87-1648 WHITE — CITV CLERK COWICII ///����J
PINK — FINANCE G I TY O F SA NT PA U L
CANARV — DEPARTMENT . (/ /�.�� -
BIUE — MAYOR File NO. Q
�
Cou il R ol ion =�
,
Presented By c� �
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D.#84267) or a Class B State Gambling License
(Pulltabs, Tipboards, Paddlewhe ls, and Raffles) applied for by
862 Inc. DBA Camel Club at 862 ite Bear Avenue be and the same is
hereby a��er�, denied.
COUNCILMEN
Yeas D�ie!1� Nays Requested by Department of:
Nicosia
Rettman � �n Favor
Scheibe.l � _ Against BY
Sonnen
Weida
V�ilson ��V � 2 �$�
Form Approved y City Attor
Adopted by Council: Date
Certified Y•s d by Council Secretary BY
By � �C��.4"'y`
Appro y Ulavor: Da Approved by ayor for Submission to Council
B BY
.y ;,'
.�s�-.. . � � �
, �������
' UIVISION OF LICENSE ANI) PERMIT ADMINISTRATIO DATE �O I /
INTERDF.PARTMENTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
� �
Applicant �(�a �� . _ ome Address ��,5-t .
�p res-t.. v�
Business Name �('�,�� �U,kj ome Phone ,c�.(�� - 'It,ocp�
Business Address `�l,ea (,�7��-R,���v`_ , ype of License(s) C' fQ�„�_�'��„�b ,
Business Phone � _ C[sS� �
Public Hearing Date � icense I.D. 46 ��a��
,
at 9:00 a.m, in the Council Chambers,
3rd floor City Hall and Courthouse tate Tax I.D. �� � �q
llate Notice Sent; / � � ealer �� r� �/3
to Applicant IL l /$7 � �
ederal Firearms 4� I�l�
Public Hearing
DATE IIvSPECTION
REVIEW VERFIED (COMPUTE ) COMMENTS
A roved Not A oved
�
Bldg I & D � �
� ; ���
Health Divn. '
� �
' " � ►1A- , _ _�
,
Fire Dept. � � �
� �% � R-�-
I
Police Dept. �(� � �� I
License Divn. �
�
City Attorney �
�
Date Received:
Site Plan It���l��
To Council Research �� -Z �� y�-�
Lease or Letter Date
f rom Landlord `�,� ��,'�
CURRENT INFORMATION NEW INFORMATION
Current Corgor-ation Name: New Corporation Name:
Current DBA: New DBA:
Currer.t Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
i ` ,�Y: � - ' - - #a,�` .
` , �`� ; ��7/lo��
.:; � • - City of Sain Paul
� �r , • . Department of Finance and Management Services
Division of License and ermit Registration � �• '
INFORMATIQN RE UIRID WITH APpLICATION FOR PERMIT TO CONDUCT CHARITABLE GAMBLING GAME' IN
SAINT PAUL .
1. Full and complete.name of organization whic is applying for license
$ _ �ni C
2. Address where games will be held � 1T � `,>T- /��
Number Streec C.ity Zip
3. Name of manager signing this application wh will.. conduct, aperate and manage
Gambling Games � � � Date of Birth �o��— �d
(a) Length of time manager has been member = applicant organization � � 0 �
4. Address of Manager � • � T � Q �
Number Str ec Cicy Zip
5. Day, dates, and hours this application is r r SL�� ��p — SC�"�jY d,CILQ � TZ� I � �. M •
6. I� the applicant or organization organized nder che laws or t:�e State ot �IId? �\�
7. Date of incorporation �
8. Date when registered with the State oi Mian sota � a/ �'(�
9. How long has organization been in esiscence? � v {�S .
10. How long has organization been in esistence in St. Pau�? g �T�S
11. What is the purpose of the organization? e v ,� S �Z�
Y\Q � � � � t T Q VY� �� U t� t i
I2. Officers of applicant organization
Name � ` �j V C Vaae � �C�ca�� � � � (x Y�t O�
Address � � . �f�' K � S� � Address ��a��"� � � � C � Y� G"
Title �/IT=P res����eK r DOB �-� y- -7 �J T:t?e SeC..��(`�qS�y��DOB �
Name �� � �'�.. � N D t�S Q� Yame �'
Address �(�C1 +� i� � ., �TUN S I � ?,ddress
T'itle -� P,1 DOB �/ S� iftie DOB
13. Give names of officers, or any ot::er ?ersons aco �a_� �or s�.^��ces tc �ze o:gani�acion.
�1ame �r Vame ^--
" Address add=e�s
Title __�?e
(Attach sepa-ata sita�� _ - ,c�--_•�r.=- .._�es. �
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- � .__ . :.- - _ . �:-�
.
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14. Actached hereto is a list af. nanies_ and-add eases of all members of che organization..
15. In whose custod.y. !�ill organization's recor s be kept? - �
_ __ _ . --.� .
.:_._...:, ._ _ _ __ . .._ _
Name ��CV\U�� LT _ �C1 V ro� Address L3�y � _ ��� (' TZ��n, c",
16. �Persons who will.be conducting, assisting n conducting, or operating the games:
Name L� A � Date of Birth ? o�
Address V\rt"1"G �- . = O t'c V i �J N ��S I
Name of Spouse 01'\ � Date oF Birth
Dates When such person will conduct, assis , or operate �(,r�dc�.,y — Sc,��vY c�c,��
Name O►�1 � L. Date of BiTth 3� � St/
Address G � P � � !� r Iv
Name or Spouse � Date of Birth —1
Dates when such pe�son �aiL? concuct, ass:st, or operate C, v ,r�� u�t — S c�TU vC�U �
17. Have ,�ou read aad do ?ou chor�ughly underst nd the provisfons of ali laws, ordinances,
and regulatior,s QOVB�i;i?'!�' [:�e ope-at`_on o� har�table Gamb�;r.g games? S
18. Attached here�o o� �he fo� °ur..ished �v tF. C�t� o` Sc. Paul is a Financial Report
which �temizes all recei�cs, e::penses, ar.d '=s�urse�eacs o= the appi?cant organization
as we?I as a;i orgar.izat{ons who �ave _e�e= ed :uncs �or c�2 DT°_C2G{{;ig caZendar year
whicn has been s=3aed, �-eoared, and �le-;�_ e �p � �,a
' �;ame
dddre s
who is che o•` the applicaa[ Organization.
vame �r 0�==ce
19. Operator of premises vctere 3ames ail� be 4e d:
Name �� � � � � �
Bu�siness Address e
Home Address � Q �,� P,
20. acnount ot rer.t paid 5y a�p�:�aac Or�ani�ac= r_ _or reac o� che hall; specify amount
pafd per `'" ,� c�QQ j 7- •
'�.t„`_ �a�•`' • .
�.�. � �=�7- l���
, , .
' 21. The proceeds oi the games will be disburse after deducting prize layout costs and
operating expenses for the following purpo es and uses:
� t O Yh �n �T�
c� � � � � �n ,.�. b �ev-s
2�. Has the premises where the games� ar2 to be held been certified for occupanc}• by the
City of Saint Paul? e S
23. Eias your orgar.�zat=on riled �edera'•_ zora 9 0—T? �P�' It answer is yes, please attacn
a copy wit:� cnis appiicac�on. I: answar i no , ��cplain why:
Any changes desirec 3;r �ae a��1=c_�c �ssoc�ac{o ma� be �ade onl;r wich =:;e consent oi the
City Counc=l.
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Or�a: _zac;on v�S � ��c'
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:iaaager in cnar oP game
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� , :,;;�o��;,?� Charitable Gambling Control Board FOR BOARD USE ONLY
, '�` '��'•� Room N-475 Griggs-Midway Building
1821 University Avenue �E°"�°`
St. Paul, Minnesota 55104-3383 �p
;�' .....� (612) 642-0555 .
';�,� •rt"1�' CHECK#
DATE
GAMBLING LICENSE APPLICATION
INSTRUCTIONS: .
A. Type or print in ink.
B. Take compieted application to local governing body,obtain signa ure and date on all copies, and leave 1 copy.Applicant keeps 1
copy and sends original to the above address with a check.
C. Incomplete applications will be retumed.
Type of Application:
❑Class A — Fee S 100.00(Bingo,Raffles, Paddlewheels,Tipboards Pull-tabs)
�Class B — Fee S 50.00(Raffles,Paddlewheels,Tipboards,Pull-t bs) �ecnea�spayab�co:
�Class C — Fee S 50.00(Bingo only) Minnssota Ch�itable Gambing Control Board
�Class D — Fee 5 25.00(Raffles only)
❑Yes(.�110 1. Is this application for a ren�wal? If yes,give comp ete license number 0 - 0 - 0
❑Yes(�No 2. If this is not an application for a renewal,has or ani ation been licensed by the Board before? If yes,give base
license number(middle five digits)
❑YesJr3�Vo 3. Have Internal Controls been submitted previously?I no,please attach copy.
4. Appli�ant(Official,Iegal name of organization) 5. Business Address of Organization
�[? ��.j(� � {., � �,.;�`{� !'T� 1`'�.�+�� A.�
" ' 6. City,State,Zip � 7. County 8. Business Phone tVumber
rt' tJ /-�cJ t_. :`� �1� � 1 � L � K q ^t� � f� � � � `7 J k'� °
9. Type of organization: ❑Fraternal ❑Veterans ❑Religious ther nonprofit* �
•If organization is an"other�onprofit"organization,answer questions 1 through 13.If not,go to question 14."Other nonprofit"organizations
must document its tax-exempt status.
�Yes�No 10. fs organization incor o�ated as a nonprofit organiz tion?If yes,give number assigned to Artictes or page and
r �
book number: Attach copy f certificate.
�Yes ONo 11. Are articles filed with the Secretary of Statet
'�Yes O No 12. Are articles filed with the County?
�1(es�No 13. Is organization exempt from Minnesota o�Federal i come tax?If yes,please attach letter from IRS or Department of
Revenue declaring exemption or copy of 990 or 9 OT. I,�r t.:� ..,; ;�
❑Yes�No 14. Has license ever been denied,suspended or revok d?If yes,check all that a ly:
❑Denied ❑Suspended ORevoked Giv date: - -
15. Number of active members 16. Number of years in exist ce Note: If less than four years,attach
� � � evidence of three yea�s
existence.
17. Name of Chief Executive Officer 1 . Name of treasurer or person who accounts for other revenues
of the organization.
� ��1 P✓"1 i�I ;-� ,•�.�� t '�J U� �` •� � '� �t +e. 1... ''.� '`� .-'� t r .�,�/
Title Title �
� � _ � � t �j? ` �`�� " .. ./ i�� ��1 � � �4�'`i 1 � �� � ���i _.:� � L, +�
� 3
Business Phone Number Business Phone Number �
( � l _:. l � �1 � �� ..�� ! 1 !�, �•� 1 '�' l �j — ! � y�
��
19. Name of establishment where gambling will be 2 . Street address(not P.O.Box Number►
conducted _ %; -- � � - .. . —
� �,
' r .
�'-';-f t: ,/ �1 i�j �` ' L fi'j' f� ;c� ;:� ;� ,' c f'`� -t �i�..�;i ��
21. City,Stste,Zip 2 . County(where gambling premises is located)
, .
�`. � ,' t� l„ �ti`�t� �.a / r� h �� v' +�`. � f- ��
CG-0001-02(8/8,6) White Copy-Board Canary-Applicant Pink-Local Goveming Body
.x , �7 i���
�� � �
, `Gambling'License Application - Page 2
Type of Application: ❑Class A C��tass B OClass C ❑Class D
, �
Yes�No 23. Is gambling premises located within city limits?
�,�;,'-�r?" es�No 24. Are all gambling activities conducted at the premis s listed in #19 of this application? If not, complete a separate
*�;�' application for each premises(except raffles)as a s parate license is required for each premises.
' � ❑Yes o 25. Does organization own the gambling premises?If n ,attach copy of the lease with terms of at least one year.
_�
�' ❑Yes o 26. Does the organization lease the entire premises?If n ,attach a sketch of 27. Amount of Monthl Rent
the premises indicating what portion is being leased A lease and sketch g a�p_
is not required for Class D applications. �
❑Yes�No 28. Do you plan on conducting bingo wit#�this license? I yes,give days and times of bingo occasions:
Days Timea
es�Plo 29. Has the S 10,000 fidelity bond required by Minnesot 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 Ma�ager Name � 36., Add�ess _ 37. City,State,Zip
� `\ 1 1 � i i j ; .� �. � '� �< � �?� �• ��r `^. ` �C.� t �✓1,�.i y J�-; s,
i _ ��w,
38. Gamb�ing Manager Business Phone 39. Date gambling mana er became �
( ,� ��� � �, �i� '~'�� �� member of o�ganiza ion: /�i, � -•
GAMBLING SITE AU HORIZATION
By my signature below,local la,w 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 gambi ng and to enforce the law for any unauthorized game or *
practice.
BANK RECORDS AU HORIZATION
By my signature below,the Board is hereby authorized to inspec the bank records of the General Gambling Bank Account
whenever necessary to futfill requirements of current gambling ules and law.
OATH
1 hereby declare that:
1. I have read this application and all information submitted to he 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 f all activities to be conducted;
6. I will familiarize myself with the laws of the State of Minnes ta respecting gambling and rules of the Board and agree,
if licensed,to abide b those laws and rules, includin ame dments thereto.
: 40. Officfial,Legal Name of Organization 41. Si�nature(must be signed b�Chief Executive Officer!
``5 i�' .� �-%�' � X �' ,.. �(� ��•,_�c�::`;;a_.1�_r
Title of Sig�er Da
'r�; ,�/- � r ci - i -- d T7
ACKNOWLEDGEMENT OF NOTICE B LOCAL GOVERNING BODY
I hereby acknowledge receipt of a copy of this application. By cknowledging receipt, I admit having been served with
notice that this application will be reviewed by the Charitable G mbling Control Board and if approved by the board, will
become effective 30 days from the date of receipt inoted below 1 unless a resolution of the local governing body is passed
which specifically disallows such activity and a copy of that re olution 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 si e is located within a township,item 43 must be completed,in
�_ ad tion to the county signature.
;,i - ; • ',,
��.��.� _, i r
Signature of person receiving application 43. Name of Township
^� .r� � . 4 c.
X \ �_t; � r'• �� •
' Title� ' Date received(30 day period Sig ature of pe�son receiving application
' , begins from this date)
' .� i i``( ;e l�S'1 X
� -
44 ame oftPerson�de,liv,,erirFig application to Local Governing Body Titl
��G(r�"�/!�—
CG-0001-02 (8/86) � White Copy-Board Canary-Applicant Pink-Local Governing Body-
-
i
�
________________________________ AGENDA ITEMS =______________________________ �/'--�7 I�v�/�
.
ID#: [370 ] DATE REC: [10/20/87] AGENDA DATE: [10/21/87] ITEM #: [ ]
SUBJECT: [CLASS B GAMBLING LICENSE - CAMEL CLU - 862 WHITE BEAR AVE. ]
STAFF ASSIGNED: [NONE ] SIG:[RETTMA ] OUT-[X) TO CLERK .EAAf6070D7'/��a �
ORIGINATOR:[LICENSE DIV. ] CO TACT:[ ]
ACTION:[ ]
C ]
C.F.# [ ] ORD.# [ ] FILE COMPLETE="X" [ ]
� � � � � � � � � � �
FILE INFO: [RESOLUTION/CHECKLIST/APPLICATION ]
[ 7
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