87-1602 WHI7E - CITY CLERK
PINK - FINANCE CO{�flCll /
CANARV - DEPARTMENT CI OF SAINT PAUL /��
BLUE - MAVOR � Flle NO• � /C �
�
cil esoluti
Presented By ��
Referred a Committee: Date ...
Out of Committee By Date
RESOLVED: That Application (I.D. #24184) for the renewal of a Class B
Gambling License (Pulltabs and Tipboards) by Arcade Phalen
American Legion Post 577 at 1129 Arcade Street be and the same is
hexeby approved.
COUNCILMEN Requested by Department of:
Yeas DY'@w Nays �
Re� [n Favor
Scheibel �
Sonnen _ Against BY
Weida
WilsOn Form Approve by City Att ney
Adopted by Council: Date 1►Illl/ _ �. YlQ7
Gertified Pass d y un ' Secr r BY
By
A►pproved 1V1av • �r ^� � Approved Mayor for Submission to Council
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Y B
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' na.►�c,.e._ E- - DEPARTMEPT -
CONTACT NAME
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_ __Q1�►� - 5 (��(o PHONE ; ;
� ; {(�`�� SS, DATE .
ASSIGN NUMBER. FOR ROUTING ORDER: (See revers� side.) �
_ Department D�rector Mayor (or Assistant)
_ Finance and Managemeat Services Director � Cit� Clerk
_ Budget Director ,� ��.,vv..c.:���a.�c.�
� City Attorney _
TOTAL NUMBER OF S.IGNATURE PAGES: (Clip all locations for signature.)
T W V Y ON T C T ? (PurposejRationale)
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COST/BENEFIT. BUDGETARY. AND PERSONNEL IMPACTS ANTICIPATED:
'� �q-
FINANCING SOURCE AND BUDGET ACTIVITY NUMBER CHARGED OR CREDITED;
(Mayor's signature not required if under $10,000.)
Total Amouat of Transgction: V1 � F1 Activity Number: 1/� ,R
Funding Source: � 1�.
ATTACHMENTS: (List and number all attachments.)
'�y p,p� �1 .
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ADMINISTRATT9E PROGEDURES � 1�
_Yes _No Rules, Regulations, Procedures, or Budget Amertdment required?
_Yes _No If yes, are they or tiraetable attached?
DEPARTMENT REVIEW CITY ATTORNi�:Y RBVIEW
J�es _No Council resolution required? Resolutian xequired? ,j,�tes _No
_Yes y�No Insurance required? Insurance aufficieat? _Yes _No
_Yes _�Po Insurance attached?
, . ' ��� �7-�l�a=
DIVISION OF LICENSE AND P�RMIT ADMINISTRATION DATE �(� � 1 �6'l � t v � /S �g'�
INTERDF.PARTMF.I�TAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
1 l-,��tr-�.-�..-- � t�
Applicant �r���h�e,�,� �_hp,r�ic�.�o�.Home Address ���,"t � �:���. p
--�-b�_1 1'V\A��t...ao��c� ,
Business Name ��,�,�,�y Home Phone
Business Address ���(� �`�� �� Type of License(s) ��r.,�„ . � ,�,���,,
Business Phone ��) - ���1 � ���j , ���,,,`��
.
Public Hearing Date- � �` -"� `" License I.D. 4{ aL� �,��F'
at 9:00 a.m. in the Council Chambers, �..�,(Q�,�
3rd floor City Hall and Courthouse State .�-��: �� � - OG�3S- DOa
llate Notice Sent; \ Dealer 4� y1 1(�
to Applicant �����g� �"���� �
Federal Firearms 4� Yl � �
Public He�iring
DATE INSPECTIUN
REVtEW VERFIED (COMPUTER) COMMENTS
A proved Not A roved
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Bldg I & D � _ .
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Health Divn. '
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Fire Dept. i �
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Police Dept.
���� �
License Divn.
1 �� « I c� �,
City Attorney �
f
Date Received:
Site Plan '�`,A
To Council Research ((� �Zu 1 u`�
Lease or Letter Date
from Landlord � �Q�.
�ct�-�-�-� .���-�- O lt 3 �i
CURRENT INFORMATION NEW INFORMATION
Current Corpo�ation Name: - New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
. . . _. .. �. . . ... �r�.....�� �—�:........ . .. . .r."' ... . �... , —.—' . . . . . . . .. .aw .i . ... .... .... . ... . . i
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r .. •;;�o���� Cha�itabie Gamblin Control Board ° � ��
� '�`� ���� Room N-475�Griggs Midway Building. ~ FOR BOARD USE ONLY
F - ;'� 1821 University Avenue 4;r' uC°`�'"�"
; St. Paul, Minnesota 55104-3383 �p
� . . :. � (612) 642-0555 •
� rt�1 } CHECK#
� . DATE
�. GAMBLING UCENSE APPLICATION ,
;
INSTRUCTIONS: �
A. Type or print in ink. --� ` �
B. Take completed application to local governing body,obtain signature and date on all copies,and leave 1 copy.Applicant keeps 1
� copy and sends originai to the above address with a check.
e
C. Incomplete applications will be returned.
F Type of Application:
� ❑Class A — Fee S 100.00(Bingo, Raffles,Paddlewheels,Tipboards,Pull-tabs)
� �lass B — Fee S 50.00(Raffles,Paddlewheels,Tipboards,Pull-tabsl MekecheckspsyaWeto:
� ❑Class C — Fee 5 SO.00(BIf190 O�ly) Minnssota Charitabb GambNng Control Boatd
� ❑Class D — Fee S 25.00 IRaffles only)
t —+ ��
k �QYes�No 1. Is this application for a renewal? If yes,give complete license number � -� � - I v�
i �Yes�No 2. If this is not an application for a renewal,has or anization been licensed by the Board before? If yes,give base
' license number Imiddle five digits) � �� '"! � ��
�
6�Yes ONo 3. Have Internal Controls been submitted previously?If no,please attach copy:
� 4. App icant IOfficial,legal name of organizatiqn) 5. Business Address of Organization
� f� i��A E � l�f,t.1'i r�E i: 'c-r�1 �� � l'G-!r+.V P S 1` l 1 1 ?. 9 � :�G�;t r- i,
� 6. City, tate,Zip 7. Gounty 8. Business Phone Number
� S�� ' ,� c L ��. 3S �� �5��� S�" � � � � , � _g �
k9. Type of orgartization: ❑Fraterr�al �/eterans ❑Religious DOther nonprofit"
�.- . *tf organization is an"other nonprofiY'organization,answer questions 10 through 13.If not;go to question 14."Other nonprofiY'organizations
;. must document its tax-exempt status.
s `��Yes�No 10. Is organization incor orated as a nonprofit organization?tf yes,give number assigned to Articles or page and
�: book number: Attach copy of certificate.
' ��fes�No 11. Are articles filed with the Secretary of State?
I
�,. �e,s O No 12. Are articles filed with the County?
�, �Yes�No 13. Is organization exempt from Minnesota or Federal income t x?If yes,pleas�attach letter from IRS or Department of
Revenue declaring exemption or copy of 990 or 990T. �l.r�u�'��i,�X+%+-w .� G �2 S
�: ❑Yes(�l0 14. Has license ever been denied,suspended or revoked?If yes,check all that a I�j:
❑Denied ❑Suspended ❑Revoked Givedate: - -
�: 15. Number of active members 16. Number of years in existence Note: If less than four years,attach
r,
� �^ � �., � , , evidence of three years
�-. 01 r; �}� ,� i ;� � existence.
f� � 17. Name of Chief Executive Officer 18. Name of treasurer or person who accounts for other revenues
K . of the organization.
�
�A3�/ F✓ I�i �yi �3 1 1y � .Seti./ � -� �� k�. k:;�.:v,5���1G�V'
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� Title Title
� 1
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� Business Phone Number - � Business Phone Number �
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r 1 �/� ) �7J .�� y� ( 6 �Z 1 L=..��_� �S2/
� 19. Name of establishment where gambling will be �OS 7- 20. Street address(not P.O.Box Numberl
�` conducted
� � S 7'
� Ar?co� = Jt�r���� �:�`'?"r?rr.�*✓ ���;v�;� S7 I l t � :-�/�C ��
21. City,State,Zip 22. County Iwhere gambling premises is located) .
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CG-0001-0218/86. White Copy-Board Canary-Applicant Pink-Local Governing Body
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Gambling License Appiication � Page 2
Type of Application: ❑C1ass A �Class B ❑Class C �Class D `
�A
'��' '�Yes�No 23. Is gambling premises located within city limits?
•��:.
�,-,:": ' es❑No 24. Are all gambling activities conducted at the premises listed in #19 of this application? If not,complete a separate
°�.�.` application for each premises(except raffles)as a separate license is required for each premises.
es O No 25. Does organization own the gambling premises?If no,attach copy of the lease with terms of at least one year.
"° ❑Yes�No 26. Does the organization lease the entire premises?If no,attach a sketch of 27. Amount of Monthl Rent
� the premises indicating what portion is being leased.A lease and sketch $
'` � �/� is not required for Class D applications. '
_��- ❑Yes�No 28. Do you plan on conducting bingo with this license?If yes,give days a�d times of bingo occasions:
`" Daya Times \—�
:�.:: '
,.�., - _ - ...
Yes�No 29. Has the$10,000 fidelity bond required by Minnesota Statutes 349.20 been obtained?Attach copy of bond.
� 30. Insurance Company Name 31. Bond Number
� �
- 32. Lessor Name 33. Address 34. City,State,Zip
35. Gambling Manager Name 36. Address 37. City,State,Zip
C�� 1 � ' ("� 7 � �. y ? � wi'i�1'r� f�'� � 1-/ �,` � � ��
38.. Gambling Manager Business Phone 39. Date gambling manager became �
'•-� � member of organization:
GAMBLING SITE AUTHORIZATION
By my signature below,local law enforcement officers or agents of the Board are hereby authorized to enter upon the site,
at any time, gambling is being conducted,to observe the gambling and to enforce the law for any unauthorized game or
practice.
- - BANK RECORDS AUTHORIZATION
- By my signature below,the Board is hereby authorized to inspect the bank records�of the General Gambling Bank Account :.�
" � whenever necessary to fulfill requirements of current gambling rules and law. � - .
OATH
I hereby declare that:
1:..,; 1 have read this application and all info�mation submitted to the Board;
2. All information submitted is true, accurate and complete;
. 3. All other required information has been fully disclosed
4.' I am the chief executive officer of the organization;
5. I assume full responsibility for the fair and lawful operation of all activities to be;conducted;
6. I will familiarize myself with the laws of the State of Minnesota respecting gambling and rules of the Board and ag�ee,
if licensed,to abide b those laws and rules, includin amendments thereto.
40. Official,Legal Name of O�ganization 41. Signat re lmust L�e signed by Chief Executive Officerl
' C� -, _ .'� :•• : � � �i31< � P G �, ti/ X t"
Tftte of Signer ' � Date
v l f'�r�✓De � � '.S�I'r' /��7
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 Boa�d and if approved by the board, will
become effective 30 days from the date of receipt Inoted belowl,unless a resolution of the local governing body is passed
which specifically disallows such activity and a copy of that resolution is received by the Charitable Gambling Control
Board within 30 da s of the below noted date.
42. Name of City or County(Local Governing Body) If site is located within a township,item 43 must be completed,in
addition to the county signature.
City of St. Paul
Signature of person receiving application 43. Name of Township
X Joseph Carchedi �+' �;� ('�
Title Date received(30 c! y period Signature of person receiving application
License Inspector begins from this date) �
10 6 87 X
44._ Name of Person delivenng application to Local Goveming Body Title
�;� ' CG-0001-02 (8/86) White Copy-Board Canary-Applicant Pink-�ocat Governing Body: . •
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� , � - , � City of Saint Paul
� • Deparcment of Finance and Management Services
Division ot License and Permit Registration
INFORMATION REOUIRED WITH APPLICATION FOR PERMIT TQ CONDUCT CHARITABLE GAMBLING GAME IN
SAINT PAUL
1. Fu1Z and complete name of organfzation which is applying cor license
�
������ � �L.�,�s�l����C�v �c��e� pas ! S7'7 .
2:` Address where games will be held ��a.�' J'¢�,�jQ � S'�'�J� �p/}�� �S�d�
vumber Streec City Zip
�
3. Name of manager signing this application who will conduct, operate and manage
Gambling Games �..A-j,�/�G�t1Zt D - .//�"/�i� ' Date of Birth O ��,,,?" 3fJ
(a) Length of time manager has been member o= a�plicant orgaaization � �/C�
4. Address of Manager �i�� �, G�y,(����n, � /�'//����,1i1��'�7_M/�i -��16 �
�
Number Street Cit� Zip
5. Day, dates, and hours this application is ror /4 � �
6. Is the applicant or organization organized under the laws ur t:�e State o� �T? � S
,
7. Date of incorporation � �,� __
S. Date when registered with the State oi K�anesota � y Gj�„
----r
9. How long has organizat�on been :n esiscence? �.� ��
�
10. How long has organization been in eYistence ia St. 2au1": � 1 �,�s.
11. What is the purpose of the organ:zation? j������}-�(/� (i}�LTl4'�i � �G•
12. Officers of applicant organization
Name M1y�U/N � ,%'/ATI/jSc�d/ 'tame L CS�1'f �� L)��iU,SG/7d/V
Address �,j.3 3 � yQ LLo�A•./ /�Y� 9ddress l� { � �
� S7� s�, L
Title G� 1�1/h/►MQ�� DOB 7 � � 3 T_it�e���� ���r�DCB —�
vaae �� � �I/�� Llame ��/�G � C., ll � /t G �r�
Address /.,� � �����/l/�", �'�Y. :�ddress'���� �
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Title �. �.(�"�l(J� DOB � , � ,� _ T.it�e "d�lli�� � 1 �.0 DOB � ,���/��
1.3. Give names of officers, or any oc:.e.- gersons ai�o ?a�d �or ser�_ces to cne or�anizacion.
Name _l �1(,(� I��D 1 �-L� � Vame
Address �' � � � � :�ddress -
—_ _ _ . __ _ ��lY -__
Title �j T_i�ie
(��ctach separata snee� _^- acc:__or.s: __�_�s . �
�����o�
14. Attached hereto is a list of names and addresses of all members of the organizatfon.
15. In whose custody will organization's records be kept?
Name LAI�VIfG�LY �. ��� Address ���7�� G�a'�r�rY Ir� , /S
I6. Persons w o will be conducting, assisting in conducting, or operating the games:
Name Date of Birth
addzess 9 � � �
.
Name of Spouse ��Q,_ Date of Birth p'���
Dates when suc!� oerson will conduct,` assist, or operate
�
Name Date of ffirth ���—.�l�
Address � /�
_ �(/'' �/�'� L s-ei
Name of S ouse ,�_' �
P �� Date of Birth
Dates w;�en suc� pers�on ai'? concect, ass=s�, or ope=ate -��
I7. ;�ave �ou read ar.e do .�ou t�:oroughly understand tne provisioas of ali laws, ordinances,
3P.d regulatior�s �OVo^{T.'1� tilE ODE?L3t=0T1 OL Cha��tdb=E �dm17i;II� �dm2S� �s
- 18. Attached here�o on the �o�: �ur^.�shed bv tie Cit� o� St. PaLl is a Financial Report
which �ce�izes a?1 recei�cs, e::penses, ar.d disburse�eats oi che apolicant organization
as well as a:� o�ganizat'_ons uri:c :a��e re�ei-�e� _unds �or tZe �recediag calendar �ear
W�1fC:1 i125 been 5�5.^.E�:� '!i Z7?_red, and Vz�����Q 7 V �V/ �H �SP1C�
G���e�
a �3 3 � /�a�,C�N,�y 1�v r pv� sr��v� dn�,v�• ss�� 5
:�ddress
who is the � �✓7�Ylh,t/pe� o` tze apglicant Organization.
' �aIIIE JL QiL1C°
19. Operator of premises ahere zames a�il be heid:
Name ir�CA{JG t�4 ��� f�ikrl��c��r ����o�i �°ds 7�s ? ? �a���d C�, u rs � ��R,
Business Address _�_%��'j /l�-/<C./4�� � �� �'`� �A-�L
Home �ddress �' � �� . G- � j� p���
20. Amount of rent oaid 'oy dDD.'_cant Orgaai�ac�on �or *ezt� o� che ;�a11; specify amount
paid per 4-hour se�s�on �Q�j`�' _
,, ,� � �/`��/���
. . � ,
21. The proceeds of che �ames will be disbursed after deducting prize layout costs and
operacing e:cpenses for the following purposes and uses:
.�L�I��1 G/�I'Q/' L,��cO �f/ I�IlQ ��h5 �' G�1 L�I��N �4a1� Y,��t7`/�'"
_ �E�� � �v�s� � ���»� r�,�� ��LL — or�c/� �-���� ��l1�es�s
�� -�.�—c� ��4we
2�_ Has the premises where the games •are co Se held been certified for occupanc}• by the
City of Saint Paul? Y�S
23. fias your orgar.izat;on ,'�1ed :edera'•_ �or:n 990—T'. � It answer is yes, please atcacn
a copy wi�;� t�,is 2DD11CdCiOR. I: 3I15w2L is no , e:cplain why:
�ny changes desirec b•r cae a��I�ca�t :.ssoc�acion ma� be �ade only wich the consent oi the
City Council.
AMERi��4Ar � � ��
, A�I��A�Dr /�tf,9�Erv ���7' S77
Organ'_zat:on
Date �Q��^ � By: L• !(�'IVG� Q� ��/`7�
�Saaager in charge oi gase
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-------------------------------- AGENDA ITEMS =_______________________________ �--��ll�Oi
--------------------------------
' ' ID#: [397 ] DATE REC: [10/27/87] AGENDA DATE: [00/00/00] ITEM #: [ ]
SUBJECT: [RENEWAL CLASS B GAMBLING LIC. - ARCADE-PHALEN AMER. LEG. POST #577 ]
STAFF ASSIGNED: [NONE ] SIG:[RETTMAN ] OUT-[X] TO CLERK (�0�9@ftj0] / ��� �
ORIGINATOR:[ ] CONTACT:[ ]
ACTION:[ ]
C ]
C.F.# [ ] ORD.# [ ] FILE COMPLETE="X" [ ]
� � � � � : +� ,� � +� � +�
FILE INFO: [RESOLUTION/CHECKLIST/APPLICATION ]
C ]
L ]