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87-1467 WHITE - C1TV CLER�i4C PINK - FINANCE � COUflC1I CANARV - OEPARTMEIN7 GITY OF SAINT PAUL �7/�c��� BLUE - MAVOR File NO. � Co cil R olution - Presented By a � � - /� Refecred� To Committee: Date Out of C�ommittee By Date ; I RESOLVEI�: That Application (I.D.#77541) for a One Day Gambling Permit (Bingo, Raffles, Paddlewheels, Tipboards, and Pulltabs) by '� Harding Area Hockey at 840 E. 6th Street on October 17, 1987, between the hours of 7:30 P.M. and 11:30 P.M. be and the same is hereby approved. ' � COUNCILIVIEN Requested by Department of: Yeas DreW Nays �a I � [n Favor Rettman Scheibel gy �n �_ Against �9eida ��y W11SOri ;��T - 7 1987 Form Approved b City Attorn Adopted by Council: Date Certified Pass I ecr y BY i sy / A►pprov Mav�r: Date c �'"'° �� - '-'� Approved by a r for Submission to Council gy BY �`i�i�� '' 6, � ��i;'� ��� ��7 � �t� a113s5 . � . - - - - - � �.- �- � • DEPARTMENT - �i CONTACT NAME Zq�S- .�Ub PHONB � 2 s B' DATE . , ASSIGN NUMBE ' JG OR (See reverse side.) _ Departmen Director _ Mayor (or Assistant _ Finance a Management Services Director '� Citp.Clerk D�.� •� �4�--�t"' � _ Budget Di ctor � � City Atto ey _ A (Clip all locations for signaturs.) W G 0 C � (Peirpose/Rationale) �- � �' � �-�- '°�- �-�'� �-�'-�`-'°�" -�. �� c-c�-� > �`,.� �`°�. i,�, a.r,;a�.ert.�� a--�--�L, 01�.�..�r�.�.�,o . OST FIT AND SO PACTS C . , � (� F N C N S AC V B R CHAR R CRE TED: , (Mayor's sign ture not required if under $10,000.) Total Amoun of Trans�ction: l�tA- Activity Number: 'In �(� Funding S ce: 1(�1�. ATTACHMENTS: (List and number all attachments.) ��'`'"�t-a �� '� ADl�t P ISTRA ` V ' Pi . �DU S ��� _Yes o Rules, Regulations, Procedures, or Budget Amendment required? _Yes o If yes, are they or timetable attached? : DEPARTMENT RE IEW CITX ATTORNEY REVIEW �Yes _N Council resolution required? Resolution required? '✓Yes _No _Yes ✓H Insurance required? Insurance suff icient? _Yes No Yes � Insurance attached4 i - �'�r/��� DIVISION OFiLICENSE AND PERMIT ADMINISTRATION DATE INTERDEPAR TAL REVIEW CHECKLIST �j�,. S��. Applicant , ; : ,'; , Home Address � �� l.�-�,� 'A-�--1-c3,� � Businese Naine �c,� ,. Home Phone �1� l - �`��� i r� Business Adldress `6yU �--lo�`S� C�"`"� Type of License(s) ��.r-.-b ��rLrw�k__ '� Business Ph,bne �1 L - � � � 1 }(�11 �jr�w 5 , Public Hearl;ing Date License I.D. # ��� �� at 10:00 a. . in the ouncil Chambers, 3rd Floor (lity Hall and Courthouse State Tax I.D. # I� �p - ' C� 3 5 REVIEW DATE DATE INSPECTION APPN REC'D VERFIED COMPUTER CO�Il�ENTS �oved Not raved Housing & ldg � _ Code Enf or�ement �U� 1 -1 �� I � Public Hea�th < < I „ i �� � I I Fire Preve�tion 4 � , � � << I I Police ' l � �, � < < i , � City Atto ey � I ENS � ' n �A � 300 Foot Nptice I � n (� � � � License In' pector's Comments: I AAVE BE GIVEN A COPY OF THIS NOTIFICATION AND UNDERSTAND THAT MY ATTENDANCE AT THE PUBLIG HEARING IS REQUIRED. i I .. _.o. . , , _. _ . , , . _ . CURRENT INFORMATION NEW INFORMATION Current Corporation Name: New Corporation Name: Current DBA: New DBA: Current Officers: Insurance: Bond: New Officers: Stockholders: . . �« . .. . �_ _ _ � �"I-i��7 . 1lhinnesota Charitable Gambling Control Board LAWFUL GAMBLING EXEMPTION R}�om N475 Griggs-Midway Building �� 1821 University Avenue FOR BOARD USE ONLY - - S . Paul,MN 551043383 . �'.......:�'� (�12)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 uniil after the activity. '3. Give the gold copy to the City or County. Send the remaining copies to the Board. The copies will be retumed with an exemption number added to the form. When your activity is concluded; complete PLEASE TYPE the financial information, sign and date the form, and return to the Board within 30 days. Orga�ization Name Number of Members License Number lif currently or previously., _ i i ,�. � �' ... :f , � -� � . � .` ;�`J� � � y� �`�' � �1 ,` ` licensedl and/or permit number.;-1 ,s i ..� --� � � � ��/ � J Address , f� /. City_ � 4 State Zip County �� :.� � ����_ �� .a A 7 ;,, y�� .� . l:� J�� i�`,1 J � ! '` .1 ; .�; Gbief Executive Officer's ame r-- Phone Manager's Name Phone Number_ J 1 . �i� i�\ `\ •.`; •`. ` 1 >i T�....�� ( 1 � ^, ��] - .c._.- _ _ -.�l ,"� 1 1 �. ` ` � �, >%. r.. .� � �� Type of Organizatio� If Other Nonprofit Organization ICheck One a�d attach proof of nonprofit statusl. ❑ Fraternal ❑ Veterans � IRS Designation ❑ Religion �IL�Other Nonprofit Organization D.Incorporate with Secretary of State Attach proof of thqee years existence. C Affiliate of Parent Nonprofit Organization Name of Premises Where�ctivity Will Occur ^ � Datelsl of Activity,drawing�sl ` �--• , - _ -. \� J t� � .r�1 r— ,i � ` � i �, i„ ', - � _ _) i Premises Address City r, State Zip., , County - �1 ' , i � 1 .� .'� .1. �� i :''� `.,�f i.�� i�1. . . .. i. /.:�, :e.,l� ' .,f' ! . 1 , �r ,s+ "� �; � -� �, � ���" ���'. Game Yes No �,. y ,��' ` �`� a;� � , �,y „., ,,: � � � � K � . . ;, Bingo �( . , � � i� ��` % ,.�•� Raffles ��` �' °� �� .� � - - ' ��.��.� �_ ;a�;.. ;� Paddlewheels � 9 � � �� Tipboards , � �$ � � �ffi � ° �j fi `��:"��,T„-�r*�' ��>���.. �� Pull-Tabs \/ � ���� < `Y����� ��' `'� £ �� I� s�� .��,�, ��`_�,�� � Use of Protit � � ` ��� � � � � , �^ �1-�. ,. _ s . � � � � �.� �� I affirm all informat�on submitted to the Board is true, accor- S `�� M,`'� "�� .�"' ttee�� ' � ate, and complete.� � ��� ��� ,�� � �'������ . �a� � ���� ^���/�r�.��...+` c'� j .� :yt �' 'J„"�' !� �� �e�„ �• �,�%� �� �`�' ��� Chief Executive Officer Sig ature � Date :�, ��_ y ��x,F�,- -;f�.w� , ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY I hereby acknowled e receipt of a copy of this application. By acknowledging receipt, I admit having been served with notice that this applicatior�will be reviewed by the Charitable Gambling Control Board and will become effective 30 days from the date of receipt (not d below) by the City or County, unless a resolution of the local governing body is passed which specifi- cally disallows suc�activity and a copy of that resolution is received by the Charitable Gambling Control Board within 30 days of the below nqted date. � ClTY OR COUNTY TOWNSHIP Name of Local GLV��nyg BO y��ty or�o�uU�� Township Name(Must be notified when County is the approving body) i Signature of PerspQn Se�cpY g,Qppl��i�n�� , Signature of Person Receiving Application . t1 fl t.aP u ' 7it�e LzcQns Inspec�or 3/18o���eceived Tt�e Date CG-00020-01 I6/87) White—Board Canary—Board retums to Organization to complete shaded areas. � Pink—Organization Gold—City or County ^_�., _ -- �/`�-"�7- ��1�7 . , � .,_-- .- �- • --.�.. � . . :�..r,.c�T.__.I� C:" r__:�,....,.. -_J ���:itC.��,:•'" .,J��'�....� ' ' �I�Sia:i or i.I.:.c,:+S�., :�i:D ?�:�'�Si •�r1liy�L:�'_"=0;� L'^'QF�ATICN �CL'I� :'�IT_3 ��°�C�iIC.;I rQR t�''_'=�u�Si TO CC:•;D�CT Gni�T�'G SGSSI01: I:: j'?'. F;.'JL ?.. .:awe oi ��oar'.izaz_on /�-�A 2'�f,n� L� I� RL�!, l�.c�c ,11�i=�! �.SS n �_ � � 2. :dc'.ress whe�e �aai.zation's re�•sla.r� ne�tings ars r.eld ���,,,.,�,c=i,1� ��.�. )Av,�+?r�* � 3.- Da� ar:d ti:.e o£ :�estin€s ��,�, �/ �L� ��. �ddr�ss F�here Cambl�� Session =.rii? �e ?�e?d S �� -�. � �-����� � �.+-�c.�c_1'� �. Is �r.:�car.t owr:er o.i pro?ert�Y -y'r.eTs Ga+.�h.��-'�:r, Sessien T•ri�'_ re �e?C' °es_�,_�'o 5. I� leas�'c, :�rro _s otaner of pro�e�:y- :��'r.srs Gar,blin�- Sessio� �ai�1l �e �-e�d^ �i± ,.�rs'1 7T i+.�.1 Z1 � G I-i.e��1� 1`T � 7. If leasdd, attac!� letter of per�ission to conduct Gar.iblirf Sessicn, s�gr.ed by lessor. �. ilame of �oi'icer �a�.:� applicaticn ��,� p.,_� � �,�;'�J`tZ 9. �,dd:ess �,of officer �a,Iang a�lication 1.�7�� ��er2 �1-h l� � J' l_�ate of birt:� j,�, i��� 10. �;a�e of 'c,ana.Eer ���o wi1Z conciuct .r.-ambling Session �o�A�.1 J��.���— ?1. �.ddx�ss of �^�.a�a�er 1��� 1� ��.�iZ � ����,� /� � �ate of bi�th j� . i�.�v 12. In con.^�ction with �rhat event is th:s Gambl:ng Session beir� held? �_ -- � -- I3. 6y�at �pe oi ganbling device(s) wi11. be used? Paddlewr�el 7� `"ipboard 7'<Pa f'le� ' 1.li. Da�, dates and hours this agpLcation is ior and nureber of sessic,ns. � ��\ � � �M Da�(s)�ip.� i7��7 Dates Nour ,� � 'f !1' 30. oi Sessions�_, � I��� :�1i11 �r�.zes �e paid in mone� or �erc!^.andise? � ! /+ - � 1.6. Is tre �apgLczn� association orr anized under the la�rs o` L�.e Staze of i:ir.r.esota?_��"� I7. riorrr lon� ras Cr�anizatior. been in existe^ce? /y� � � � lE. Tdhat is t�e nurpose of the Or�a.r.i,zation? l/�, � f � n ��,� _— _._...__ .. - I9.. Officez�s oi. the Organizatioa ilame-Title Address �aie oF bi�~'th _ ... � ._ _ , �i � ��7� �y 7 ?;�. �,ve _^_�:.es or oi�icers or ar�; o�:�er ;.e=�or_s �a=� �or s2�ces ra �'r.e �TM�^=zTT�or_. , • '"= �le :�.^:d�-�ess 1ate of h. :�ia�*.e-�_ �. �f�.� ,.� r�-- , �� � T�, . eo ^ ;J1:L1. :'OCO��S OI'. Q2'�3ILZ22.tiCIl�S '�2..�'1:�.��'If S2SS:�OIIS }'° �f2!J�7 2�.. �._ a'r_o.... custcd� f ��S" C� t���R R t� ��'•` � � .�ame �7 0�nl � �� �`��- :�adress __�`�7' � i7rs �� .ti►.� �5"'��'!:� � 22. �t�ach a copy of �our Crg�i-zatioa�s memberst�i.p roster and date each �ember joiued. 2j.. ANI,G\r�l t:ze Ga�h}�*� Session ?•tana�°r's bond. 2�..:. iti3C�' S CO�y Oi �:78 ::epa.r*.�,er_t OI t.B `T'�3StL"?� In�e2".2�'�. :'.everue ::2"S'�CS �t�..etUt'.^_ 02 i OI'P,1 9CQ� ��.�18.^.+.,°Z' �!1.4.J�.! �l�. 1 Crganizatld�L' �7CBt•".�t �=OLI IIICOt."ie `n3X�t� - �• ?`,,.e T ; �svenue •�.@�C°� �t�'.:CB^iD� �'�3_*1— 25. �ttach a cqnf oi �ep2st�?ent oi �.�e : asur„•^, n,.er�a1 ization �uSiness Income Tax", rorn 9°O1. (Chapter !�l?.01� (2},} 26. attach the ,annua? report recuired of cr�aritab?e or�an=zations bp i�.i��nesota :,tatutes, Section 3��•53• (Chapter 1�19.�L �3)• ) � 27. �?'a4e �ou read and do vou tho�ou�hl� un�?e='star_d the -�rov:sions o�' all Iaws, ordinances and re�ula�tions �cverr�r.� the operation o� C3Rh'l�IIF, �essions? ��. �� c�ans�e�s des;red bp �re a�pl_car�t assec:.at�or_ nag �e r�ace onl� ��t:� �r�e coasent o� '- t�e. Licens�e Ca�ittee. � rson(s) oa:ticipaty:.g in the operation of any o� y�.l:e ga.^�bli^.� sessions cov- z9:_ :ias � P� - ered by this 1�c�nse ever been con�icted oi a �elony :.n tre State of. �iir.nesota or i.� '"�� "�- ax�r oiher ''State or �?edera.I. Coux't? Yes �Io � . Ii ar.swer• is "7es", grovide . r,ames, ad�resses and birth-dates. � - - ,0 ,a.. o c. S C� Gr�anizati or.) --- . . ' _ _-_ p ' (Offic�r-?'itle . ' an . (Iana�er in c:ar�e o ambli:� Sessioni Staze of t4ir�esota) %SJ �ount� of 3.aL�ep ) �o-r, � an� ce�ng c3u1? sw rn s 7 that �"ley a:'° t:�e pet�.t'_oners i.n -�r•e above a�plication; �hat �.ev havs rsati the *ore�oing pet�tion �d '•�ow �he contents. t.ereof; Lha.� :.he same is -:�z° c� _�z=� o:•rix ?�o«ledge. ; Su�scx~`_bed an�. swarz �o bei�re �e t�.is �.� ;��1ST1*7A L.S�!�t�� � ���G3�f p2 �� ���.L '—';� ?;OTAAY PUBI'sCr��itNNESOTA � j;?. DAKOTA COtJ�:r� . _ � n ' MY CCMM.EXPiRES J��.Z. 1992 ��J �..�J�,�, ' �iotarr- ?ub�;:.c, I�a�.�'�-�- Count�, :L�nesota y :�:f cc�missior� expi�es 1 � 3u�?air:� �eu�:�en� Approved�isa�proved�i�y � ' �'isap roved_^^v :i�e �e�arti:.telnt �l�nroved F - ?olice �eoaz't�ae^t np�roced—'—"�isapvr�rzd •�Y �