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87-1687 WHITE - CITV CLERK PINK - FINANCE GITY OF S INT PAUL Council G7_ � GANARV - DEPARTMENT Flle NO. � /� � BLUE - MAYOR � C uncil esolution Presented By '� Referred To Cocnmittee: Date Out of Committee By Date RESOLVED: That Application (I.D.#19484) for a Gambling Location License-A by Shaul Enterprises Inc. DB Herge's Bar at 981 University Avenue, Application (I.D.#63787) for a Class B State Gambling License (Tipboards � Pulltabs) by Lo er Eastside Football at 981 University Avenue (Herge's Bar) and App ication (I.D.#66292) for a Gambling Manager, License by Percy A. Hyland D Lower Eastside Football at 981 University Avenue (Herge's Bar) be and e same are hereby approved. COUNCILMEN Requested by Department of: Yeas ��p Nays � Nicosia in Favor Rettman Scheibel � _ Against BY Sonnen Weida Wilson NOV 1 9 1987 Form Approved City Attorney Adopted by Council: Date Certified Passed o ncil Secre BY By Approv iNavor: Date N�V Z �j � Approved by yor for Submission to Council By �°�� . ._,�_...�_ �. ��!(��7 p - ;,� Fir�ce & r�ctsnent Serviaes UE PARTMENT . �• _ O�2�g Ki;is� �c�nle� ,� CONTACT 298-5056 PHONE, , Navenber 6, 1987 DATE �� ASSIGN NUMBER. FOR ROUTING QRDER C1 i Al l Locat.io s f.or Si nature : Department Director Director of Management/Mayor Finance and Management Services Director � 3 City Clerk Budget Director 2 �C�il R�esearch �l City Attorney A7 WILL BE AC�FIEIF�D BY TAKI#G ACTION ON THE ATT HED MATERIALS?. ,(Purpase/ Rationale) : Percy A: Hy�ancl, a m�anbe� of the L�r Ea.st S•. �'�otball As�c3atio� for 8 years, is requestirig Gquncil appr�val af his applicati for G��nbling Manager of the spo�oring organization!-s pulltab operation which wi11 cc�ducted at Herges Bar at 981 Universi.ty. COST BENEFIT BUDGETARY AND PERSONNEL IMPACTS ANTI IPA�ED: N/A FINANCING SOURCE AND BUDGET ACTIVITY NUhBER CHARGE OR CREDITED: (Mayor's signa- tare not re- Tota1� Amount of"Transaction: N/A quired if under � $10,000) Fundin.g Source: N,IA Activity Number: N/A aTTACHl�NTS (List an� Number All Attachments) : Departrr�nt CheGklist . l�sblution , ti� -� - ��c:��.jFw , � � , DEPARTMENT REVIEW CITY ATTQRNfY REVIEW X lfes No Council Resolution Required? ' Resolution Required? x Yes No ��es ��No Insurance Required? Insurance Sufficient? �� Yes No Yes No Insuran�e Attached: (SEf •REIIERSE SIDE FOR INST UCTIONS) Revised 12/84 - . , ; � ��7 DIVISION OF LICENSE AND PERMIT ADMINISTRATI N � DATE p y'� / Z�� INTERDFPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by Lic Enf Aud Applicant �e�G� � , �f`�,y,�Q ome Address (xp�y' ��,�; �r� --� , Rusiness Name ��}��Y �� ;��-�,bwQQ, ome Phone Business Address �� ,,� {,,�c��,,�� ype of License(s) . Business Phone � _ Public Hearing Date �v��, ��"� icense I.D. 4� �� at 9:00 a.m, in the Council Chambers, 3rd floor City Hall and Courthouse tate Tax I.D. �1 �,� llate Notice Sent• �� ealer �E � �R to Applicant � $� �ederal Fi_rearms 4� 1��- Public Hearing DATE INSPECTION REVIEW VERFIED (COMPUTER COMMENTS A roved Not A r ved � Bldg I & D � Y1 I r� , Health Divn. ' � �a ' � , Fire Dept. i � I n 1�- � � �olice Dept. I License Divn. � � City Attorney � I Date Received: Site Plan 1C71 1 � 1Y�7 To Council Research Lease or Letter Date from Landlord t J( �� l 4--� �� o�a� _ , , , _ ._. . . � , �. `. CURRENT INFORMATION NEW INFORMATION - Current Corporation Name: New Corporatio� Name: Current DBA: New DBA: Current Officers: Insurance: Bond: Workers Compensation: New Officers: Stockholders: "-- . �"" „ ��7—i 1��7 . . � -� - , City of Sain Paul � . � Department oE Finance and Management Services Division of License and ermit Registration INFORMATION RE UIRED WITH APPLICATION FOR PERMIT` TO CONDUCT CHARITABLE GAMBLING GAME IN SAINT PAUL i. Full and complete name of organization whic is applying for license .L p W p�/� � � Cy 1-L S C � O 2. Address where games will be held � 1 5 . a, Yumber Streec City Zip 3. Name of manager signing this application �ho wfll conduct, operate_ and manage Gambl.ing Games v �, Date of Birth (a) Length of time manager has been member o" applicant organization ��j�S 4. Address ot Manager /� v Lt��. r � �' �r Yumber Scre c Cicy Zip ',5. Day, dates, and hours this application is io Tb.._ Is the applicant or organization oroanized u der the ?aws o= t:�e State o� ?�i? ��7 j� Date of incorporation , �j �"► U _ _. . .. 7'$. Date when registered with the State o= Kinne oca S'(�,��'. �, � ��J� 9. How long has organization been in esistence? � Q► ��q S 10. How long has organizaLion bee:� in eYiscence n St. Paui". � p � S --� 11. What is the purpose of the organization? o U � � oo L L i� � o r a ,�2. Officers of applicant organizat�oa . Name �U,`�'y l,t'e.Q,((�, I't• ��lC�r(�IWV 1 Vame /�i�r� r a a r e,T �'7 . S !q n f--� Address '1�� G�ilYl �1 , :�ddrzss �n�C �,(�S�z°_r� Y'1�IP. ,��j , Title � ,�"r DOB D 1 5 � T;*_1e /fi�a Su.� �.� �os �� /� — �,5 Name �n�iE�2_f D. L u5;� 5 2 Vame �1/9 RG Fiv� �'h� � L ��ic� Address ��/D C f� JrG �l IJE �ddress �,'�� .� �"' cs�7�0 �7�" Title ��cF Prrs�o�� DOB 3 /8 8 '"��ie5�'! Ei�4k ✓ DOB l�'-�S � �/ 13. Give names of officers, or any ot^e- gersor.s no ?a�d �or ser-r:ces to �ae o.7an'_�at;on. Name vame Address addre�s Title _-c?e (Attach separate sZe� = �c;.___�..__ ,�_es. � . � . (.�� 14. Attached hereto is a list of names and add esses of all members of the organization. 15. In whose custody will organization`s recor s be kept? Name Address �D� ,P,qR/�4JA y 16. •Persons who will be conducting, assisting n conducting, or operating the games: Name G �, j� Date of Birth Address �o(o Name oi Spouse v Date ot Birth L�/$'�h/S' Dates when such person wi2.1 conduct, assist, or operate Name Date of Birth Address Name or Spouse Date or Birth Dates wzen such persor_ *ai1: concLCt, ass=st, or ope=ate I7. Have ;rou read ar.� do ?ou thoroughly understa d che prov�sions ot" aiI laws, ordinances, di2d reg*slat�or.s gove��:1� Ci1E operat:on CL C 3��tab_e GdmD�=II� �3II2S� � 18. Attached hereto on �he for� �ur..�sltea b�r che Cit� o: St. ?auI :s a �'inancial Report whic:� :temizes a?1 rece=�cs, e:c�enses, ar.d d sbursemencs or cne appiicant organization as we11 as a�? o:?ar.:zat_ons ::ne :ave _e�e_� d :unds �or cae �recediag calendar year Wt1IC^ �id5 be=� 5-:�-12La.� ��Z']2�'°_d, and 'J2'�':.'�° �V �'ame �edras who is che o` t:�e app?icant Organization. �_ Vame �r 0�:=�e I9. Operator of prem;ses ahe-e aames :��1_ be ze1d: Name LL �'y � iL e Business Add:ess u� ,p �G L Home :�ddress 20. P,mounc of rent pai,d bv apo�;csnc Or�sni�ac�on ror re.^.c o: che ha11; specify amount paid oer 4-hour se��:Qa . �;, . �,. ��7��7 . � - .� 1 Z1. The proceeds oi the games will be disburs d after deducting prize Iayouc costs and operating expenses for the following purp ses and uses: e ' e �os 2Z_ Has the premises where the games are co 5e held been certified ror occupanc;• by the City oE Saint Paul? �3. has your orgar.ization riied cedera' �orm 9 0—T? It answer is yes, please attacn a copy wit:� this applicac�on. I: answar i no , e:cplain why: Any changes desirec b J tae d*�D�_C2:1L .-'.ssoc_ation ma� be �ade only wic^, �:;e conse^.t oi tne City Counc;l. �L�J�' T.i4`J'T S/OP. �730�Bi3�-L �'.S.�lp7 Or�az'_zac:on , �7ate g ; � . a in charge or g�me a a _ E � z! I :n r- _ ^ ,-, � i � � � r� •-a � ; � - _ _ ,. I c� cn rr � rD rr� � _. - _ _ � � � r fD ry ^; ^. � � � ;� ��.. '� _r � ' -' � �7 `D 7 � r. (0 Z � 7 '? .� I r' fD — n - •c � n � - � ' � i ,... � ... rr O . _ � ' ' (0 i— — " � rn � � A Jf v O — R _ f0 r T ,� ? f � I � , � � r F I 3 7 I 7 , i I — � =� � O � JI fJ , ;t , . •t f0 V7 r _ �I I 1f :.7 = �r = � �G O r , ^ � R - � '+ 7C' .7i .. 67 �.7i i� � I � £ I � :� (D .. '�G � �� ^i7 ^•7 r `�C ..i..i�✓ a �. — , ,I � ° �- � I � � _ ; � . _ , N F�'- fD ;1 — T � 11 y n �o � _ � i " �9 I �o c�: � ; �i � '�, �_ n j� -� �� T� ? ' =� i � � � � ro �T I � • - � ' � I A I n � Ii r- T � `9 � '� _ ' � � � � � � � I � J �7 � I — � " � � E n -� � �n I • �, :� � T !o C a .-� I � , � � � -• � �� 7 . �, � �� DIVISION OF LICENSE AND PERMIT ADMINISTRATIO DATE �v�Lgj�(-7 / �p�-L� /Y� INTERDF.PARTMENTAL REVIEW CHECKLIST Appn Processed/Received by Lic Enf Aud bto Applicant � pw.�r ��i� ��-�� ome Address �(�(o _�G�,��i, ,��- , _�_�� Rusiness IvTame ome Phone lX 3 �- � U(1 Business Address u - � �J ype of License(s) �qp,,� � .�� , Business Phone �3(Q , lC�{� � � Public Hearing Date n�� , �'�, �1 icense I.D. 4F (��'�g� at 9:00 a.m. in the Council Chambers, 3rd floor City Hall and Courthouse tate Tax I.D. �� yl �.y r llate Notice Sen /�--L-�-� ealer 4� �� to Applicant �y -� ederal Firearms 4� y� �� Public Nearing �"rT DATE INSPECTION REVI�,W VERFIED (COMPUTER COMMENTS A proved Not A r ved � Bldg I & D i �� ; Health Divn. ' Y1 �4 ! , Fire Dept. � � i n�� I I Yolice Dept. I License Divn. � ( City Attorney � I Date Received: Site Plan (�� , g� o Council Research �� (, � �{-] Lease or Letter Date from Landlord 1 O ` L�l � `(-1 �(t�A� � � 1 �-�� `.� ' .� CURRENT INFORMATION NEW INFORMATION Current Corporation Name: New Corporation Name: Current DBA: New DBA: Current Officers: Insurance: Bond: Workers Compensation: New Officers: Stockholders: '• Fin�x�ce & Mai�acre�nent Service� QE PARTMENT ; _� _ � C�'�lp�' j,Q _O��S O Kra.s Sch�ae�,nler � , CONTACT 29$-5056 PHONE , , � Novsnber 6, 1987 DATE �e� �� , AiSSIGN N ER F4R ROUTING ORDER Cli All Location for. Si �aturs :� � Depai�tment Director � Directo"r of Management/Mayor Finance and Managemen.t Services Director � � City Clerk - , , ,. � . : . �, Budget Di rector ' - . 2 ,Cauncil Re�e�ch 1 City Attorney 4�HAT WILL BE ACHI.EVED BY TAKING ACT�ON. ON T�IE ATTA HED MATERIALS? (Purpose/ , . Rationale) : Kathleen iKcGrath, president of the Lvwer East ide Footbali �ssocYativaz, on beh31� of the organiz�.ti.c�, is request:uzg Council a of the�r State. Gaanblxng Licpnse �app7,�.� cation. This will allaw the Lvwer East Side F tbal.l P,ssociation to sperosor pulltabs at Herges Bar at 981 Uhi�ersity Avenue. COST BENEFIT BUDGETARY AND PERSONN�L IMPACTS ANTI IPATED; , ., . . ,.. N�p, FINANCING SOURCE AND BUDGET ACTIVITY NUM�ER CHARGED OR CREDITED: (Mayor's signa- ture not re- Total Amo�nt of'7ransactipn: N/p, quired if under . " $10,000) Funding:Soar:ce; N;�A - Activity Number: N/A ATTACHMENTS (List and Number Al1 Attachments) : , Depa�etr�nt CY�klist R�esolutian ` _ �t�Lc c�.�1-i�m . . DEPARTMENT REVIEW CITY ATTORNEY REVIEW x Yes Mo Cnuncil Resolution Required? ' Resolutlon Required? x Yes No x Yes No Insurance Required? Insurance-Sufficient? X Yes No Yes x No Insurance Attached: . . . , : . (SEE •REVERSE SIDE FOR INSTR TIONS) Revised 12/84 - ` . -- - ''_ U� .�-. �— r1��7 ' . �o�a��9 Charitable Gamblin Control Board ; :.� - -�.,?�� 9 FOR BOARD USE ONLY ��'�� Room N-475 Griggs-Midway Buiiding 1821 University Avenue u`°°s°N°"'e°` ; _ St. Paul, Minnesota 55104-3383 AMT ' - � (612) 642-0555 1 �;: ,�►iebs+ ` CHECK# �" %'- DATE GAMBLING LICENSE APPUCATION ,� INSTRUCTIONS: �,• A. Type or print in ink. ► ' B_ Take completed applicatian to local governing body,obtain sign ture 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 returned. Type of Application: �Class A — Fee S 100.00(Bingo,Raffles,Paddlewheels,Tipboard , Pull-tabs) ' .�'Class B — Fee S 50.00(Raffles,Paddlewheels,Tipboards, Pull- bs) Makechedcapayable[o: €_ •C7CIass C — Fee S 50.00(Bingo only) Minoesota Chariteble GambNng Control Board� r ❑Class D — Fee S 25.00(Raffles only) • � ❑Yes�No 1. Is this application for a renewal? If yes,give com lete license number 0 - 0 - � ❑Yes�110 2. If this is not an application for a renewal,has or an ation been licensed by the Board before? If yes,give base license number(middle five digits) ❑Yes�No 3. Have Internal Controls been submitted previously? f no,please attach copy. 4. Applicant(Off�ial,legal name of organization) 5 Busi�,es Address of Organization �. � rc��:�C� i� 5 � t �v ' ��Jr SS►E. �t� ' 6. City,State,Zip 7 County 8. Business Phone Number �� ;� p , - _ ��, * ��i� ► 6 3b- /o ` `• 9. Type of organization: �Fratemal ❑Veterans ❑Religious�:. Othernonprofit" �_ 'If organization is an"oiher nonprofit"organization,answer questions 1 through 13.If not,go to question 14."Other nonprofit"organizations 4.��':.. S '- must document its tax-exempt status. w �Yes�No 10. Is organization incor orated as a nonprofit organi ation?If yes,give number assigned to Articles or page and ` book number: ��" �~+?^ Attach copy of certificate. Yes ONo 1 1. Are articles filed with the Secretary of State? ❑Yes I�No 12. Are articles filed with the County? : QYes❑No 13. Is organization exempt from Minnesota or Federal i come tax?If yes,please attach letter from IRS or Department of Revenue declaring exemption or copy of 990 or 9 OT. _ ❑Yesl$No 14. Has license ever been denied,suspended or revok d?If yes,check all that a ly: ❑Denied ❑Suspended ❑Revoked Gi edate: - 15. Number of active members 16. Number of years in exist nce Note: If less than four years,attach evidence of three years � p Y existence. 17. Name of Chief Executive Officer 1 . Name of treasurer or person who accounts for other revenues , !/��1��G�� '�,� �� of the organization.t � J '�` � �. .< ' Title Title i' -. �t��;li�;� �l�" _ - _ . Business Phone Number Business Phone Number : ! i �' � c .� �� C�j G}— �.^5�-� � � � _, _ _ _ ; -. :� 19. Name of establishment where gambling wilt be 2 . Street address(not P.O.Box Number) i conducted ; ��c �S��t r 21. City,Stste,Zip 2 . County(whe�e gambling premises is located) �,�, S;-� �Ct,l�( �� Cxi1�S�. , - CG-0001-02(8/861 White Copy-Board Canary-Applicant Pink-Local Goveming Body �u:. _ � _ '• �c ��-/10�7 _ � • . . � Gambling•License Application Page 2 Type of Application: �Ciass A ❑Class B ❑Class C O Class D j$.YesONo 23. Is gambling premises located within city limits? *.JS1Yes❑No 24. Are all gambling activities conduct�d at the prem es listed i�#19 of this application? If not, complete a separate applicatio�for each premises Iexcept refflesl�as a eparate license is required for each premises. ❑Yes�.No 25. Does organization own the gambling'premisesl If o,attach copy of the lease with terms of at least one year. ❑Yes L�No 26. Does the organization lease the enljtRe premises?If no,attach a sketch of 27. Amount of Monthl Rent �:'` the premises indicating what portion is being leas d.A lease and sketch g � ' is not required for Class D applications. O O'�+ '' OYesJ�lto 28. Do you plan on conducting bingo with this license If yes,give days and times of bingo occasions: ` Daya Tlmes G�� ❑Yes�No 29. Has the 510,000 fidelity bond required by Minnes ta Statutes 349.20 been obtained?Attach copy of bond. 30. Insurance Company Name 31. Bond Number 32. -essor Name 33. Address • 3. �_ j�it-y,�-tate�j p �'� • �c2i''✓ � f�� -/�:r�+:' C'.t�'h'--' /�L/ �/_�.C.c�C. �� 35. Gambling Manager Name 36. Address 37. City,State,Zip �c `.� ' y�. r� ' ��( �� i.% y r� t° S �� M �/`�'s/�� F� 38. Gambling Manager Business Phone 39. Date gambling ma ager became (�� 7� _ �a, member of organiz tion: / � � � GAMBLING SITE A THORIZATION By my signature below,local law enforcement officers or agen s of the Boa�d are hereby authorized to ente�upon the site, at any time, gambling is being conducted,to observe the gam ling and to enforce the law for any unauthorized game or �l .,, practice. - - _ - �, BANK RECORDS A THORIZATION ' ' �� By my signature below,the Board is hereby authorized to inspe t the bank records of the General Gambling BankAccount � � whenever necessary to fulfill requirements of current gamblin rules and law_ c_`.' r OAT I hereby declare that: 1. I have read this application and all information submitted t the Board; 2. All info�mation 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 operatio of all activities to be conducted; 6. I will familiarize myself with the laws of the State of Minne ota respecting gambling and rules of the Board and agree, if licensed,to abide b those laws and rules, includin am ndments thereto. 40. Offic�al,Legal Nameaf OrganizatiQn 4 . Si nature imust b si�n d b`lL"C, hief Executive Officer) - �,�U�Y �lS� �1�1t�, I�(.L"t�:Gt�t ��tCLfIG�� Cj,��.�'D�J , A�t S��GI,��\ _ Title of.S,i,gner � D te M `� �S►Ct�� 1�' � ACKNOWLEDGEMENT OF NOTICE Y LOCALGOVERNING BODY I hereby acknowledge receipt of a copy of this application. B acknowledging receipt, I admit having been served with notice that this applicatio�will be reviewed by the Charitable ambling Control Board and if approved by the board, will become effective 30 days from the date of receipt(noted beio ►,unless a resolution of the local governing body is passed which specifically disallows such activity and a copy of that solution 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 ite is located within a township,item 43 must be completed,in S ; �� a dition to the county signature. `�•�yl/�.'± __ . , 1,- • ^'t .�'�., r�,. Signature�of person receiving application 4 . Name of Township ; � ; , r--, ' i. X �`� i.�:.^*—;...`�� ..f ` ��'`i � `- , l .,�'L,:. .-�, � Title � Date rec iued(30 ay period � Si �ature of person receiving application j begins f!ro►nt this d te<�► r, 'r; .i'r�t..� .�, ^s'�-�t� 1�l '4� � 1� X C . . . � " 44./'�V'ame of Penso e' ` pplicatt"o".- o Local Goveming Body Ti le �. l.��,/yi�� / � _ �" G'G-0001-0 (8/86I. ;f White Copy-Board Canary-Applicant Pink-Local Goveming Body ✓ . ,. � ' ��7�1��? . •� � UIVISION OF LICENSE AND PERMIT ADMINISTRATIO DATE Y`"I l I� � INTERDFPARTMENTAL REVIEW CHECKLIST Appn rocessed/Received by - �� n Lic Enf Aud �5�-�-e�. Applicant (,J, �� i /�,.,,� �.r ) .T „-��,c��.e-Sr ome Address �v SC:� , ;n�,.�, Business Name �.�,er�„� � �jc�,� ome Phone ��{Gt -��l p(p Business Address �4(� 1�,� ,' ��S��, ype of License(s) �(;�/y�.�� , � oc c,�-�-i'cn-, d � Business Phone �C� (� - Gj ,� � � �� ,�,�A, Public Hearing Da icense I.D. �{ �� at 9:00 a.m. in the Council ChambE:rs, 3rd floor City Hall and Courthouse tate Tax I.D. �� llate I�TOtice Sent � �� ealer �� 1 p to Applicant S �..3 /S/g � ederal F3searms �� ,� Public Hearing � DATE INSPECTION REVIEW VERFIED (COMPUTER CUMMENTS A roved Not A r ved � Bldg I & D � �� ; Health Divn. ' � ,�\r� � , Fire Dept. i � i � �� I I Police Dept. I � ,� License Divn. � I1 ) � � o � City Attorney � ►�� , Date Received: Site Plan �(� To Council Research �j�r �� --� Lease or Letter Date from Landlord �(�,�� J c,�A-�-�-�-�- O`l�-�C 1 ._ . . _. e � r � CURRENT INFORMATION NEW INFOItMATION � Current Corporation Name: New Corporation Name: Current DBA: New DBA: Current Officers: Insurance: Bond: Workers Compensation: New Officers: Stockholders: ��. y.� �'�'7-/��7 � r ' � Application No. Date Re eived By CITY OF SAIN PAUL, MINNESOTA ' CHARITABLE G LING LOCATION Directions: This form must be filled out wi h a typewriter or by printing in ink by the sole owner, by each partner, by each person who has interest in excess of 5Z in the corporation and/or as ociation in which the name of the license will be issued. THIS APPLICATION IS SUBJ CT TO REVIEW BY THE pUBLIC 1. Application for (name of license) . // j (�, � 2. Located at (address) 6 �� VJ j - �/ 3. Name under which business is operated — � 4. True Name �`1 f�'_ � /J � ��. Phone ��- y�,�� (First) ( iddle) (Maiden) (Last) 5. Date of Birth 3 Place of Birth '�/�,.�,�� /yj�ij� , (Month, Day, Yeaz) `� 6. Home Address �� cS� , Home Phone `f�% 3�u [ 7. Have you ever been convicted of any gamb ing violations? �� 8. List licenses which qou currentlq hold a this location. L��U��f, �. � � �, �„� 9. SUBMIT A SITE PLAN WHERE THE �AI�LING BO TH WILL BE LOCATED ANY FALSIFICATION OF ANSWERS GIVEN OR MATERIAL SUBMITTED WILL RESULT IN DENIAL OF THIS APPLICATION. I hereby state under oath that I have answered all of the above questions, and that the information contained therein is true and corr ct to the best of my knowledge and belief. I hereby state further under oath that I have eceived no money or other considerations, directly, or indirectly, in connection with th s license, from any person by way of loan, gift, contr:ibution or otherwise, other than al eady disclosed in the application which I have herewith submitted. . State of Minnesota ) ) ss County of Ramseq ) � � ; / �--�. Subscribed and '�;�arn�to. beforg�me__this ' - �--Z� f ��'�� ,, ��'� ��,�! — (Signatu of Ap licant) �(u da.y�,of, � C�`-''o� 19 � , ��'� 1 � otarv Publ�,c, Ramsey Countq, Minnesota . � � �� .' My Cou�iss ion�ex�i�re's _� � � ., • yy �r -----• '— -• ' �7 , ��- /� I understancl ancl will uphold the ordinance amending Chapter d0� of ttie St. Paul Legislative Code (Intoxicating Li uor) . I further understand that failure to compl may result in the suspension or revocacion of . , On Sale Liquor and cor esponding iicense�. � � � -- Signature r� _s /��-r � !l�S � Establishment �U— /� � � Date Re[urn co: License u Per�ic Division Room '_U3, Cicy (�all Sc. Paul , �IN 551U� Attention: K:is 3/3b . , �y � .��—��7 �o � ' 072'79 , F� & Mar�aqsnent Services DEPARTNIENT . � - Kra;� Schweinle�' CONTACT 298-5056 PHONE . _ Navgnber 6, 1987 DATE � ,r� �Qi � ASSIGN NuhBE� FOR ROU�'ING ORDER Cl i Al l Locati.on for Si natu�re :, � Department Director � Director of Management/May�r � Finance. and Management Services pirector � � City Clerk • Budget Directar _ 2 Cc3ur�cil Res,c�arc;� � 1 , City Attorney _. , . , I�EHAT WILL BE ACHIEVED BY TAKING ACTION OM THE ATTA WED MATERIALS? (Purpose/ ; . Rationale) : Sh�ul �nt�erprises, Inc. (Williaan A. Hawt�wrne, Sr., President) DBF, Herges_Bar at 981 University Avenue has agreed to allvw the East Side �ootball A.ssociation to use his establisht�e.nt tro sell p�lltabs. _ COST BENEFIT BUDGETARY AND PERS4NNEL IMPACTS ANTI IPATED: _ . N/P, FINAI�kCING SOURCE AND BUDGET ACTIVITY Nt�ER CHARGE OR CREDITED: (Mayor's signa- . ture not re.- Total Amour�t of 'Transaction: N/A quired if under � � $10,OQQ) FuAding Source; N/,�► . . Activity Number: N1� A�TACHMENTS (List and Number All Attachments) : Department Ghecklist R�l�ition - - . DEPARTMENT REVIEW CITY ATTORNEY REYIEW x Yes No Council Resolution Required? ` Resolutlon ��equired? X Yes No X Yes No Insurance Required? `insurance Sufficient? � Yes No Yes x No Insurance Rttached: � .... ., . ,. (SEE •REVERSE SIDE FOR INST UCTIONS) Revised 12/84 r . ♦ . � • 1� . . • " �� HOW TO OSE THE G�tEEN SI�ET The GREEN SHEET has several PURPOSES: � � � � 1. to assist in routi.ng documents and in securing required signatures 2. to brief the r�viewers of documents on the impacts of approval , 3. to help ensure that necessary supporting materials are prepared, and, if , required, �ttached. , Providinq complete information under the listed headings enables reviewers to make decisions on the documents and eliminates follow-up contacts that n►ay delay execution. The COST/BENEFIT, BUDGETARY AND PERSONNEL II�ACTS heading provides space to explain � the cost/benefit aspects of the decision. Costs and benefits related both to City budget (General Fund and/or Special Funds) and to broader financial impacts (cost to users, homeowners or other groups affected by the action) . The personnel impact is a description of change or shift of Full-Time Equivalent (FTE) positions. � If a CONTRACT amount �is less than $10,000, the Mayor's signature is not required, if the department director signs. A contract must always be first signed by the outside agency before routing through City offices. � Below is the preferred ROUTING for the five most frequent types of docutaents: CONTRACTS (assumes authorized budget exists) " � 1. Outside Agency 4. Mayor ;� 2. Initiat�nq Department 5. Finance Director 3. City Attorney 6. Finance Accountir�q ADMINISTRATIVE ORDER (Budget Revision) ADMINISTRATIVE QRDERS (all others) 1. Activity Manager 1. Initiatinq Department 2. Department Accountant 2. City Attorney 3. Department Director - 3. Director of Manaqement/Mayor 4. Budget Director 4. City Clerk ' 5. City Clerk � 6. Chief Accountant, F&MS COUNCIL RESOT�iITiON (Amend. Bdgts./Accept. Grants) COUNCIL RESOLUTION (all others) 1. Department Director � 1. Initiating Department 2. Budget Director 2. City Attorn�y 3. City Attorney 3. Director of Management/Mayor 4. Director of Manaqement/Mayor 4. City Clerk 5. Chair, Finance, Mngmt. & Personnel Com. 5. City Council 6. City Clerk 7. City Council 8. Chief Accountant, F`&MS SUPPORTING MATERIALS. In the ATTACHMENTS section, identify all attachments. If the Green Sheet is well done, no letter of transmittal need be included (unless signinq � such a letter is one of the requested actions) . Note: If an agreement requires eviderice of insurance/co-insurance, a Certificate of Insurance should be one of the attachments at time of routing. Note: Ac�ions which require City Council Resolutions include: ' 1. Contractual relationship with another governmental unit. 2.. Collectfve barqaininq contracts. • 3. Purchase, sale or lease of land. 4. Issuance of bonds by City. 5. Eminent domain. 6. Assumption of liability by City, or qrantinq by City of indemnific�tion. : 7. Agreements with State or Federal Government under which they are providing fundinq. 8. Budget amendments. . . ' ��`7-/��7 -------------------------------- AGENDA ITEMS ------------------------------- -------------------------------- ------------------------------- ID#: [453 ] DATE REC: [11/09/87] AGENDA DATE: [00/00/00] ITEM #: [ ] SUBJECT: [HERGE'S BAR APPLICATIONS - GAMBLING OCATION, CLASS B STATE, M6R. ] STAFF ASSIGNED: [NONE ] SIG:�J�� ] OUT-[X] TO CLERK-E89f88f683-- �� Z--- ORIGINATOR:[LICENSE DIV. ] CO TACT:[SCHWEINLER - 5056 ] ACTION:[ ] C ] C.F.# [ ] ORD.# [ ] FILE COMPLETE="X" [ ] �r � s � � +� +e � � � � FILE INFO: [RESOLUTION COVERING 3 LICENSES/3 C ECKLISTS/3 APPLICATIONS ] C ] [ ] ---------------------------------------------- ------------------------------- ---------------------------------------------- ------------------------------- b {��} g 1987 COUNCILMAN AMES SCHE►�EL