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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• �� / � Co ncil solution � j � , �(� i Presented By � � ' Referred,To Committee: Date Out of C�mmittee By Date I 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. � ,I 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., � �-���� � .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, �— . - `'�'-' ..�..� ' _ b �c-�`-� � `'`."� i�.� `� � � .s� � � ° ��' � COST B F Y ND C S D: � I � N C O TACTV G D RD Dt (Mayor's si ature not required if under $10,000.) Total Amo t of Trans�ction: d� ` /�- Activity Nwnber: In �/� Funding So ce: n '� ATTACHMENTS: (List and number all attachments.) � . 1�'" � ��� �� AD N T OC DURES _Yes o Rules, Regulations, Procedures, or Budget Amendment required? _Yes o If yes, are they or timetable attached7 D RTMENT RE IEW CITY ATTORNEY REVIEW _Yes _N Council resolution required4 Resolutio� required? =Yes No _Yes ,�N Insurance required? Insurance sufficient? _Yes _No Yes N Insurance attached? � �7-i��f� 'DIVISION I�i OF LICENSE AND PERMIT ADMINISTRATION DATE g�'���$+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 � � I I � � �` I I Fire Prev�ntion 4 � � �� I� I I Police I � � � , � , , i City Attorney � I � ENS � I I ��� � 300 Foot NQtice I � � � � � License In ector's Comments: �p I I HAVE BEE GIVEN A COPY OF THIS NOTIFICATION AND UNDERSTAND THAT MY ATTENDANCE AT THE PUBLIC HEARING IS REQUIRID. i CURRENT INFORMATION NEW INFORMATION Current Corporation Name: New Corporation Name: Current DBA: New DBA: Current Officers: Insurance: Bond: New Officers: Stockholders: , ' �_� .. �_ . �:��y �-r f�-���� � ....:zi�.T.: ..�, . ,,.., ._, ..,,, xy:,� :.....T.-_��.. ._._,� C.' _�:�.;,.: _.� ���::tG:. :.�_ � � • ' ; uI'�II.SIO:I Qr �.i.:.r�i+j� :�I17 ?t,:;i�Si •�iI�LIi�j`':�1�0:T 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 i 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 . , � ��-1-,�� ?�,. ;;�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 . ��i4 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 � - r.ames, 'addresses and birth-�tes. ' S� Co IrU�J1 �t�u�C.N �1 ,,, - �Gr�anization ���,} ' ;;�.. B Y `+ ( f' � -�'itle � a�d ��./��Q.rvr--- (I!an�zr �n c:asge of Caribli*i,? Session; S�ata of .�iir�escta) � /SJ �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$teni h��roved-�isa�roved-�:y �I :: � '`� , � � . � ��—���0� �- rVlinnesota Charitable Gambling Controi Board LAWFUL GAMBLING EXEMPTION �� Room N475 Griggs-Midway Building FOR BOARD USE ONLY `=�"� '1821 University Avenue - �5t. Paul,MN 551043383 '+"'+� M612)642-0555 INSTRUCTION�: 1. Submit request for exemption at least 30 days prior to the occasion. 2. When completing form,do not complete shaded areas. � 3. Give the gold copy to the City or County. Send the remaining copies to the Board. The copies will be ' returned with an exemption number added to the form.When your activity is concluded;complete the PLEASE TYPE � financial information, sign and date the form,and return to the Board within 30 days. �Organization Name ��"�'��f�"^"^�'°a°`"01�'�� St. Col�ba. Church i�T L1GE Af SE D Address City,County,State,Zip Code 1327 La�ond Ave. SL. Paul� �iam�e,y� >tN. 5�1 U4 Chief Executive Officer{s Name Phone Number Manager's Name Phone Number Rev. 12o�er F. Carroll ii4.�—H173 ':arl �ckef�aann ti�ii—tili�:.'7 Type of Organization If Other Nonprofit Organization ICheck One! � Fratemal � Veterans ❑ IRS Designation �Religion � � Other Nonprofit Organization ❑ Incorporated with Secretary of State ❑ Affiliate of Parent Nonprofit Organization Name of Premises Whe Activity Wll Occur Datelsl of Activity SL. Co�umba� School Premises Address i? � 1 y�7 1327 La��ond �ve. Uct. Games � Yes No ������pt� ��;�[u���ze� d,� Eicp�ns�;. �ratl'�`- �,��� r: � a Bingo i XX � �"�'a'`�,��>rz ,���� �'5'���, �����r; ''� �� F�' k ? � F; °` ���� s '' �S �'`'n$,<�'_� ,�a,. A ��:�4,'.P� g,'�c." �Y ""�.� ,..� .�,'�'a ��+. >.�x s Raffles ' ;CX �"�yX����;��'���� �#���� -� ��''�Y�, �� �`� � ` �' '����'�E� � , �E S �,���� ��� ,��� � :'� �, � � r �' �s��; � � � ; �- � � u �., � .� � .. . � ,:< x � ,,:. �,��, � � � a,..; �, .� . �„ �, .. � �yF` t �r�' �ez .� �+:?�� � a �.. �, �. � q�a � ��+�y . v -: Paddlewheels , XX �"�-�� ���.�� �°��; � 3 '�3� �� ��m� y , � ����� � � �� � �� ��;� k �,r���a��,����� � �� � ,�, ��� �s ,,, °'�� tia • Q , i ,. , < r - . ,KK . � �,< � " ; <. � ,'� 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 _ � � � � �:� �.; �: � � � �� a ,� � y�����' � �'; ` ` � ��. �. � x � ����, ! �r��_���'����� � � .� „� � a., �, , . . �. . � �,� � 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' p � ,,, . . � �` k� , . ,.: 6 �� � ,�.c.�n. `�' .ka� �+�` � . , ,., :. .xa, ... �_sw� < , � �^ -�,. .. .. . .. :•-.-'. ..,., z 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 � I / � - *.�.`� r :�� ��� K " � , • ��J � -� � ��- . � -��!`�f � r. �'J L•_' . , ,�vw„���'r"����,�'�`"�{a� a r � � . " 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,��.�._.....