87-1555 WMITE - CITY CLERK �
PINK - FINANCE GITY OF SAINT PAUL Council . F�`
CANARV - DEPARTMffNT File NO• v �_/���
BLUE - MAVOR
�
Co ncil eso tion
Presented By �`r�
Referred T� Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D.#95247) for renewal of a Gambling Manager's
License by Sheila Smith DBA Highland Area Hockey at 825 Jefferson
be and the same is hereby approved.
COUNCILMEN Requested by Department of:
Yeas ,�.� Nays �
Nicosia ln Favor
Rettman
Scheibel �' Against BY
Sonnen
j9l�eler
WilsOn �CT 2 7 �8� Form Appr e b ty At ney
Adopted by Council: Date
Certified Pa: y ouncil Se ry BY
By. 1':�-2�d
App e 1Aavor: Date 7 Approved by Mayor for Submission to Council
B BY
Pt�iiS'r�D �„�v �' � 19�7
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- . .�° 011395 ,
, . - - - - - -
DEPARTMENT -
CONTACT NAME
- 5 _ PHONE
/v DATE
ASS GN 0 G 0 (See revarse side.)
_ Departm t Director Mayor (or Assistant)
_ Finance nd Management Services Director �, Citp Clerk
_ Budget irector ,� ��l,c_ ,,.r �' �r� a�r�•cT_
� .City At r�ney _
G (Clip all locations for signature.)
T C � ? (Yurpose/Rationale)
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COT BUGE NDPR
� 1�
F N C V HARGED
(Mayor's si ature not required if under $10,000.)
Total Amo t of Trans�ction: � 1/� Activity Number: � t�}
Funding So rce: � I�
ATTACHMENTS: (List and number all attachteents.)
c'�� �
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D �1 'ST TI ROCE URES � l�
_Yes No Rules, Regulations, Procedures, or Budget Amendment required?
_,Yes No �f yes� are they or timetab2e attached?
DEPAt �1T I t,T CITY ATTORNEY REVIEW
✓Yes Council resolution required? Resolution required? ✓Yes _No
_Yes Insurance required? In,surance sufEicient� _Yes _No
Yas Insurance attached?
��i.�:sJ
DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE � d/ (� l lp�2,�� b`7
INTERDF.PARTMFI�TTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
Applicant �� �,, �,� Home Address t��
Rusiness I3ame � Home Phone ���j (� �"Z�{C�
�
Business Address Type of License(s) �� , �C,/� •
Business Phone (.p�� - `��-��
Public Hearing Date License I.D. 4F �' ,� a�`�
at 9:00 a.m. in the Counci am ers,
3rd floor City Hall and Courthouse State Tax I.D. �t
llate Nutice Sent; Dealer 4� � �(,�-
to Applicant /Ql Zc7�4(�1
Federal Firearms 46 � �
Public Hearing �T�
DATE INSPECTION
REVIEW VERFIED (COMPUTER) COMMENTS
A roved Not A roved
�
Bldg I & D ��� i
Health Divn. '
vL �� �
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�
Fire Dept. � �
I � '� I
I
Police Dept. I
/
License Divn.
IOI ���1)
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City Attorney
1 C�, ?.I� �
I
Date Received:
Site Plan � C� �ZC� ( `67
To Council Research ���2O L �`"�
Lease or Letter � ' � Date
from Landlord (v � � `J��, '�-�`
a� -��s
CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
� • � - � - City of Saint Paul ��/`jS��
• . � Department oF rinance and Management Services
Division of License and Permit Registration
INFORMATZON REQUIRED WITH APPLICATION F�R PERMIT TO CONDUCT CHAR.ITABLE GAMBLING GAME IN
SAINT PAUL
1. Full and complete name of organization whfch is applying for license
i`i ��ll n� /Z I' �°��, I-f o Gk��.1 �I,� C'D G r��,�i r►�
2. Address where games will be held ��� t�TP �-�e-�' c�yl �tle. �f �L7//. � �����dp�
Yunber Street City Zip
3. P�ame of manager signing this application who will conduct, operate and manage
Gambling Games S �'�"�..L �.A 5µf�-f Date of flirth °J�� / - �
(a) Length of time manager has been member of apolicaat organiza*_ion f�
4. Address of Manager � �`t�q 3 �y�-�.� SI . PA-(,( L ��I� �
Number S[reet Cit� Zip
5. Day, dates, and hours this appl�cation is ior 5���"'f ��-04Gt� S/4r �F�2X.�l��e)
6. Is the applicant o� organization organized under the Iaws or t�e State o= �1? ye s
. ,
7. Date of incorporation M� ��73
8. Date when registered with the State o= K�anesoca N� A'�{ /y� /�7�
9. How long has organization been in e:ciscence? �q�j S
10. How long has organization been in existence in St. Pau1": l �5�
11. What is the purpose of the organ;zation? �fD�o� yo�..`��fi��_j �l1
�����q� ��a�
I2. Officers of applicant organization
Name �Y� . �...e-� 2.r ';1ame ��(O I"L�..�l'c.�v�n�
Address J3 � S• S�A-TC�6 � Js�� Address I �p �( �(,1,�C7 SSI��
Title �('e$i�¢� DOB �Q.. Tit?e V�C2 Pres noB 1^2
Name s�2 ��trv���5 Name �:C�,�� U,..;�C1A 2_�" I
Address c�-� `��j �-�-iQ� �0.,�d1 PI�(,�� �ddress o�-(7� ��Q.C(.��JD� Ss���j
Title S �(+_ DOB �� T_f�le ��..�{�`S DOB �Q
13. Give names of officers, or any ot::e- �ersons ano ?a;d �or ser-�:ces �o =ze orga�i�at;on.
`'ame � vame __�/�' _
Address addre�s
Title -��'-e
(Attacn Sei7STdC� Silc."'� -_,- ac:___�^__ ..�_�s• �
. �����s�-s
14. Attached hereto is a list of names and addresses of all members of the organization.
15. In whose custody will organization's records be kept?
Name S�Q � t q S '_� Address �7y � ���n
16. Persons who will be conducting, assisting in conducting, or operating the games:
Name Date of Birt ��
Address 7 � G(��.� J�,SI
Name of Spouse Date of Birth
Dates when such person will conduct, assist, or operate __�.LC_ �t .
vame _� ���/� f�j �- r,� n 9 e� Date of Birth l � C� , J
�
Address 1.�-r'�� sLJ�1"k���� S�" �Q u�/ �j�'�Q�z".
Nane ot Spouse Q,nn� �� Da[e of Birth �L.°
�
Dates wzen sucn per�or_ �ai�l concLCC, ass;st, or ope:ate ��, ��r �
17. Have ,�ou read and do ;�ou thor,�ughly understand che orovisions of all laws, ordinances,
ar.d regulatiors Qo�rer-!in; c�e ope-at:on oL Caa��tab_e Gamb�ing gumes? �Q,s
18. �ttached hereto on the fo^� �ur::�sned bv the C�t� o� St. Paul is a Financia? Report
whic:� it��izes a1� rece=acs, esperlses, and d�sburseme�ts oi cae applicant organization �
a, well as ai_ or�anizat'_ons :�ao zava �ece=-�e� =unds �or the f
Qe�'io� �(bc�eu�be:^ �/�/9�'6 ��41j� 3/, /9�7
whica aas beeZ s�.5-:ed, �repa_-ed, and ve;i==ec �y ��C,��1
�iame
Z,��� �'1�Ct�G�da� �D S� G'/�Cf( /1!� SS//�
�adress
who is che _J�(�/�(,�/�iQ, o` cne aoplicant Organization.
tiame oL Of=_�e
19. Operator o: pre�;ses :rhere �anes :�i1= be heid:
N2me _ �O 2 � �.� e.k�e.(
B�rsiness Address �J OS�s �j� � ZD�,�--N �ZS i k'�?J-sJ�J
Home Address 1���"
20. Amount oE rent oaid by app�_csnc Or3sni�ac�on �or renc of che hall; speci�y aaount
paid per 4—hour se�c�on �� �/�,aw
���7�ss�
2I. The proceeds oi the games will be disbursed after deducting prize layout costs and
operacing expenses for the tollowing purposes and uses:
Y(�L,u�.r..,. 'JC' �� �e.h..«S �A/' �0�.'�n� �I. �C,�C.e-c./
�
� ; a..,�s � I-I-f}-i-��}- �ckc� /r�c�r�r,h
2Z_ Has the premises where the gzmes "are to be held been certified for occupan�}• by the
City of Sainc Paul? __� QS
23. Has your orgar.izat�on riled :ederal �orm 9°0—T'. -� I� answer is yes, please attacn
a copy with tF,is applicac�on. I= answar is r.o , explain why:
-j�ld f3uSioU�S'.S� CGYTJd7u`�",L�'�7{�/}-T /S tLiUfZ,EG�7�b TO D�C-�`�/."zJr}-T10t�
/�c�/K oT •��l2.oeS�
P.ny changes desirec bv �ae a��1_c�::t sssoc�ar:on ma� be �ade on1;r wich c;;e conser.t oi the
City Cour,cii.
� �t'G� �q,�.dl �}!'e� 1��y '�`� �V
Orgaz_za�:on
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------------------------------= AGENDA ITEMS --------------------------______ ��?/�.z�S
---------------------------- --------------------------
ID#: [368 ] DATE REC: [10/20/87] AGENDA DATE: [00/00/00] ITEM #: [ ]
SUBJECT: [GAMBLING MGR'S LICENSE - SHEILA SMITH - HIGHLAND AREA HOCKEY ]
STAFF ASSIGNED: [NONE ] SIG:[RETTMAN ] OUT-[X] TO CLERK.�OOf98f0�] l D�-� �
ORIGINATOR:[LICENSE DIV. ] CONTACT:[SCHWEINLER - 5056 ]
ACTION:[ ]
[ ]
C.F.# [ ] ORD.# [ ] FILE COMPLETE="X" [ ]
� � � � � � � � � � � �
FILE INFO: [RESOLUTION/CHECKLIST/APPLICATION ]
C J
[ ]
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