87-1503 WHITE - CITY CLERK
PINK - FINANCE COUflClI �� �
�CANARV - DEPARTME,NT GITY OF SAINT PALTL ��
BI.UE - MAVOR File �O.
� �
C un i solution � (�
Presented By ��
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D.#92143) for a One Day City of St. Paul Gambling
Permit (Pulltabs) by St. Paul Athletic Club at 340 Cedar Street on
October 23, 1987, between the hours of 7:00 P.M. and 11:00 P.M. be
and the same is hereby approved.
COUNCILMEN Requested by Department of:
Yeas Drew Nays
��i 3'�.
Rettman In Favor
Scheibel
Sonnen � Against BY
Weida
WilsOn ��,T � �} �987 Form A ove by C' rne
Adopted by Council: Date �-
Certified P • ed by Council Secretary BY
B}' i
A►ppro by iVlavor: Dat ���'fi � 9 �1 Approved by Mayor for Submission to Co cil
By
p(��c�D �C T � � 1�87
�F7—�.�3
� . • � �I°_ Q11352 ,
, - - - - - -
� DEPARTMENT �
�� CONTACT NAME
�G �` - " PHONE .
� - DATE .
ASSIG D D (See reverse side.)
_ Departme t Director Mayqr (or Assistant)
_ Finance nd Managament Services Director � City Clerk
Budget D rector _, �
� City Att rney _
TOT L G S: (Clip all locationa for signature.)
N 0 E A T C 1 (Purpose/Rationale)
`�,� w-�i v�, � �..�.5�4- 1�-�- �'�-�.-
op�,-^�,. �c...:�-�C�,��.,;..s�� �-.�.�.9- ...��.�.�. �.�..�,��� .S�.B�--
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CO T B N I UD Y ND O N C `
✓��A-
IN CI G UDGE AC IV BE C GE 0 CREDIT D:
� (Mayor's s ature not required if under $10,000.)
Total Am t of Trans�ction: ✓llpr Activity Number: y� �q
Funding ource: y�\�}
AT NT : (List and number all attachments.) , �
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ADIi NIS RA PR CE � ` A'
Yes No Rules, Regulations, Proeedures, or Budget Amendment required?.
_Yes No If ges, are they or timetable attached?
D TlIEN REVIEW CITY ATTORNEY REVIEi�I
, ✓Yes No Council xesolution required? Resolution required? v�Yes ,_No
�Yes o Insurance required? Insurance sufficient? _Yes _No ,
Yes No Insurance attached?
. � ���5��
DIVISION OF I.ICENSE AND PERMIT ADMINISTRATION DATE c —� / � v ; �
INTERDF.PARTMFNTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
Applicant ��,�� ����4�;� C:�� Home Address 3�('� ��� ,�, ,
Business N�me �,� Home Phone a��, - ?�(g(y (
Business Address � ��C 9��1 pu � ,�_ Type of License(s) � � ��i� �J� ,��- pn,�,_,,�
Business Phone �-ZZ- ��Rl� � —1�-- - _Q�-r_�,
Public Hearing Date ��f ��,'r��": License I.D. 41 G/a �c� ,3
at 9:00 a.m. in the' Counci`1 CfiambErs,
3rd floor City Hall and Courthouse State Tax I.D. �t �(1�A
llate A'otice Sent; Dealer 4� j/� � A
to Applicant �('� � j I $�
Federal Fi.rearms 46
Public Hearing
����� � �
DATE INSPECTION
REVIEW VERFIED (COMPUTER) CUMMENTS -
A roved Not A roved
Bldg I & D �
t��� �
Health Divn. '
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i
Fire Dept. ; �
i
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Police Dept. I
; h ��P�
License Divn. �
' � � � I
City Attorney �
I
Date Received:
Site Plan }n.,!� I
To Council Research � l(�� r1 I �-1
Lease or Letter � I � Date
from Landlord
����- � �13 � z...
CURRENT INFORMATION NEW INFORMATION
� Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
_ (!��z -i.�z�-3
• Minnesota Charitable Gambling Controi Board LAWFUL GAMBLING EXEMPTION
Room N475 Griggs-Midway Building FoR BoAR�usE oN�Y
' � 1821 University Avenue
� - St.Paul,MN 55104-3383
�......: 1612)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.
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 the
PLEASE TYPE � financial information, sign and date the form, and return to the Board within 30 days.
� Organization Name � � . � , �°N""����"�°f�'��'��
Saint P�ui Athletic Club
Address City,County,Siate,Zip Code
34a Cedar 5treet St. �au1 , ?IjR1i�50�3 5�1��1
Chief Executive Officer's Name Phone Number Manager's Name Phone Number
� SL2�hen �vans (612) %22-36u1 Sten��en Evans (�12 �'2?-36�1
. Type of Organization If Other Nonprofit Organization(Check Onel
❑ Fraternal ❑ Veterans C� IRS Designation
❑ Religion �Other Nonprofit Organization ❑ Incorporated with Secretary of State
0 Affiliate of Parent Nonprofit Organization
Name of Premises Where Activity Will Occur Datelsl of Activity
Sai�� �3u1 At:�let�c Club
Premises Address �V—G S��'J�
34a Cedar StrQ�t
Games . Yes No �G�os��teceipt�- . . Value�af P'rizes� : �cpense�� Profit: :
� � Bingo X ,����< ,��
r. Rafffes .._ _ _s _ - :___-- x� � � `��"�.-��.,�,�. .,�. �:���:���, ,�.��� ���,.�:� �,�..'. ,�
�: , -,
, ���'� J�!' .a S � � �. �,.. Y '4',y 3 y F.
+,
Paddlewheels X � ���" � �';
�,�;_ , .._.° :.;t. ;;,�, ��:, � ,°! .a.. ..�
a „ .. ,
._ rr . : . . .
-r� � , ,
Tipboards � � " '
X ��:�� �� .:
,�: �.
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Pull-Tabs � ��
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��m " � �;; ��. ; �' � $ �
� '�","��� � �f �� �`"'u��"�.�'� ' _
Q�f'rom. G�xgE4ui � te��� Dtsmbntar°s�l.iasnse.Na..
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I affirm all information submitted to the•Board is true, accu- L;af�rrx�al��fictanciaC i�sfortnatio�a.submitted to�itkte°Board�is
rate, and complete. tr��„accurate;:and:cn�pt�te�.. .'
:.� ;..�,�,_.�'---�---- c�( � r _
Chief Executive Offider Signature Date Chiaf.EzecutiveOffiaer,S'ignatina�= < ���'
- ACKNOWLEDGMENT OF NOTICE BY LOCAL GOVERNING BODY
:,
I hereby acknawledge receipt of a copy of this application. By acknowledging receipt, I admit having been served with notice
that this appli�ation will be reviewed by the Charitable Gambling Controi Bo�ard and w+ll 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.
ClTY OR COUNTY TOWNSHIP
Name of ocal Govmrping Body l itY or County) Township Name(Must be notified when County is the approving body)
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Signature of Person Receiving Applicatwn_.'z^' - � Signature of Person Receiving Application
• i - , •-r`� r-' ,J�� I /, �
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�r Ttle/'� ��"� "`"''v ateAeceiv� Title Date
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CG-00020-01 14l88) :White—Board � Canary—Board retums to Organization to keep
Pink—Organization Gold—City or County
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� �111L�r�o�/ O` �`/rY��JL �\�L/ �%Ji��YT 11UL�1�1��1�1i���ol!
T'•='QP_'•ATICN �CUI� �:iITH .^-.c�?�C1TIC�1 �OR r'�'_'?�?'•" T� CC?,`L�CT Gri��T�'G SG�SI�PT I�: ST. F4'JL
1. ::a..-:z �i �oa�i.zat;on �7l /�� � Cl��
2. �ddress where �a�i.zation's re���la.r meeti.ngs ar� r.eid 7�/G ���/:�'G :f�
3. Da� ar.d ti.ze of :�:�esLi.n�s ✓/��'
�
��. AdcL^�ss ,�he:� CamblfnP Sessioa ;aii? he r_e�a �7 G ��°�v ��
5. Is �r.:.�,caat o*.�r:er o.i p:opert� c�ri-.eTs �2a.-:b7.:�:� �essicn T•ri?1 re he'�'.�_?es '?o
5. I� Iea�ec, :•;t�o :s o�aner of pr�ert� �r�'r.sre Gar,blin�- Sessior �a=�?I ne "e?d?
7. If leased, attac� letter of per:sission to conduct Gar�bli^� Session, s�gr.ed by lessor.
S. �+ame oi� ofiicer ma..F�a� applica�ica _��/���,v �U�.�/I
9. �lddress of oi�icer maiang applica�ion 1r/Q ���%/�'2 Date of birth .
10. �:a�e of r.ana.Eer who c�rill conauct Cambli� Session,,fT�/��✓ ���'ti.s
:1. �ddress of «�sa^.s.ger ��l/ ��2'!/` �ate of �?rth
I2. In con.��ction with wha.t event is th:s GambLng Session beir.g held?
'. "_��r/// .�� �� /�,F� �'�i�,ac.�yc, _.
�
I3• 6y'�iat type of ga�bl� device(s) �ri.11 be used? Paddlewreel '!Ypboarc��_Pa"le
iZ:.. �a�, dates and hours this appLcation is `'or and nur.tber of sess�ons.
.._.. 7.O�.-//•� G�a,��,r
Da�(s) ��,- �N� Dates /��,����`7 uours ''��6�' _ ..o. of Sessions�_
.. _ I�. :rT'�T prizes �e paid i.n none� or--r•ierc�.andise? /��iri�y .
I6. Is trm appi�cant association o:r2nized under the la�rs o' Lr.e Staie oi I�:irsssota?_'�
Z7. How long .".a� Cr�.anizatior been in existe^.ce? /�/�
lE. Tr'hat is tue ��ose of th= Or�anization? �6ivAT� C�SI.I/�-�ll �/�A��!��
19.-. Qf�icers oi the Orga.nization
�dame-Title Addx�ss �aie of birth
, � � � �,i i . ►��3 ��1���1��2 ,5`75� � /g �v�
���• �,�r ,,,��; �
�.,✓r.sy� ,�n. �'�.r���a-N.�. 1��3 1�.������.-`c-�41'�, ���-�'� �5u �'ti'� . ��
l�ilc ' s�e�:.l�r.�*� � 1 \- \ �,,�` �' �
G C��/C°ic/� e�4 l�\ �`n�7��'�\ �-"`�t�`�'+CL�' �' , � , ��i
� /�i��� s 5 a�
. :S'e�-r 1�'yr�j � , `1 . �(j� �� �C�v�`- `�5�G5 3 `�}� C i`��
.�.f'Y� l��Jirli,c/c.f
__ ^_.:. �c3„{i.l�s✓ � ` .
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���-��a�
?:: �ive =�.es a= oi��.cers or ar,� ot:�e� JA+�vor_s �ai� 'or se�ces � �:�e �r=-a.r�ZaLiOr. �'
. i•ic'ZII'.E=�ti2 �G�"eS5 �a�e O? �iI"tl':
� � l�
' Zi. I� Wr05° C"�^�'••C4a� +dl..'LZ �'OCOiCS OZ' QI'�321ZZ8t'.iCI1�S '�2.'"i.^.�=:IF. Sess_ons }'° ✓ED��
:�ame�c-✓T�� ��/.�oi.r :�ddre s s .��� ���� J�
22. �ttach a cot�y of ;�our G�gar�.zatioa's members'r�p roster and date each cie�ber joiaed.
23. AV VaCr< t:�e Ga�hli*� Sessior. t•fana�er's bond.
2L. �ttac!^ a coDy o� �::e �epart:ner_t oi t:e '?'reasu�^r, Inte�a.l :'_everue ;e�cs "'..etvr^ o�
Cr�anizat;c� �xecr!�t �ror I:.cor.:e '"ax", Fo� 99�. (�ha��er L19.0��� �ii.i
25. :�t�ach a co�� OI' :-@�2I't;'?2llt oi �ne mreasu�--?, Inter-�a.1 'e•,enue �e:�vice, ''°12:1D� CrFan-
ization �usiness Income ?'ax", For� 9°OT. (C'r_apter �.Z?.0►� (2).i
26. �.ttach the arLnual renort recuired of cr.as�table orran=zations by ;�i�nesota Statutes,
Section 309.�3. (Chapter 1�19.OL (3). )
27. �t?ave �ou read and do vou tho^ou�hl� un�?erstar.d the �rov=sior.s o�' aIl 1.a*�rs� ordinances
an� r°�ulations €overrin� the operation oi Car::hi=n�- Sessions?
28. ?x�y cran�es des�red by �re appl_car�t asseciat�or_ nay �e ►�ace onlf ?�t:� �he cor_sent oy
t!^.e License Cocrcrtittee.
� ' � T • .
2g: iias a� person(s) �a.�ticipat�g in the operat�on of any o� tt:e �a^:blir.� sessions cov-
ered by tr�.s L:cense ever been con�cted oi a felony in tre State of :iir�esoza or i.n
__._ ____. •
ar� ot:ier State or 4sderal Court? Yes �lo Ii ar.swer is "�es", grovide
r,ames, addresses 2nd birth-da�es.
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�anizatior�
..._ �P _/ .
C�
- (Cffic�r-_ tle �����/ ''�`�
a�d �i�Ld//�.�
(I� ,,er in c:2r�,e of Cambl�n� Sessionj
S�a�a of t�3nuesota)
%SJ
�ount� oi ?.as:ses )
i ��.� � n S ana �E� �iv��i s
be_ ,, dulv sworn sa7 that the� a:�= t:�e pet�t�oners ;n �he above 3DDLCZtion; that �::e�r hav=
^?�� }i+:lE _*'OY'@�0111� D@t�t10t1 d11C� r�1CW the COI1t2AtS. ��ereof; Li13�- `�.�"i@ S3A1@ I.S `:1° O£ :i:2?�
O:•Rl 4L0«�.2�F@.
Subscx-'_bed and,s�r�rn to b f�re �e t:�.is
�f9'� d3� ai �°�
��� � , DAHLBERQ
ountY.�'
�otax'y' ?u _ ' , vIl bbN�����ec.11•1tiM -
::� ccsuni�sion P�cai_es��,,,,missionE�P
. � .
�tiiZ'cinF`��epa.rc�ent �,pDroved Disa�vroved by .
� ,. ,,..
. =1re �e�arr't.:.eat :�D�roved �i.sa�p�ved_�4
� �DoS�.ce. �enart:�er_z nDproved-�isapnr�vzd ^y
C1`-�-/SZ�3
---------- AGENDA ITEMS --------------------------------
---------�_____________________ --------------------------------
ID#: [332 ] DATE REC: [10/07/87] AGENDA DATE: [00/00/00] ITEM #: [ ]
SUBJECT: [1-DAY ST. PAUL GAMBLING PERMIT - ST. PAUL ATHLETIC CLUB ]
STAFF ASSI6NED: [NONE ] SIG:[RETTMAN ] OUT-[X] TO CLERK [�1070D70DT /���'
ORIGINATOR:[LICENSE DIVISION ] CONTACT:[SCHWEINLER - 5056 ]
ACTION:[ ]
C )
C.F.# [ ] ORD.# [ ] FILE COMPLETE="X" [ ]
� � � � � � � � � � � �
FILE INFO: [RESOLUTION/CHECKLIST/APPLICATION/GAMBLING EXEMPTION ]
[ ]
L ]
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