87-1688 WMI7E - CITV CLERK -
PWK - FINANCE GITY OF S INT PAUL Council ���JJJ/�
CANARY - DEPARTMENT � �.r ����
BLUE - MAVOR File NO. ��
�
Cou cil esolution -
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Presented By
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D.#34856) f r a One Day Gambling Permit
(Raffle Only) by Riverside Lion Club at 1026 W. 7th Street on
November 30, 1987, between the ours of 7:00 P.M, and 10:00 P.M.
be and the same is hereby appr ved.
COUNCILMEN R uested by Department of:
Yeas �J- Nays
Nicosia
Rettman In Favor
Scheibel �
Sonnen Against Y
Weida
VdilSOn N�V � 9 '�a7 Fo m Approve y City Attorney
Adopted by Council: Date
Certified Passed o cil Secret y Y
sy
A►ppro by iVlavor: Da � ��V 8 Ap roved Mayor or Submission to Council
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N° �11336 �
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� . DEPARTMENT -
� CONTACT Dl�lE
�_9 56 -SU S(o PHONE � ' ,
� �i�t�1$1 DATE .
ASSIGN NUMBER'FOR ROUTING ORDER: (See reverse side.)
_ Department Director Mayor (or Assistant)
_ Finance and Management Services Director � City Clerk
Budget Directar � �c,,�.►.._�,Q,..
� City Attorney _
TOTAL N[JMBER OF SIGNATURE PAGES: (Clip a 1 locations for signature.)
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CO T BU G L MPACTS D:
►�I R
N C G S C U T TY NUMB GE 0 C
(ldayor's signature not required if under $10, 00.)
Total Amount of Trans�ction: l(1IR Activity Number: 1n '�
Funding Source: rl�pr
ATTACHMENTS: (List and number all attachment .�
�,�,��.�-�a� . .
. ����
�. c:.o�._. i�.�
ADMINISTRATIVE PROCEDURES Y� �(}-
_Yes _No Rules, Regulations, Proced es, or Budget Amendment required? "
_Yes _No If yes, are they or timeta e attached?
DEPARTMENT REVIEW CITY ATTORNEY REVIEW
�/ Yes No Council resolution required? Resolution required? �Yes _No
_Yes ✓No Insurance required? Insurance 'su€ficient� _Yes _No
_Yes ✓fTo Insurance attached?
., �� ��'�i���
DIVISION OF LICENSE AND PERMIT ADMINISTRATI N DATE �Z.� ��`- / ZZ
INTERDF.PARTMENTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
Applicant c� ;u-�y��, n5 �� Home Address �__r�i ,�,��
Rusiness Name lUa(p CJ� '�� � Home Phone �C�- /�-�Q �
Business Address (,O�/(�� �,� ��,, Type of License(s) �
Business Phone �� �- �v� �
Public Hearing Date icense I.D. 4i 3�-�S(D
at 9:00 a.m. in the Council Chambers,
3rd floor City Hall and Courth��/ � State Tax I.D. �� � �(�}
llate Notice Sent������/ s�� g ealer 4�
n ��-
to Applicant
ederal Firearms 4� y})�
Public Hearing
DATE INSPECTION
REVIEW VERFIED (COMPUTER COMMENTS
A roved Not A r ved
Bldg I & D �
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Health Divn. '
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Fire Dept. i �
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Police Dept. I
� IPr
License Divn. �
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City Attorney �
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Date Received:
Site Plan ,\�n`
To Council Research ��� (���x�
Lease or Letter Date
from Landlord
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CURRENT INFORMATION NEW INFORMATION
- Current Corporation Name: New Corporation Name:
Current DBA: New D$A:
Current Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
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� �;:F��T.•��T OF ::?��1:;C:: . � iL�;�^-C��:T SL�T�TCLS
� � DIs7rSIQii Q� Lii.^��T�iSr. �:1D ?F�.Y'BT :�^l�i�?ISTa.A�G�I
�T'r'Ot�'ATICY �CUI?:..� '�iI��? ���C�TIGP1 �OR �'u 1 TO CC'•I7iIIC'" Gni��IT`;G SES�IOP' T;r cT. aAIIL
i.._ ::�e o�. Organization Riveraide Liona Club
2. �dciress whe� Q�anizaiion's re�ular �e�t ^_a,s a� h�ld 175 W. 7th Street,St. Paul.
3. Day .anci ti.me o�' �ee-�i:.�FS 2nd and 4th Z� sda of the month@ noon
I�.- Addrsss �rhere GambLing Session cai11 he he d 1026 W. 7th Street, St. Paul.
�. Is aaplicant owner of propertp where Gamb ;a� Session. wi11 be k:elc? Yes X "o
5. I'_° leased., Wno :.s owner oi pr�ertp w'r.sre Gamblin� Sessier_ 1�riI1 be !:eid'
Doc Dolan DBA Doc's Place
7. i� leased, attach 1st�er oi oer;ni.ssion �o conduct Gz.*�blir.� Session, s_g^.ec hy iessor.
8.- Vame o.£ officer .ma.tang a�plication a McG'
9• �ddress of officer maIang a�oLcation 2 9 Cit Hall �7ate oi birt:�
10. ;;ame of mana.ger who wiL conduct �ambling Session Roger Vik
L. ��.ddress of�,�ar.ager 126 Court House Date of b?rth. 4/1/32
12. In. connsction with Tahat event is th:.s Gam Lng Session beir.g held? N/A
Z3• Gdhat type of �a.rlbLng device{s} �aill.be eci? Paddlewr_eeT. '?�pboard P.a_flle g
IL:: :�ay, dates and hours t:LS arn�Lcation is_ �or ana number of sessions.
Day(s) 11/30/87 Dates =�ours 7 pM_ippM ilo. oi Sessions 1
i5. %ti1,.I pr±zes be paic �n :�one� or �ercha.*�d.i e? Money
16. Zs the appLcant association or�an.izec un er �he laws of t:^.e State oi :�:��nesoia?Y�s
1 j. �ow Iong r.as Cr�anization oeen in e�c.stien °? 1979
i�. ;�'hat is the pux�ose oi t.".e Or�an:.zation? Lions charit
19. Officers oi the Orgacization.
ilame-Title .4 cis�ss �ate os oirth
. s:'
Milea McGinlev ?��' �
.. � :.,�;
. �,`-�,���'
20. �ive _�.es of oi°�cers or a�y oti'ier �erso �a.�.d •°or serv-±ces �o ihe Or:a,�.�.zatior_.
�1ame-Title �ddress �aze oi �_�ir •
None
21. :.n wiose-c•;stod,; .;�ill. �orris oi Cr�aziza ion's Gamb1;nc Sess�ons te �epi?
;Iame J. Schneider � ss Rnom 36� Co�trt Ho„e,.
22. �t�ac:x a c opy oi lour Qroa.nizaiion's mea�b rs'r.:;.p roster and dat� eac� membe r j oi.ne3.
23. At�ach z..e GaAb �T Session 2•ana�er's bon ..
2L�. �ttac!^ a copy o� �he Depa.r*,.ment oi the T 2.su��, Interna? .'_evenue Serv'ice "Retvr^ o�'
Organiza�icn rxe�t �ro�z =nco�e '^ax", �0 990. (Chanter Llo.OL (1;.)
25. �ttach a co�y of Depa.�t;aent oi the ^,=as , , In;.er-ial °evenue �e:�v:.ce, ''�tierrmt Gr�an-
ization 5usiness Income Tax", Torm 9°oT. (C'r_apier �19.OL. (2). i
26. 3ttach t"e annua'_ report recu�red of c:� table or�anizat�ons by ��ir�esoLa Statutes,
Sect�cn 3C9.�3. (Chapter �.19.OL (3). i
27�. ::ave �ou read and co �ou thoro�hl.? uncer �ar.d the �ro�sions o� a11 1a*as, ordinanc�s
and �egulations governing the operation o Gamblir.g Sessions? y�a
� 28�. � cn�n es des_red bp �:�e appLcar.t asso iatior_ may he mace or,1y :aith �he consenti o�
` the Iicer_se Commit�ee. � �� �
�
29. � �a.s an� person(s ) partici�ati.-�g in the op ration o� any oi ��:e �ariblir.F sessions cov-
ered by this Lc�nse ever� been convicteci i a ieloriy in t�:e State oi :ii�nesoia or in
� ar�7 oiher StaZe or ��ederal Court? °es i Ii ar.swer is "�es", �rovide
rames, acid��esses and birth-dates..
� r �� �c..�//,r�r �' cc'F//oG..
v �
anization
. i`� �
�p `
(Of ic�r-T- e
and
(I� �er :.n c- oi ambLn� Session)
Staze oi :�nesota)
%SJ
C ount� oi ?.ar�s ey }
` -���� ` and
being du?, sworz sa� �:�iat �'r_e 3 e t�`?e peti��, er 'n �he above a��lication; .`.t12L �hev �ave
�°2� �he 'oregol?7� D2�ii.1.0II P_7'.fi �fS10W �i@ COZl't2 'CS t:�ereof; ��13't tri@ 53IDB 1S �?"�I2 Of Li:2=S'
OL+7P_ _'�S10W12Gr�?. °fMti VL�.�ANtk,inM���,,M,��
n �
Su�sc^i�eed and sworz=o bes�re �e t�s �: .� J�:�NN{,�-
' � 9 �a� oi 0�%�_� '°� � . Y�cro�t��i.��r1��a
��� ! :RB AilG.?9, 1Sa.
Y
:�i azy ?�s�i�c, Couniv, :Iinnesot2 '
:.�r cosunission P�i��s �-�-��
3uilding Depary:�e�t :�pproved L1S8DD1"OQ �. by
Fire Depart,,.ent rl�proved �i.sav�rov �p
Poi�ca �e�artnenL :�Dproved--Disa�orove �y
r . _ �-�-i-����
•�i Minnesota Charitable Gambling Controi Board LAWFUL GAMBLING EXEMPTION
Room N475 Griggs-Midway Building
�` 1821 University AvBnue FOR BOARD USE ONLY
� St. Paul,MN 551043383
�....��. (612)642-0555
INSTRUCTIONS: 1. Submit request for exemption at least 3 days prior to the occasion.
2. When completing form, do not complet shaded areas until after the activity.
3. Give the gold copy to the City or Count Send the remaining copies to the Board. The copies will be
returned with an exemption number ad ed to the form. When your activity is concluded; complete
PLEASE TYPE the financial information, sign and date t e form, and return to the Board within 30 days.
:;� Organization Name Num er of Members License Number(if currently or previously ,,��L..:;j���_r'y ;
5 licensedlandlorpermitnumber.,���i���',;.���! '
3IVERStDB LIOI�S CZUS of ST. ?AU�.. � '
Address City State Zip Counry
126 Jourt Plause �t. , u1 �. 55IC2 ',�:���•�
Chief Executiva Officer's Name Phone M nager's Name Phone Number
Miles ;�Gia2e � � �3£s 4371 .��er Vii i i ^�'.; _:�::1
Type of Organizatio� If Naiprofit Organization IChedc One�d attach proof of nonprofit statusl.
❑ Fratemal � Veterans IRS Designation
❑ Religion �] Other Nonprofit Organization Incorporate with Secretary of State
Attach proof of three years existence. � Affiliate of Parent Nonprofit Organization
Name of Premises Where Activity Will Occur Da2e1s)of Activity,drawinglsl
i7pC�3 P28CC
Premises Address City tate Zip County
1026 W. 7th Street, 5t. ?aui, :�il;'3b��� `�t. 55192 2arascy :d���e:�l�ss �0,��:�7
��;,�,3. , . . .. . , 4 .� >..�. :..:
� _
Game Yes No ; �
Bingo g
,
:;�,__-'., Raffles. , X
�,
Paddlewheels x
Tipboards � R
Pul I-Tabs x
Use of Profit
��;, Profi.[s ar� to be caatrfbut�a t� �:eedy ar ar.i�ations anL :ndiv�du�lsl.:. �or����T ���':� �r
�, -
, ., ,� .,
I affirm all information submitted to the Board is true, accor- �"` `� �
�._
ate, and complete.
r�---r'j- �� � %^ •r`" , , . _- - "� �����
1.�.�-L:a. "i.;'.�—�-�-c �� �
"pkr' &..; �u"'����; ���:,;
Chief Executive Officer Signature ,� Date � , n�,�C4���;„ �` � '
ACKNOWLEDGEMENT OF NOTICE Y LOCAL GOVERNING BODY
I hereby acknowledge receipt of a copy of this application. By ack owledging receipt, I admit having been served with notice
that this application wiil be�eviewed by the Charitable Gambling ontrol Board and will become effective 30 days from the
date of receipt (noted beiow) by the City or County, unless a resol tion of the local governing body is passed which specifi-
cally disallows such activity and a copy of that resolution is rece ved by the Charitable Gambling Control Board within 30
days of the below noted date.
CITY OR COUNTY TOWNSHIP
Name of Local Governing Body(City or County) Tow ship Name(Must be notitied when County is the approving body)
City of St. Psu2, Ma.
Signature of Person Receiving Application Sig� ture of Person Receivi�g Application
_.-1
� .(':'.-� �,. . -S . .. lti. , ,}.,
� Titlb- Date Received Title Date
s �
' , R .,. . � j �
�CG-00020-01 (6/87) i Whke—Board Ca ary—Board returns to Organization to complete shaded areas.
Pink—Organization G d—City or County
��i��
. ----=------------------ AGENDA ITEMS
ID#: [459 7 DATE REC: [11/10/87� AGENDA OATE: (00/00/007 ITEM #� f 1
SUBJECT: [1-DAY GAMBLING PERMIT - RIVERSIDE LI NS CLUB - 1026 W. 7TH ]
STAFF ASSIGNED: [NONE ] SIG:[SCHEIB ] OUT-[X] TO CLERK -E6@f86760� ///��--
ORIGINATOR:[LICENSE DIV. ] CO ACT:[SCHWEINLER - 5060 ]
ACTION:[ �
C ]
C.F.# [ ] ORD.# [ ] FILE COMPLETE="X" [ ]
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FILE INFO: [RESOLUTION/CHECKLIST/APPLICATION ]
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