87-1650 WHITE - CITV CLERK �
PINK - FINANCE GITY OF SAI T PALTL Council /�
CANARV - OEPARTMEN7 � 1 Y'/��
BLUE - MAVOR . Flle NO. �
�
Co cil olution 1.z -��-�
j�_ ;t'::`{ !,�'
Presented By
Referred_T Committee: Date
Out of Committee By Date
RESOLVED: T'hat Application (I.D.#87496) for renewal of a State Gambling
License (Class B-Tipboards � ulltabs) by Gopher Elks Lodge
#105 at 739 Selby Avenue be a d the same is hereby approved.
COUNCILMEN Requested by Department of:
Yeas �- Nays
Nicosia _�_ In Favor
Rettman D
Scheibel Against BY
Sonnen
W�ida
WilsOri NQV � � �� Form Appr d City ttorney
Adopted by Council: Date
Certified Yasse by Council Secretar BY
By �
A►ppro y Mavor: Da ` � Approved by Mayor for Submission to Council
By BY
r
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4�34;��� ����'�,a' - -} .
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,� ���'`y l��
UIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE I D � �, / ►U� I�o � �7
INTERDF.PARTMENTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
Applicant �� �Q k,p �q�,��p;�' Ho Address �U� � �-�-r�YA
Rusiness Name _;� Ho e Phone A ZZ- �1�I Z
Business Address �q��Q {�� Ty e of License(s) �,p � ,���j
���
Business Phone �a"�- � („C..1
Public Hearing Date�,�::..�.�,�;±�.-r Li ense I.D. �� �"7c.�.� (o
at 9:00 a.m. in the Council Chambers, i-ic�,,,�n,,_
3rd floor City Hall and Courthouse S ate ��-_.;,. �� �j ��j ZZu1 -UUl
llate Notice Sent f 6 / D aler �� � �!�
to Applicant / 2�$ -?�. $� )
I' deral Firearms 46 � r�.
Public Hearing
DATE INSPECTION
REVIEW VERFIED (COMPUTER COMMENTS
A roved Not A r ved
�
Bldg I & D +
� I� '
�
Health Divn. '
�'� I
i
Fire Dept. � �
I � '� �
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Police Dept. I
��I� U l.C� �-Y�._¢_.�.v C:�-�.
License Divn. �
lc.)I �� j G
City Attorney �
l(�' �
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Date Received:
Site Plan �� �� � 1
To Council Research (('� 2�j ' g`�
Lease or Letter Date
from Landlord 1 CU� (�e � ��1
��,� ,�-�� o l l 3 3s
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 Pae
• Department oE rinance and Man gement Services
Division of License and Perm t Registration
INFORMATION RE UIRED WITH APPLICATION FOR PERMIT TO ONDUCT, CHARITABLE GAMBLING GAME IN
m SAINT PAUL �
- � i , .
1. Full and complete name of organization which is applying_ for license �
b U. '�.l �
2. Address where games will be held 739 e� �. c, SSio y
__ ' - Yumber Street °� City Zip
3. _Name of manager signing this application who w 11 conduct, operate and manage
_ Gambl.ing Games Date of Birth � r- /c� ' �-�
(a) Length of time manager has been member oi appl=caac orgaaization ��G�e,.�
4. Address �of Manager 6 � " /� r' ,C�dl� �� ;�S� d-"
Yumber. Scree Ci[y Zip
5. Day, dates, and hours this applicat�on is ror r�Q��� ��i�` � � '�� _ ��
6. Is the applicant or organization organized u er the laws o= the State oi �IlV? %�
7. Date of incorporation
. __
8. Date when registered with the State ot �iir.ne ota 1 y� �
9. How long has organization been in existence? , . ��f �}���
10. How long has organization been in esistenc� in St. Paul? � � �jG �
11. What is the purpose oi the organ�zation? �
12. Offi rs of applicant organfza ion
{ �_��/�G ��.���G
Nam Va.m
� �-tP
Address U ' � � � � �'l � v Address�D�� �.t�c"':�,67 �'`�
Title � � DOB `�— ' S" Titie �'��9`� JOB �j �� ' �
. ,
Nam Vame
Address � � p � :�ddress
Title-��VSf'FC� DOB T.�.tle DOB
13. Give names of officers, or any ot::er �e*s ns ano ?a_d �or serr�cas to �:e orgar.i�at'_on.
hame Vame
Address __ _ _ _._ .__ �:_ address •---
Title __�le
(�ttach separate sn _ ',,. acc'_:_cr.__ ��__s. �
�/�V � f'W���
14. Attached hereco is a Iist of names and address s of all members of the organization.
15. In whose custody will organizati� records b kept?
Name . ddress '�� � �j V�
16. .Persons w 11 be conducting, assisting in onducting, or operating the games:
Name Date of Birth �, �
/. -��" � �".
�
Address �� �-�"-�" ���
Name of Spouse Date of Birth
Dates when such person wf1l conduct, assist, r opera[e
Name � /L Date of Birth �
� � C%'(�
Address �—
Name. or Spcuse Date of Birth
Dates whea suc� pers��? �ai11 conduct, ass'st, or ope=ate
17. Have �ou read. a^.d. do �rou t?�oroughly underst nd che prov�sions of a11. Iaws, ord'nances,
and regulatior.s ;overaing� che operat_on of aa�_rab,e Gamb_�ng �ames?
18. Attached hereto on the ior:.+ �ura�shed 'ov �� C�ty o� St. Paul is a Financ�al ?teport
whic� ��e�izes all rece;�cs, e:fpenses, ar.d isbursemencs ot t�e appl=cant organization
as we?y as ai�. organ�zat:ons wno Zave re�eired =unds �or t:�e or�cedfag ca?endar year
w ich has been si3ned, pre�a_red, ar.d ver_=�ea 3 �
�
e .
. � �--/�
' �ddr ss
r
who is che �_� � o` t:�e applicant Organization.
Vame OL Oi::ce
19. Operator or" premises �rhere �ames �r�1= �e `� ?d:
:�
. Name a �L .� G
Business Address l .Q� �" � �' �
Home Address �� '��' � ��L j �j��� � ��y
20. Amount of rer.t oaid 'oy app�,csnc Organi•�a ion tor reat oi che nall; speciry amount
paid per 4-hour se�s:on �Ci �'
� . �'��7 %s�
�r ..
ZI. The proceeds oi tne games will be disbursed af er deducting prize layout costs and
operating expenses for the following purposes nd uses:
� s � � ��
.�
27. Nas the premises where the games are �o be he d been certified for occupanc}� by the
City oE Sainc Pau1?
23. Eias your orgar.�zat;on Liied �edera' �orm 9°0 ' � I: answer is yes, piease attacn
a copy Wi C:'l this applicac�on. I: answar is , o, e:cplain why:
Y. .ac ,�,�� c*r" e,
�►�, c�,� ,�.�,�. � r.:,�e.r-�.t �
Any changes desired �T tae a�ol�ca::t :�ssoc�acion a� be �ade only wich [:;e consent oi the
C:ty C�unc�1.
. ����-, ' �� ��l/l S ��.�
Organ_zac_on
Date ��/��/�� � ��;�C�� �� ���--�
zaga� in charge or game
�
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� Charitable Gambling Control Board .
' Rm N-475 Griggs-Midway Bldg.., For eoard Use Only
� 1821 University Ave. .. `• Paid Amr.
, - St. Paul, MN 55104-338� ' ' - Check No. :'
. .�,.,^ ; ••;.....�•' (612) 642-0555 ` q , .,
Date:
{ - GAMBLING UCENSE RENE AL APPLICATION •
, �_`- .��LICEN$E NUMBER: ��gZ.�Jdl /EFF. DATE: 12/OI/86 �AMOUNT OF FEE: ` - $���p
�1.Applicant—Legal Name of Organization 2, treet Address
�.�. ET.;tS LOIX� lt� 715-739 Selby Ave .__ .
3.City, State,Zip 4. ounty 5. Business P n
St Paul, diN 55104 ` � � �_ �
f � ,
�. 6. Name of'Chief Executive Officer ,� . .s, , ` r Business Ph
one
�,:,:. : Corrielius Br.o�m. Sr � ,, t , �
8. e qf Treasurer or P n Wh� o � e,ye� s - 9. Business Phone
- 10r Name of Ga bling Mari ger 11. ond Number '12. Busines Phone �
Jack Cootieri� E?IPi^c887
13. Name of Establi Where Gambling Will Take lace 14. ounty 15. No.of Active Members
EI Ft�lc,�doe R� �
16. Less , am� t • � s , ` �
a�'_ ,, 17. Monthly Rent:
;' 30 ,
; 18. If Bip�o will be conducted with this license, please specify days and times o Bingo. • -
. �: �ays Times Days Times Days Times � "�
1 �• Lr. .
�`
- 1� �+as license ever been: ❑ Revoked Date:___. ❑ Suspen ed Date: p Denied Date:
2��."Have intemal controls been submit�ed previousty?� e ❑ No(If"No,"attach copy)
r2t:F�s current lease tieen filed with the board? .�a es ❑ No(If"No,"attach copy) �
. ' 2. Has current'sketch bee!►-tiled with the tioard~�"
� _ ._
- - es,.n..i-.O Na:(tf..Ncx.:..attach cn��---��--r . ..
!%S " ' �"'`"-•—�^"`,,,�AMBLING SITE AUT ORIZATION
_ By my signature below, local law enforcement officers or agents of the Board ar hereby authorized to enter upon the site,at any time, gambling is
r _�being,conducted, to observe the gambting and to enforce the law for any unaut orized game or practice.
� �;_ ; BANK RECORQS AU ORIZATIO,N ,-_, ,. ',...�� . .: -, ._ " f.-
�.,.�::. y my signature below,the Board is hereby_auihorized to inspeci the b�ank rec ds of the f�eneral Gambling Bank Account whenever necessary to
f filt•requirements of current gamblingrules and law.
*�, � OATH
'' I he ;declare that:
"'` 1. I ave read this application and all information submitted to the Board;
2, All information submitted is true,accurate and compiete;-l' / ' • �
3. All ofhec required information has been fully disclosed; ; '`� � �
4. I am ttt,e�chief executive officer of the organization; 4-- �� ' .
,�,' 5. I assu �,�iet, full responsibility for the fair and lawful operation of all activities to be conducted; �� '
6. I will farroibarize myselt with the laws of the State o esota respecting g bling and rules of the board and agrea;if licensed,to abide by those
laws anc�;rules, including amendments thereto.�1 � . . ;_.__ ,
2�fficial Legal Name of Organization Signatu�e(Chief Executive Officer) Date: 1 Titl�_; . '
f o . , _ __ ` .� , y_j� ,
_ � � �.�.� -� �
• ' ACKNOWL ME OF N ICE LOCAL GOVE NING BOD
- I herdby acknowledge�receipt of a copy of this.applic�on. By nowledging r ceipt, I admit having,ti�n s ed with notice that this application will
be reviewed by the Charitable Gambling Conhpl B�� rd and if roved by the oard,will become e$ecYive 30 days from the date of.receipt(noted
below), unfess a resolution of the local goveming bo?1y is�passed�nr#�ich specifi ally disallows such activity and a copy of that resolution is received by
the Charitable Gambling Control Board within 30 days of the beTcw noted date
-_ �
24. CirylCpun ame ocal Go rning Body) To nship: If site is located within a township,please�omqiete,items.24
_�� �- an 25: .
., , � \ �'`�:�
Signature f,P'�i�son Receiving`Application:- ' �.,��J 25. Signature of Person Receiving Application � `�r
:-. '' '.� f"' •; t S _1
� 4�.- .
tle Date Received(this d iFlS 30 day^p@�iod) Titl : � `
- �� � . �� � -� �, - . '��, �
a ' of'P��son Deiiv ring Applicatio to Local�verning Body: To nship Name }
.� ��`� _. �
� -01 (5/8� White py—Board Canary—Applicant Pink�to �I ove�nting Body �
� � '
�
, � , ,
p .
; ;,,
._..._�_ __.._________._________.-.--=-----= •
- -- --_ --_. ___--- -- --- _�� � .
. � (���105�
° , � 1 N° Q1�.335 ,
'�-i �Ait�c� � �Vlwr..�. -�u • DEPARTt�NT - ^
n�, r_ . _� : .. 4. _ CONTACT NAt�IE
_� - PHONE
� 1 O(2 i� g'1 DATE _ _ _.
ASSIGN NIIMB� FOR ROUTING ORDER: (See reverse s de.)
_ Departffisnt Director _ Mapoi� (or Assistant)
_ Finance and Management Services Diractor _ City�Clerk
_ Budget Director _
_ City Attorn�y _
TOTAL NUMBER OF SIGNATURE PAGES: (Clip al locations for s�.gnature.) �
i1 T '? (Purpase/Ratio�ale)
� ��� � ' - .�.� � �.. .
.� ���,� �. �o c c� c.� > �: ��.
_ , � ,
.,�o l�c�,�-. � c� � c�,c�{-:�r-z°
v o
' C CT
Y ` C� ;
C 0 V D O
(Maqor's signature aot required if under $10, 0.)
Total /lmount of Trans�ction: �`� Actinity Number: 'n `F�}
Funding Source: � '�
ATTACHMEN�S: (List and number all attachment .)
�.,�-b�^'�"t oY1
r�P�-� �
. C�t� l�a.�. �
ADMINISTRATIVE PROCEDURES 11 �A
_Yes _No Rules, Regulations, Proced res, or Budget Aatendment required? �
_Yes ,�No If yes, are they or timeta le attached?
DEPARTMENT REVIEW CITY AT�"QRNEY REVIEW
vYes _No Council resolution required? , Rasolution �equiredt -�es _No
Yes .�1� Insurance required? Iasurance su�ficient� _Yes _No
�Yes ✓l�o Insurance attached?
�,.�
. (�- �7 l�;� ,
________________________________ AGENDA ITEMS =__ ---------------------------
---------------------------
ID#: [429 ] DATE REC: [11/02/87] AGENDA DA E: [00/00/00] ITEM #: [ ]
SUBJECT: [STATE CLASS B GAMBLING LICENSE - GOPHER ELKS LODGE #105 - 739 SELBY]
STAFF ASSIGNED: [NONE ] SIG:[RETTMAN OUT-[X] TO CLERK -�88�86f90] /�/�
ORIGINATOR:[LICENSE DIV. ] CONTA T:[SCHWEINLER - 5056 ]
ACTION:[ ]
[ 7
C.F.# [ ] ORD.# [ ] FILE COMPLETE="X" [ ]
� � � � � � � � � � �
FILE INFO: [RESOLUTION/CHECKLIST/APPLICATION ]
C 7
[ ]
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