87-1617 i
WHITE - CITV CLERK �
PINK - FINANCE G I TY OF SA$NT PAU L F le ci1N0.
CANARV - DEPARTMENT �7 f���
BLUE - MAVOR 1
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C un il � solutio � ��`�
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Presented By
Referred To Committee:- Date
Out of Committee By Date
RESOLVED: That Application (I.D.#26019) for the transfer of a Gambling
Manager License from Chaxles an Avery DBA Brunette's Youth
Boxing at 1091 Rice Street be and the same is hereby transferred
to Robert Brunette DBA Brunet e's Youth Boxing at the same address.
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COUNCILMEIV Requested by Department of:
Yeas �i�+ii Nays �
�1COSld
Retta��an In Favor
Scheibe]. � __ A ainst � By
Sonnen g �
Weida
WilsOn �OV � Q '�87 Form Approv d y City Attorney
Adopted by Council: Date
Gertified Pass d y o ncil Secretar ' BY
By
Approved 'Vlavor: Date � Approve Mayor for Submission to Council
I By
Pu��s� ;:��d ; i �987
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�-�7-/(i7
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�i Gc� 4. . • DBPARTMEDIT - ' - - - — -
' � CONTACT NAME .,
, - ' ' PHONE
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� !@ I.z3 �[-� DATE '
�SSIGN NUMB�R FOR ROIITING ORDER: (S�e revers side.)
_ Department Director Mayor (or Assistant)
_ Finance and Management Services Director „� C ty Clerk
_ Budget Director � �.1� y :p•��
� City Attorney _
TOTAL NUI�Bffit OF. SIt�NATURE PAGES: (Clip 11 locations for signature.)
V Y ? (Purpo$e/Ra�ionale)
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OS Y A I AC
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F N AN D C V E C ED D:
(Mayor's signature r►ot required if under $10, 00.) ' ,
Total Amount of Trans�ction:�(� Activity Nwaber: t(� �� �
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Funding Source:�;,�
ATTACHMENTS: (List and number all attachmen .)
_���a,�
L.�c�v► ,
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ADI�IINISTRATIVE PROCEDURES. N� � �
_Yes _No Rules, Regulations, Proced es, or Budget Amendment required7
_Yes _No If yes� are they or timeta le attached?
DEPARTMENT R�VIEW CITY ATTQRNEY REVIEW
�Yes _No Council resolution required?, Resolution required? �Yes _No
_Yes ,�No Insurance required? Insurance sufficient? `Yes .No
_Yes _�No Insurance attached?
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UIVISION OF LICENSE ANI) PERMIT A.DMINISTRATI N DATE Z,- - / l (.� Z X'"�
INTFRDF.PARTMFNTAL KEVIEW CHECKLIST Appn Processed/Received b
Lic Enf Aud
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Applicaut �1 {'�Y�� �_ Home Address �d31 �O • �tJ.R�
Business Name�r�,Lh �S Up�'i'V1��K,y Home Phone
Business Address �pa, � �,� � �, , Type of License(s) C,'7C . �_c _
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Business Phone
Public Hearing Date �^� License I.D. 4� � (n(�� !�
at 9:00 a.m. in the Council Chambe s,
3rd floor City Hall and Courthouse State Tax I.D. 4�
llate Nutice Sent; Dealer 4� ���
to Applicant �d � �I� 7 (�So�� ) .
Federal F�_rearms 4� �
Public Hearing
DATE INSPECTIO
REVIEW VERFIED (COMPUT R) CONff�fENTS
A proved Not A roved
Bldg I & D � �
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Health Divn. '
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Fire Dept. i , �
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Police Dept. �Q'�3 I
License Divn. �
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City �ttorney �
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Date Received:
Site Plan
To Council Research �(� �LCo g"�
Lease or Letter Date
f rom Landlord ���� ��� � , �-�J��
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_ � - ' ., City of Saint Paul
. Department o[ Finance and anagement Services
Division of License and Y rmit Registration
INFORMATION RE UIRED WITH APPLICATION FOR PERMIT 0 CONDUCT CHAR.ITABLE GAMBLING GAME IN
SAINT PAUL
1. Full and complete name of organization which is applying for license
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2. Address where games will be held � -L, 55 (
;� - -- Number Street Cfty Zip
3. Name of manager signing this application wh will conduct, operate and manage
Gambling Games r ,.�.�� Date of Birth � �Cz � 5 Co
(a) Length of time manager has been member = applfcant organization
4. Address of Manager �� — �C�.�� S 5 I t
Number Scr ec Cit� Zip �� ��
S«-.1 t-z.=�r-
5. Day, dates, and hours chis applicaticn is r r � Q�� _ Sc��. �;�(�a. ,,,.., � �CX�s4r,n-
6. Is the applicant or organization organized nder the Zaws oT t:�e State ot �IId? �S
7. Date of incorporation i � B"1
8. Date when registered with the State or �Iin esoca (� �`�"�
9. How long has organization been in e:�is cenc ? 5� �p.,� � _
10. How Iong has organization been in e�cistenc in St. Pau�'. s � r�.ILS
11. What is the purpose of the organ�zation? w�
I2. Officers of applicant organizacion
Name �,�ir.�,��;�� �� Ya:ae � �C�v�2s� VGt�v� hl i�'�.r�.! _
Address �(� �"� I(t„ . �,.�rw- Address 3�"� � . �-�--v�--�-
Title���o � DOB�tZ�co � S� Title � DOB � (q� �C�
Vame "iame
Address �dd:ess �
T'itle DOB � Title DOB
13. Give names of officers, or any oc:^.er pers ns �rno ?aid ior ser�ices to �ae organi�ation.
Name Vame
Address _ ___ _ _ __._ __ _ .._ - _ Address-.�_`
Title T'-�?e
(Attach separate sne• '_ .- acc'___�n__ ..�=�s• �.
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14. Attached hereco is a iist of names and add esses of alI members of the organization.
15. In whose custody will organization's recor s be kept?
Name�n�� �rt.�r��� . Address �U3�1 �� �.�.Q.St�.�.�.�
16. Persons who will be conducting, assisring n conducting, or operating the games:
..Name k� f I Date-of Birth �
Addzess
Name of Spouse Date of Birth
Dates when sucn oerson will conduct, assis , or operate
�.�. � `--�-1.��
tVame Date of Birth
�.ddress
Name ot Spouse Date of Birth
Dates waen suc� person ai11 conc•.:ct, ass;s , or ope:ate
17. Have ,�ou read ar.d do ;rou choroughly unders and the orov�sions oF aiI 1aws, ordinances,
and regulations �o�re`--i�ng c�e operat:cn ct Cha�_tab_e Gambi=n� �ames? �,o.
18. Attached here�o cn the fc�-�+ �ur^.�shed b�� t �e C�t� o� St. Paul is a Financial Report
whic:� �te�izes al! receipcs, e::penses, ar.d d=sbursemeats oi t?�e apoiicant organization
a; we_1 as ai: cz�ar.:za�:ons ane :�a�re re�e '��e� =unds �or t:�e precedi^g calendar year
whi_n has bee:: s:;�*.:ed, p;epared, and .=e_;�'ed �v
�;ame
�ddress
who is t�e _ o� the applicant Organization.
Vame or Oi='_ce
19. Operator o* prem;ses anere zames :��'_: �e � eLd:
Name � ��-�-��
Business Address \U 5�
Home Address
20. Amount of rent oaid by app�:csn� Organi_a ion ror re�[ o� the ha11; specify amount
paid per 4-hour se�s:on � p ��j
��r-����
ZI. The proceeds oi the games will be disburs d after deducting prize Iayout costs and
operating expenses for the following purp ses and uses:
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2Z. Has the premises where the games�are co b held been certified for occupanc}• by the
City of Sainc Paul?
23. Has �our orgar.izat:on riled :edera' �orm 90-T' �_ Ii answer is yes, please attach
a copy wit:� this apoiica[�on. I? answar 's no, e:cplain why:
Any changes desired �J t:�e apgl=cazc :.ssociac: n ma f be �ade onl.r wic� t:;e consenc o� �ne
Ci[y Counc=l.
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Organ:za��on
Date /�"' 1 7 �- �� By:
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________________________________ AGENDA ITEMS =_ __________________-__________ �d �/��/
ID#: [395 ] DATE REC: [10/27/87] AGENDA D TE: [00/00/00] ITEM #: f. 7
SUBJECT: [TRANSFER GAMBLING MGR. LICENSE- CHARLE VAN AVERY TO ROBT. BURNETTE]
STAFF ASSIGNED: [NONE ] SIG:[RETTMAN I ] OUT-[X] TO CLERK fA@f6��00] � � �z- �
ORIGINATOR:[ ] CON ACT:[ ]
ACTION:[ ]
C ]
C.F.# [ ] ORD.# [ ] FILE COMPLETE="X" [ ]
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FILE INFO: [RESOLUTION/CHECKLIST/APPLICATION ]
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