87-1601 WHITE - C�TV CLERK
PINK - FINANG�E COIlIICIl G� /f' /
CANARV - DEPARTMENT G.I TY OF SA�I NT PAU L File NO. `� `(��/
BLUE - MAYOR '
�
C 'l esolution
Presented By ��
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D.#10977) for a One Day City of St. Paul
Gambling Permit (Bingo Only) by Holy Spirit Men's Club at
512 St. Albert Street on November 10, 1987, between the hours of
7:00 P.M, and 9:30 P.M, be and the same is hereby approved.
COUNC[LMEN Requested by Department of:
Yeas Drew Nays �
R�� In Favor
Scheibel �
Sonnen _ Against BY
Weida
W11SOn NQV — '� pp7 Form Approve by City Atto ney
Adopted by Council: Date
Certified Pass uncil Secr BY
By
A►pproved b Mavor• Dat N�V — Approve y Mayor for Submission to Council
By � BY
PUBItSHED t���V 141987
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, - .�I° 011360 ,
�-,:.�,t�, t �rt� ..�.u$p��rrr - - - - - -
�.;-.S 1� . ., �.,tiSl...� CONTACT NAME �
a-9`d -�S(�io PHONE �
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� � l'O I zZ L �!"1 DATE
ASSIGAT NUMBEF FOR SOUTING ORDER: (See reverse side.)
_ Department Director May�r (or Assistant)
� _ Finance and l�ianagement Services Director � City� Clerk ,
_ Budget Director � " ���,�
� City,Attorney _
TOTAL NUMBER OF SIGNATtJRE PAGES: (Clip all locations for signature.)
WHAT WILL B� ACHIEVED B�t TAKING ACTION ON THE ATTACHED MATERIAI.g� (Purposs/Rationale) � � �1�- �
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COST/BENEFIT. BUDGETARY. AND PERSONNEL IMPACTS ANTICIPATED:
. r� � �:
FIN CI G S BUDG C V C G OR CRED D;
(Mayor's signature not required if er $10,000.) '.
;:
Total Amount of Trans�ction: V�'A Activity N�#mber: n l�-
1
Funding Source:�'a
ATTACHMENTS: (List and number all attachments.)
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ADMINISTRATIVE P�tOCEDURES � �
„Yes _No Rules, Regulations, Procedures, or Budget Ametldment required?
�Yes _No If yes, are they or timetable attached?
DEPARTMENT REVIEW CITY ATTORI�EY �t�VIE�i
✓Yes No Council resolution required? Resolution required? L Yes _No
_Yes � No Insurance required? Insurance� sufficient? �Yes _No
Yes ✓�lo Insurance attached?
_ �,.r , . ; �,�7—l��/'
'�'` Minnesota Charitable Gambling Control Board LAWFUL GAMBLING EXEMPTION
Room N475 Griggs-Midway Building FOR BOARD USE ONLY
" 1821 University Avenue
- St. Paul,MN 55104-3383
��""'��� (612)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 until after the activity.
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
PLEASE TYPE the financial information, sign and date the form, and return to the Board within 30 days.
Organization Name • Number of Members license Number Iif currently or previously
S D S.O licensedl and/or permit number. A 1 U—� �L e S e
L � �.n
Address " City State Zip County
. c a g iA� cszt- "� S��au �6 1CZS S�
Chief Executive Officer's Name Phone Manager's Name Phone Number
A ,bt�� l�Q�( -�I� 3 �tR� �� i��a� (0�5- �cx(
Type of Organization If Other Nonprofit Organization ICheck One and attach proof of nonprofit statusl.
❑ Fraternal O Veterans ❑ IRS Designation
�;Religion ❑ Other Nonprofit Organization ❑ Incorporate with Secretary of State
Attach proof of three years existence. ❑ Affiliate of Parent Nonprofit Organization
Name of Premises Where Activ_ity_Will Qc�uc.. ' °"�"�'` �^ M Datelsl of Activity,drawing(sl
_'__._`— .�_
- - _ �_ _S_^, -r u.�C � Cc,v�+eR_ �cLC-�b�. j o,
Premises Address City State Zip County 1 Ct�7
s�z t� � , s� s P��� �� �w�s�`
R�� ����'��
Game Yes No
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Bingo `
Raffles �
Paddlewheels �
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Tipboards • �
g����� �
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Pull-Tabs �( ��� ��`����
_ _.,� ::,�.
, . _ _ . -
Use of Profit '1 =— . _ - ,f�" 't . �..L.� . , .. _ .. .
i� , , . . :'.1'r..�+�1 ,��.1�) u � �� , - .., � , ��1 `,1. .. , . . . • . . � ... � � -
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I affirm all information submitted to the Board is true, accor-
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ate, and complete. F � � g
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_:__:._..._ . . . . .. __. . - �. . . :. � t � '. . ``
ChiefExecutiveOfficerSignature Date � z.^:� �;.'; ��;.��, s�s '`�'��� �`'� •����`i
ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY
I hereby acknowledge receipt of a copy of this application. By acknowledging receipt, I admit having been served with notice
that this application will be reviewed by the Charitable Gambling Control Board and will become effective 30 days from the
date of receipt (noted below) by the City or County, unless a resotution of the local governing body is passed which specifi-
cally disallows such activity and a copy ot that resolution is received by the Charitable Gambling Control Board within 30
days of the below noted date.
CITY OR COUNTY TOWNSHIP
Name of Local Goveming Body ICity or Countyl Township Name(Must be notified when County is the approving body)
Signature of Pdrsor�Receiving Application Signature of Person Receiving Application
. ,� . `. , � i � ' ,_ —
,:Title: � � Date Received Title Date
� �` J: I. 1 �'�
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CG-00020-01 16/87) White—Board Canary—Board returns to Organization to complete shaded areas.
Pink—Organization Gold—City or County
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DIVISION OF LICENSE ANI) PERMIT ADMINISTRATION DATE ��-Z / !(> /(e 7
INTERDF.PARTMFI�TTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
A�plicant � ( � � �it� Home Address ]aG� � ����� n b�'
Business Name Home Phone ��'J �' � Q �p�
Business Address �(a, � ��� ,�,�� . Type of License(s) r�_
Business Phone �C��j - bad(.I�
Public Hearing Date� � License I.D. 4� � ��� '"j�
at 9:00 a.m, in the Council Ch bers, ^�—
3rd floor City Hall and Courthouse State Tax I.D. 4{ � 1�
llate Notice Sent; /� Dealer 1� h�}
to Applicant !� � � l. ��U
Federal Fi_rearms �� �
Public Hearing
DATE IIv'SPECTION
REVIEW VERFIED (COMPUTER) CUMMENTS
Approved Not A roved
Bldg I & D � �
n �
Health Divn. '
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Fire Dept. � �
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Police Dept. I
� ��
License Divn. �
IC��Z�� ��
City Attorney �
I
Date Received:
Site Plan 1� I F�
To Council Research i(�(Z�p � g'�
Lease or Letter Date
from Landlord n �A ��
.�lr�,,,�} c� l l 3�s,a
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.+� �,�y'• r pr r�A -•7,'-w- .'., �
Dir:�T���T OF r�?r�1.�,C� �I�ID' i1����C��.►.T �u?�JICiS
, � w DIVISiOiI OF ISC�tS�, sI�ID P�.t�T " MI??IS'�'�AT..IC:1
ilydP�fATICN �C.UL� �;TIiR �r°�C�TIGPd :OR �'u"� '•."C CC?•�IICT Gi:•�r,I_`;G SES5i0P? =.? �T. ?4UL
?_. i:are o� Organi.:ation � l�.i 5�i (� . ,,,�� ��� �
2. �d�sss where C�gani2ation's reFUlar-m�st.�s a� hald S I �, S . �� �� S�
3.� Day and time of ^�estirlFS . �S� YYLcrn rQ.a� , �, � a G� VVt�,�,d�l„
l�... Addxbss Where Gambling Session *�sill he- held ��a 5_ ���e,�-�.
�. Is anpli.cant owner oi oropert� where Gambli�� Sessi:on will be he1.c? I/ Yes "o
6. I_ leasee, who is owner o£. pro�ertp *�rY�.ere Ga.�nbli..-� Sessioa T,ri11 'oe :^.eld? � ��
7. If leased, attaca lst�,,er of permission to cor.duct Gz..*�bli.r� Session, s=gned by Iessor.
8. :dame of officer ma.I�:.n� a�pLcation J . �Ct�y� ` � �,� �;� �
.
9. Address of of_icer ma{Qng a�olication. l a �1 l � r���i�i� Date of birth � I ,� I S
. �
10. ,tame of mana.ger �ho wiL conduct Camblit� Session � , � .� �,.� v��
L. �ddress of ,�ar�er- l3 `� � �o�-h�4��l��, �ate of birth. ""'f
12. In: connection with what event is th�s Gambling Sessioa bei� held? ��
�1� �, n,t -
I3• r�'hat tppe oi ganbLng devics(s) ;�i.11. be used? PaddleW�ee1_ '?�pboard ?.af�"].e
Ila.. �ay, dates and hours th�.s a�nlication is ior and nu.�ioer of sessions. ��` ��� �
�� ��:
�-f s) '(� , , i p . � � ��urs���1�.,?C�I�g�oi S es si ons 1
15.� �1i1i prizes be paic i.n mone� or mercY+.andise? -�-����� z �
16. Is tre a�plicant association or<�nized und�r �he laws of t;�:e State of :�:innesota? 1�,�� ,
_ t
I7. Mow long :as Cr�a.nization been in e_�.sterce? l G13�1
1�. `r��at is the pur�ose oi the Orga.nization? � �,� c,icZ_�
I9. Qf�icers os the Orgarization
'3ame-Title 9ddress �ate of bir�.