87-1464 WHITE - CITV CLERK
PINK - FINANCE � G I TY OF SA I NT PAU L Council
CANARV - DEPARTME T 1
BLUE - MAVOR � Flle NO• �� /
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Co ncil solution �
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Presented By � � '
Referred,To Committee: Date
Out of C�mmittee By Date
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RESOLVED: That Application (I.D.#95519) for a St. Paul Gambling Permit
(Bingo, Raffles, and Pulltabs) by St. Columba Church at 1327
, Lafond Avenue, on October 11, 1987, between the hours of 12:00 Noon
I and 4:00 P.M. be and the same is hereby approved.
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COUIVC[LIV�EN Requested by Department of:
Yeas DreW Nays �
�.�,�._. ^�..:,:3 �
Rettman In Favor
Scheibel �
�n _ Against BY
Weida
ti9ilsOri I �C�' _ -1 1987 Form Appro d y City or y
Adopted by Counc�l: Date
Certified Pas ouncil , t BY
By�
A►ppro Ylavor: Date �"�y Approved by Mayor for Submission to Council
By
���Ya pr'a� .^ . . . . � . '�•).7 �
t.,
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� .N° Q11379 .
n E. ��uo DBPARTI�NT . - - - - - -
e:� • '�� CONTACT NAML
�t - S o PHONE
Z..� '1 DATE .
SSI F G ORD (See reverse side.)
_ Departme t Directar � Mapor (or Assistant)
Finance ad l�anagement Services Director �City Clerk��- 'l� ��-�°"'""�
_ Budget D rector _
� City Att rney _
T (Clip sll locations for signature.)
W V Y I G TIO 0 T C T ?. (Purpose/Rationale)
—j� �c�:ue. � � 1,,,,�.1tR, �— . - `'�'-'
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COST B F Y ND C S D:
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N C O TACTV G D RD Dt
(Mayor's si ature not required if under $10,000.)
Total Amo t of Trans�ction: d� ` /�- Activity Nwnber: In �/�
Funding So ce: n '�
ATTACHMENTS: (List and number all attachments.) �
. 1�'" �
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AD N T OC DURES
_Yes o Rules, Regulations, Procedures, or Budget Amendment required?
_Yes o If yes, are they or timetable attached7
D RTMENT RE IEW CITY ATTORNEY REVIEW
_Yes _N Council resolution required4 Resolutio� required? =Yes No
_Yes ,�N Insurance required? Insurance sufficient? _Yes _No
Yes N Insurance attached?
� �7-i��f�
'DIVISION I�i OF LICENSE AND PERMIT ADMINISTRATION DATE g�'���$+7
INTERDEPt�RTMENTAL REVIEW CHECRLIST
Applican� ,,�- � ��,�n,n�c� C� Home Address � ';3a � ��; Qu ,,,�.��,
Business Name �1`�vv..� Home Phone �D�((� - �p CSo�'1
Business jAddress l 3 a-1 ���Q-n dl. � • Tqpe of License(s) ���h.�2 Y 1�.,�-�
Business !Phoae (9�� - cj l � �) r c,�.Q.Q�� ,
Public Hel ring Date �. � � License I.D. # a� S �C'j
at 10:00 �.m. in the Council hambers, ,n
3rd FlooriCity Hall and Courthouse State Tax I.D. # I► !a
O
REVIEW I DATE DATE INSPECTION
' APPN REC'D VERFIED COMPUTER COI�IlKENTS
ved Not ed
Housing &�� Bldg f
Code Enfo�cement q � 5 I �
,
Public He�lth �
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Fire Prev�ntion 4 � � ��
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Police I � � � , � ,
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City Attorney �
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ENS � I
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300 Foot NQtice I
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License In ector's Comments:
�p
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I HAVE BEE GIVEN A COPY OF THIS NOTIFICATION AND UNDERSTAND THAT MY ATTENDANCE AT
THE PUBLIC HEARING IS REQUIRID.
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CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
New Officers:
Stockholders:
, ' �_� .. �_ . �:��y �-r f�-����
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I3i^QF�ATICN I?:CUI� ��TT3 nr°�C?TI�1 cOR �':t:�T mQ CC?•;DtCT G;L�IT_"G ScSSICt' I:; ST. °4�
1. .:a,.-:e oi, �oar.�.zat'_on St' �OLL(n/IBA PL�R I S � /�H�RC N
2. �dcires� t�rhere �aaization's re€•.ila.r mestings ar� held S'� �'OI.U/Y1 . A SG(-fOo L
J �3a7 LA-Fe�tl� U�
3.- Da� a.ncl ti-ie of :�e�zir.€s SU� OC_?� r�T 19$7. /�+�oql-6�/�'�
�.�. �dd.-sss� ;,;here CatablinP Session :ri.i? � he?d � ��27 1--�OA/D QI/E
5. i5 3DT?�iC3I:� o*.�r:er O.2 CI'Op@Z't�T ?3Z'@,+e �?�.''.bli�£ C2�S1Q'1 T•ll�i '(:e �:@iC� �s ves �r0
5. I� leas�ee, :-r'r_o �.s owner oi pr�ert� a;'rwr� Gar,b7.ir.�- Sessicr. �a��ll �e he'd':
� Gl-�-�(fZC�.} �o��'R'(y
7. If leasled, attac�i letter of per.sission to conduct Gar.iblir� Session, s�gr.ed b3r lessor.
�. ;+ame of oi_icer ^��:� a�pLicaticn
9. rlddressl; of of�icer �naf�.ng au�lica�ion �3a� L.A�,v� H✓E. Date of birt:�
I0. �:ane of' nana.ger �rho caill conduct Cambling Session -t�i�(Z�. �-G{�E:�/j'l�/�y
�
TI. �d�ss; of « T�er� I 3oZ ( � /UGLEZl�001� �ate of t�r*�h as 49
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I2. I� con.n�ction with �hat event is th�s Gambling Session. beir:g held?
- ' P�-R.�S�} �ALL 1=��ST�✓!�L _
I.3. 6y'hat ty�e oi garibLng device(s) wi11 be used? Paddlewr�el 'Z'ipboard Pa f'le�
Il:. :�a�, dates an� hours th`s application is ='or and n�uaber of sess�ons.
R. �
Da�(s) ���u�.J��/��/ Dates �� !/ S u-ours v�� °.'o. oi Sessions Qi�
T—T �p,v— M
� ?�. ;di11 px�:zes be �aid in none� or-�►erc�.andise? f3o-r�-I - -
16. Is_ tre SDDLC?.Ilt associatioa o:r a�iz�� under the Iaws or Lhe Staie of �:i.^sesota?�
I7. rio�r lon� �:as Cr_anizatior. been i.n existeTc�? �s2 yRS
�
1�. t,�at is j tre ��.:r�ose of the Orsar,ization? L' �RG+ °F- y c(rtff �c[' ,t/c'�Io.c)S
._..._. �
19.. Officer� o� the Orgaaization
;iame-Title Addrass �aie of bi�"th
��t� �c��vn� ����s 13a � �,v�c��a �/as—/¢ 9
M �r��- u�Rt�'�T , J. f�. 679 5i�t�n/ 1��7
/YlA-l�t/ -C�--�o2sF� , T�EAs. !7i� ff�J !'7T- � l`f'�
_ . �.�-�-��Es ���E�� Sc�y �6�0 ���s f��l
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?�,. ;;�ve ��:.es o� ci�:.cers or arl,; ot:7er �ersor_s ?a_d 'or se�ces Lo �he �r^�r=zaL�or_.
. '�iaa.e��tle �cd.�ess �ate of �i�r .
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Zi. �L' WGC��9 CL'Sr'..CC:?' :dl.�. '_'OCO�.^.S OZ' QT�3II�.Z3��.CA�S ':23.Z�.^.�_^.f' S@SS�OIIS C° fETJ}'i.:
;�ame �j 1CA-+�L ��12�YIA�/!� �d.�sess /3� l �i��GELt/az�D
22. �t�ac:� a copy ot ;�our G`rgar.izaticn's membersr:.p roster and date each. �ember joined.
23. 4�tac'r.� the Ga�b?i*� Sessior. ?•anager's bond.
2�_. �t�a.c"i a copy o� �he :;epa.Tta�er_t oi tr.e Trea.sur7, In�err:al �eve*lue �e�ce "°..e�u*.�^ o_*'
Organi�at�cn �xee!�t �ror: �ncor:e '^ax", �o� qcn. (i.ha�ter L19.���� (i j. i
25. �t�aehl a copJ oi� Lepart:.,er.t oi �:�e T�easus^-, Ta�P.T':12.1 °sver.ue Se:�rc�, '':'..e:�rot CrFan-
izat�o#� �usiness Income T_ax", rorn 9°OT. (CY�apter !�l?.OL (2).}
26. �ttach� the annual repori requ:�red oi cr�aritanle or�an;zations by ;linnesoia ;,tatutes,
Sectiot� 309.53. (Ch�.pter Lt19.OL (3). )
27. � ?iave Jdu read an� do vou thorou�rl� un�?ers�ard the �rovisions o�' aIl Iaws, o:-dinances
and xe��alation� €overr�nF the operation o� Ca�hLn� �essions? 'y�S
, �
28.. :�ny c��ri•es des=red by �2:e 2DPI�C3.*�t assec:a�:or_ �ay �e mace onl� c�r th ths cor.sent o�
�he Iidense Co�nittee. �
2q: iias auyr person(s) na��t�cipat�g in the operat�on of any o� tre �a_^:blir� sessior�s cov-
ered by� tr,is licanse ever been. concicted oi a felonp in tre State of �iir.nesoza or i.z
�� �-��- a� ot:ier State or �ederal Court? ges ;?o � . I� az:swer is "�es", provi�?e
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r.ames, 'addresses and birth-�tes.
' S� Co IrU�J1 �t�u�C.N
�1 ,,, - �Gr�anization
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;;�.. B
Y
`+ ( f' � -�'itle
� a�d ��./��Q.rvr---
(I!an�zr �n c:asge of Caribli*i,? Session;
S�ata of .�iir�escta)
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�ouatp of ?a,��3se� )
j ��v. 20�� CA-RRoL� an� �-Q� ,4��,A,v�/
beiag duly s-�rorn sa� that they a:�= the pet�t;oners �n ��^�e above 3��LC2L�on; �hat �.ev have
^°2� }i.:lB f02'��03.27€ p@titlOA 327f.3 rrS10W ��1@ COl1t2At5. �:er?of; tlza� y�i@ S3D'lB ]..S `�1° Or �.`.z1I'
O:•7ZI kI10W1@i��.
Su�scr'_bed ar�d sworn to bei�rs �e �:I1S s �"^�'`�°'`"""""'""
�S�''` �a��of 1 q g� .� EUZABETH M.WELLS
_ "'� NOTARY PUBUC—MRpiESOTA
(�,_ ���„ A/I_ RqMSEY COUNTY
7/7 `/y �t.�vrc�
� MY COMM.EXPIRES AUG.28, 1990 '
.,ot ,, ub.i:�a�, Co�tv, :r;-+ esota „
:'-� c a�uni s si or� P�cpi:/��/' -��- 9�
�uildir:� �epa4z-c:�ent �p�roved Disa�nroved by �
cire �epa.�-�tne$�t �.DOroved �`isa�p:�ved '���
� ?olice �egart$teni h��roved-�isa�roved-�:y
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rVlinnesota Charitable Gambling Controi Board LAWFUL GAMBLING EXEMPTION
�� Room N475 Griggs-Midway Building FOR BOARD USE ONLY
`=�"� '1821 University Avenue
- �5t. Paul,MN 551043383
'+"'+� M612)642-0555
INSTRUCTION�: 1. Submit request for exemption at least 30 days prior to the occasion.
2. When completing form,do not complete shaded areas.
� 3. Give the gold copy to the City or County. Send the remaining copies to the Board. The copies will be
' returned with an exemption number added to the form.When your activity is concluded;complete the
PLEASE TYPE � financial information, sign and date the form,and return to the Board within 30 days.
�Organization Name ��"�'��f�"^"^�'°a°`"01�'��
St. Col�ba. Church i�T L1GE Af SE D
Address City,County,State,Zip Code
1327 La�ond Ave. SL. Paul� �iam�e,y� >tN. 5�1 U4
Chief Executive Officer{s Name Phone Number Manager's Name Phone Number
Rev. 12o�er F. Carroll ii4.�—H173 ':arl �ckef�aann ti�ii—tili�:.'7
Type of Organization If Other Nonprofit Organization ICheck One!
� Fratemal � Veterans ❑ IRS Designation
�Religion � � Other Nonprofit Organization ❑ Incorporated with Secretary of State
❑ Affiliate of Parent Nonprofit Organization
Name of Premises Whe Activity Wll Occur Datelsl of Activity
SL. Co�umba� School
Premises Address i? � 1 y�7
1327 La��ond �ve. Uct.
Games � Yes No ������pt� ��;�[u���ze� d,� Eicp�ns�;. �ratl'�`-
�,���
r: � a
Bingo i XX � �"�'a'`�,��>rz ,���� �'5'���, �����r; ''� �� F�' k ? � F; °` ���� s
'' �S �'`'n$,<�'_� ,�a,. A ��:�4,'.P� g,'�c." �Y ""�.� ,..� .�,'�'a ��+. >.�x
s
Raffles ' ;CX �"�yX����;��'���� �#���� -� ��''�Y�, �� �`� � ` �' '����'�E� �
,
�E S �,���� ��� ,��� � :'� �, � � r �' �s��; � � � ; �-
� � u �., � .� � .. . � ,:< x � ,,:. �,��, � �
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� �yF` t �r�' �ez .� �+:?�� � a �.. �, �. � q�a � ��+�y . v -:
Paddlewheels , XX �"�-�� ���.�� �°��; � 3 '�3� �� ��m� y , � ����� � �
�� � �� ��;� k �,r���a��,����� � �� � ,�, ��� �s ,,, °'�� tia
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Ti boards � XX �'���� �` �� ��'��, '����,����� �;�r � ' y� � �>�,`�'t � � � ,'` � �� :� �
P r �„��:, �,.����'�' ,. ���m�` ,s���������,K��,, s:,� � �� �_:: � � �
. l�,'�:'� �F �,� ,j., � t YK�`'ie � h �- :.&f i�.;
Pull-Tabs � ' ����'����'��`� ��� § �' � ��`������ ���Y p� � a
V _ � � � �
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� ��. �. � x � ����, ! �r��_���'����� � � .� „� � a.,
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. . �. . � �,� � x'�r .� .�xE;. ��..�a .�u �., ;8� ,,:�r��
. . .. ':, ",��:� �s.,%-���� - r«�:�.�a�. �w��'r°� `�'. '��'�3�w� 't^" � ��SLt1�El���.VF�4e '�M
. ��. "�3� � �s � � � �'2q�,�c� ,� +� F v'
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6 �� � ,�.c.�n. `�' .ka� �+�`
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I affirm all inform tion submitted to the Board is true, accu- ���at����ia�inf��c��s�bm�tte�ta�tfe��c�ar�is
rate, and comple�e. � � a�tr�.a�co�P��,.�` ; �F �
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" P . I . --1✓'U�. ' ,eA �._�= - �-�� -
Chief Exedutive Officer 5lignature Date � ` �"'�� , � `��t�' '
ACKNOWLEDGMENT OF NOTICE BY LOCAL GOVERNING BODY
I hereby acknowl�dge receipt of a copy of this application. By acknowledging receipt, I admit having been served with notice
that this applicatian will be reviewed by the Charitable Gambling Control Baard and will become effective 30 days from the
date of receipt(n�ted below) by the City or County, unless a resolution of the local governing body is passed which specifi-
cally disallows st�ch activity and a copy of that resolution is received by the Charitable Gambling Control Board within 30
' � days of the:belowil noted date.
� CITY OR COUNTY TOWNSHIP
' Name of Local Governing Body ICity or Countyl Township Name IMust be notified when County is the approving bodyl
: Cit Of Jt. I�dlil
' Signature of Person Rece ving Application Signature of Person Receiving Application
Jose h archedi , -��'r -
`:-Trcle• Date Received Title Oate
I_icen e Ins ector � S/15J87
CG-00020-01 14/86) White—Board Canary—Board retums to Organization to keep
Pink—Organization Gold—City or County
�....i,��.�._.....