIang application �'Y �_(� S rz�s C?�IT�
9. Addres� of officer maIang application a(o j �� $� syl Date of birth / ,?g <
10. ilame o� mana.ger who will conduct Gambling Session /4yY,�J/� , �[>2�viM34e,c�'
11. Addres� of mana.ger �1� B(,��j,� 1`� ��� � Date of birth_�����
�
12. In con.t�ection with� what event is this Gambling Session being held?
� d'tl
13• 6dhat tytpe of ga.r.ibling device(s) �i11 be used? PaddlewY��eel 'I�pboard Raffle�
].lr.. Day, d�tes and hours this application is for and number of sessions.
Day(s) . Dates BCi^E� �� •`_iours / ..'O��vH �BQ,o,4o. of Sessions_L_
15. �r7i71 pzfizes '�e paid in money or merchandise?
io. Is tne applicant assxiation or�anized under the laws of ihe State oi �:innesota? ta�-s_
�_.
17. How lonjg has CrKanization been in existence? ��� y�rS
18. i�v'hat isl the purpose of the Or�anization? �� �
19. Officer� of the Organization
� �1ame-Title Address Date of birth
�ir . v�' �-r� a�l��� g� -s�- �� a�r �/�
��� 1�e�nr,.��, 5e.�r�+a `� , 1L��-`�--�--
��P i � ��✓�l� ��LC�Scfc�vL°v' 1�<a `�Qa,�. ,r aC �� / / a
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. ��-r-���9
20. Give na��s of officers or ar�y other persons paid for services to the Organization.
i tJame-Title Address �ate Of �'.'lI'th �
I /1
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t
21. In whosejcustody will records of Organization s Gambling Sessions be kept?
:1ame �1' �:(�t�t/�S �fr}�^zOS � DN?� Address a6 ( �icsv� Ff'—' S�'.
22. Attach a icopy of your Orga.nization's membership roster and date each member joined.
23. Attach tY�e Gambling Session �ianager`s bond. �,�(�
2I�. Attach a icopy of the Deparrtment of the '"reasur�, Internal ?evenue Service "RetUrn o£
Organizat�.on �empt from Income '"ax", Form 990.. (Chapter 1a1.9.01t (1).)
25, Attach a pI ot�y of Department of the Treasury, Internal Pevenue Service, "Tacemnt OrPan-
ization Biusi.ness Income Tax", Form 990T. (Chapter �.19.0lt (2). }
26. Attach th� annual report required of charitable organizations by i�.i.ruiesota Statutes,
Section 3Q9.53. (Chapter 419.0�. (3). i
27. j:ave you }�ead and do you thorou�hlv un�erstand the prov�sions o�' all Ia*rrs, ordinances
and regul�.tions governing the operation of Gazrtblin� Sessions?
28. Any chanF-�s desired by the applicant association may be� ma�s only ?aith the consent of
the Licen$e Committee.
29. 3as any p�rson(s ) participating in the operation of any of the gambling sessions cov-
ered by t�is license ever been convicted of a felon in the State of Il�esota or in
a.x�y other State or rederal Court? Yes No�. If answer is "yes�', provide
names, add�s�esses and birth-dates.
!I 1 � �
, Organization
BY — /� �
' (Offic..r-Tit1e
I, and r
(I�lanager in c..arge of Gamblin� Session)
State of i�innesota)
' )SS
C ounty of Raras e�r )
�t�.�a. �v 0�l a.na
being duly swo s that they are the petitioners in the above a�plication; that they have
re2d the forego''�.ng petition and Tmow the contents thereof; that the same is t.rue of treir
own ?�owledge. I
Subsc�bed and �worn to oefore me this
�l da� of�p�wt, Y 1° 8 • nnnnnnnnnnnnnnn■
T MARTHA WILCZYK
!���S. ��� � ���� I ���� NOTARY PUBLIC-MINHESOTA
i�
��,.,� DAKOTA COUNTY
�io Pub1iC� Cotultv� ��Li�'uiesota My Comm.Expl�ea Oct.4, 1990
,�r co�mission e�pires o o = ww�ww�wv�v.
Building Depart:�ent Approved Disapproved by
rire Departnent ! Approved �isapproved by
°oLice Departmer�t Approved—�Jisapproved—by