87-1690 WHITE - CITY CLERK �
PINK - FINANCE G I TY O F SA NT PA U L Council /
CANARV - DEPARTMENT Flye NO. �� /^� �d
BLUE - MAVOR
�
: ounci lution
Presented By
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D.#82974) for a Class B State Gambling License
(Tipboards and Pulltabs) by W st Side Booster Club at 883 Payne
Avenue (Louie's Bar) be and t e same is hereby approved.
COUNCILMEN Requested by Department of:
Yeas�a Nays
Nicosia ln Favor
ltettman b
Scheibel Against BY
Sonnen
'�7eida
W]llsOtl N�V � 9 �1 Form Approv y y tto y
Adopted by Council: Date
Gertified Passed b cil Secret BY
By
A►pprove iNavor: Date
�Q'/ '� Approved by ayor r Submission to Council
By BY
Pl���`��� . _ ;`.:�u(
.. _ ����2d
_- . , l�l°_ 411332 �
�j�r � , DEPARTMENT , - - - - - -
S � r�. �.� CONTACT NAME
- SGA So PHONE �
� �UIZS� �1 DATE �
ASSIGN NUMB FOR lL4IJTING ORDER: (See rever side.)
_ Department Director Mayor (or Assistant)
_ Finance and Management Services Director � City Clerk �- � n
_ Budget Director �? , C o�4 ��5
� City Attorney _
TOTAL NUMBER OF SIGNATURE PACES: (Clip 11 iocations for signature.)
o T ? (Purpose/Rationale)
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C ST N T B G 0 C C A D:
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N C 0 C VI G 0 D TED:
(Mayor's signature not required if under $10, 00.) �
Total Amount of Trans�ction: (/1 � Activity Nwnber: n (�
�
Funding Source: y�(�} ,
ATTACHMENTS: (List and number all attachment .)
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��DMINISTRATIVE PROCEDURES ✓�,�
Yes No Rules, Regulations, Procedu es, or Budget Amendment required?
Yes _No If yes, are theq or timetab e attached?
DEPARTMENT REVIEW CITY ATTORNEY REVIEW
�s No Couricil resolution require�l7 Resolution required? �'"Yes ,,,_No
_Yes ✓No Insurance required? Insurance sufficient? _Yes _No ,
_Yes ✓�lo Insurance attached?
' C��7 i���
UIVISION OF LICENSE AND PERMIT ADMINISTRAT ON DATE �� (L� -i / tc;,: �
INTERDF.PARTMENTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
Applicant �,{ ,���;���,,,,,��-�Q��� � Home Address J `�� �. �����,,
Business Name ���,� Home Phone
l �
Business Address ���],�c��� y� Type of License(s) _�,� S���,�,.;,;� ,
Business Phone � �A��J .� �c,p�j�.��p e�����po
Public Hearing Dat��� License I.D. �� � c�-�1�
at 9:00 a.m. in the ,ouncil Chambers,
3rd floor City Hall and Courthouse State Tax I.D. �� ��
�^
llate Notice Sent � ���v" Dealer �� n�pr
to Applicant �� �
Federal F3.rearms 4� ��
Public Hearing
DATE INSPECTIO
REVIEW VERFIED (COMPUT R) CUMMENTS
A proved Not A roved
�
Bldg I & D � '
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Health Divn. '
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i
Fire Dept. � �
i � I .
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Yolice Dept. I
License Divn. �
�c��a� i
City Attorney �
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Date Received:
Site Plan 1Cj �� � �{'1
To Council Research i�� z-�'��]
Lease or Letter Date
from Landlord 1 U I l� � �`� ���J p � , b �(�3�
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i��.��... �up� �
� n ;••����?� Charitable Gambling Control Board FOR BOARD USE ONIY
� `•�, Room N-475 Griggs-Midway Building LicsnssNumber �
` �� 1821 University Avenue
St. Paul, Minnesota 55104-3383 PAID
_ � " (612) 642-0555
AMT
��� ' CHECK#
� DATE
'� GAMBLlNG LICENSE APPUCATIO
INSTRUCTIONS:
A. Type or print in ink.
B. Take completed application to local governing body,obtain si nature 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.
r` Type of Application:
� �Class A - Fee S 100.00(Bingo,Raffles,Paddlewheels,Tipbo ds,Pull-tabs)
�� �1Class B - Fee S 50.00(Raffles,Paddlewheels,Tipboards,P I-tabs) �e�n�spay�to:
E ❑Class C - Fee S 50.00(Bingo only) n��neeoea cnaricawe�amn�ng conva eoa.d
". ❑Class D - Fee S 25.00(Rafftes only)
_. � - �� - 0
� DYesONo 1. Is this application for a renewal? If yes,give co plete license number
�
F ❑Yes�No 2. If this is�ot an application for a renewal,has or nization been licensed by the Board before? If yes,give base
` license number Imiddle five digits)
i
� DYesONo 3. Have Internal Controis been submitted previous ?If no,please attach copy.
f 4. Applicant IOfficial,legal name of organization) 5. Business Address of O�ganization
` S s E �s� �. 1� E kc,G i �; �.t
6. Ci State,Zip , 7. County 8. Business Phone Number
� ST �o�� ���1����►�T:� �s 1 C� 1�fl 1'�l ��1 a ���d7^
�:. 9. Type of organization: ❑Fraternal ❑Veterans ❑Religiou �Other nonprofit"
•If organization is an"other nonprofiY'organization,answer questio s 10 through 13.If not,go to question 14."Other nonprofit"organizations
must document its tax-exempt status.
f_
❑Yes�No 10. Is orgarnzation mcor orated as a nonprofit org nization?If yes,give number assigned to Articies or page and
kbook number: � ^ Attach c py of certificate.
� C$1(es�No 11. Are articles filed with the Secretary of State?
�.�-:
OYes�No 12. Are artictes filed with the County? `
` ❑Yes❑No 13. Is organization exempt from Minnesota or Fede al income tax?If yes,please attach letter from IRS or Department of
�% Revenue declaring exemption or capy of 990 0 990T.
�' ` ❑YesL�No 14. Has license ever been denied,suspended or re oked?If yes,check all that a ly:
� .
� �Denied ❑Suspended ❑Revoked Give date: - -
k 15. Number of active members 16. Number of years in e istence Note: If less than four years,attacfi
�` ,� f evidence of three years
�;G -r/ . , existence.
17. Name of Chief Executive Officer 18. Name of treasurer or perso�who accounts for other revenues
� { of the or anization.
� -�--�n� L.-.0 nlf� �C K � G►=.JU�4 n�,C�,Z,
Title � Title
� PR�►��� -r�;� - �
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,�. �. ��.�:, -
� Business Phone Number Business Phone Number
�
,� 1 i "! c"� ) ��� �. �' ,��� ,! ��. ,� ) , .� '.
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�. 19. Name of establishment where gambling will be 20. Street address(not P.O.Box Number)
�' conducted j ' '�; . ,., ;� {'"; ,.
�. �.:��V1 I �� ��,r-,;� ` �v ;�;_f'l :.r ��ti ;.J
21. City,State,Zip 22. County(where gambling premises is located)
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Y
CG-0001-02(8/861 White Copy-Boa�d ,Canary-Applicant Pink-Local Goveming Body
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�J "� � Gambling License Application Page 2
Type of Application: ❑Class A J1�ICIass B ❑Ctass ❑Class D
�Yes�No 23. Is gambling premises located within city limits?
- �clYes�No 24. Are all gambling activities conducted at the pr ises listed in #19 of this application? If not, complete a separate
application for each premises(except raffles)a a separate license is required for each premises.
❑Yes�dNo 25. Does organization own the gambling premises? f no,attach copy of the lease with terms of at least one year.
DYes.�ir7No 26. Does the organization lease the entire premises. If no,attach a sketch of 27. Amount of Monthly Rent
the premises indicating what portion is being le sed.A lease and sketch � $ r ^O e•
is not required for Class D applications. I / L� a +v L=K
��` ❑Yes�No 28. Do you plan on conducting bingo wiih this licen e?If yes,give days and times of bingo occasio�s:
�:�- �ars r es
�'` �1(es�No 29. Has the 510,000 fidelity bond required by Minn sota Statutes 349.20 been obtained7 Attach copy of bond.
�. .
30. Insura�ce Company Name 31. Bond Number
-�:�i ,.t ��:.�-1 O ��,. �� aQ i�' � `�i/
32. ,Lessor Name � 33. Addre s 34. City,Staxe,Zip
E o�; A L ��,2 �� X �_3 1�;,�+; .v d9� � 7- i%��i �ti s3�%.��
35. Gambling Manager Name 36. Addre s � 37. City State,Zip
R ,` { ` 1� � '.:� ..'," ;,�} `�`! �.. ';��+._.►�:, ;!)G S� l,'+,�vS� (�.I� .j �' v�
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� 38.. Gambling Manager Business Phone 39. Date gambling an ger beca e
�: ( f'i ,� � , � ! i � .� member of org nization: ; , � �';
-� 1
�
GAMBLING SITE AUTHORIZATION
� By my signature below,locaf I�w enforcement officers or ag nts of the Board are hereby authorized to enter upon the site,
� at any time, gambling is being conducted,to observe the g mbling and to enforce the law fo�any unauthorized game or
practice.
�'°_,=i BANK RECORD AUTHORIZATION
�;;� -; By my signature below,the Board is hereby authorized to in pect the bank records ofithe General Gambling Bank Account
�;: `._ whenever necessary to fulfill requirements of current gam ing rules and law.
�' � . O TH
�', I hereby declare that:
1. I have read this application and all information submitt d to the Board;
��-�' - 2. All information submitted is true, accurate and comple e;
k 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 opera ion of all activities to be conducted;
�_'; 6, I will familiarize myself with the laws of the State of Mi nesota respecting gambling and rules of the Board and agree, !-
if licensed,to abide b those laws and rules, includin mendments thereto. �
40. Official,Legal Name of Or anization 41,. S�ji nature(m�u,�ti b'e�gned.by C, ef Executive Officer) , '
W 1 Si 0't'- l�-.�CUT�;I� �'1.L1 X ',�.\�""�'.�'"`� • ,
� T(i�le of Signer� Date,� � • .,
t'QtS�ObY�J ! J.')� �< �'Y� `� � � ,.
i ' �; ,-;._.
ACKNOWLEDGEMENT OF NOT CE BY LOCAL GOVERNING BODY ::,'r''r -<�
I hereby acknowiedge receipt of a copy of this application By acknowledging receipt, I admit having been served with
notice that this application will be reviewed by the Charita te Gambling Control Board and if approved by the board, will
become effective 30 days from the date of receipt(noted b low),unless a resolution of t4e local gaverning body is passed
� which specifically disallows such activity and a copy of t at resolution is received.ry'`t�ie Charitable Gambling Control
Board within 30 da s of the below noted date. � �` '
� 42. Name of City or County(Local Governing Body) If site is located�fiin a township,item 43 must be completed,in
�- �.� -, f•� addition to the c6unty signature.
�� i..:._ - _ r� ._ ,�"�,r-,
� S�gnatur�of person receiving application 43: Id`arr e of Township
� �.\ r f ' :L l'L„L\:. ie � �- � `
Titl; ' Date received 1�0 day period Signature of person receiving application
'+ begins from this date)
- i, ,% . :: . i�.�! i.� i x-�1 x
44. N�rti f Person del' e ppli ti n to Local Goveming Body Title
��� �
?�:;i, CG-00 1-02 (8/86) White Copy-Board Canary-Applicant Pink-Local Governing Body
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, � � � ���---1���
-------------------------------= AGENDA ITEM ----------------------------
ID#: [410 ] DATE REC: [10/29/87] AGEN A DATE: [00/00/00] ITEM #: [ ]
SUBJECT: [CLASS B GAMBLING LICENSE - WEST SI E BOOSTER CLUB - 883 PAYNE ]
STAFF ASSIGNED: [NONE ] SIG:[RETT AN ] OUT-[X] TO CLERK E6@t6070U� �0�2�
ORIGINATOR:[LICENSE DIV. ] ONTACT:[SCHWEINLER - 5056 ]
ACTION:[ ]
C ]
C.F.# [ ] ORD.# [ ] FILE COMPLETE="X" [ ]
� � � � � � � � � � �
FILE INFO: [RESOLUTION/CHECKLIST/APPLICATION ]
C 7
C 7
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