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87-1115 WHITE -I CITV CLERK � PINK =�. FINANCE COl1I�ClI (y�' �J / CANARV - DEPARTMENT G I TY OF SA I NT PA iT L (� / � ///� BLUE - MAVOR � FIIe NO. I ' cil Resolution Present�d By 3�_ I Referred To Committee: Date ._ Out of Committee By Date i i �I �RESOLVED: That application (I.D.#35433) for renewal of a Class B State Gambling License (Raffles, Paddlewheels, Tipboards, and Pulltabs) I by St. Paul Aerie #33 Fraternal Order of Eagles at 287 Maria Ave. be and the same is hereby approved. I I i i j � � COUNCILMEN Yeas ��W Nays � Requested by Department of: �' In Favor 2ttman chei.bel � Against By Sonnen ��Je�.da '4�Ti1�On AUG 4 1981 Form Approved by City Attorney Adopteq] by Council: Date Certifield Pa s uncil Sec r BY By � A►pprov y �Vlavor: Date Approved by Mayor for Submission to Council By BY i P�tSlIED AU G 1 5 1987 i .� � i�� ' � �'7� /�/..� DI�ISION OF LICENSE AND PERMIT ADMINISTRATION DATE �t l �`�. �`'� IN�ERDEPARTMENTAL REVIEW CHECKLIST A I licant � Home Address �p ( � �U p� rf1 Bu�! Y� b r �► m� ( iness Name � , o . Home Phone ��q - �$$'y� ��° S-��.- Bu�iness Address y��''1 1M�a��t� I�c1. Type of License(s)�o h�e � Bu�iness Phone �� - `j�a� 3 Pui�lic Hearing Date . ��_ License I.D. � ;��. 3 3 atl 10:00 a.m. in the Cou cil Chambers, L„��A� 3�fd Floor City Hall and Courthouse State �. # �j � D O�� - C) � VIEW DATE DATE INSPECTION ' APPN REC'D VERFIED COMPUTER) COMl�iENTS �oved Not raved H�using & Bldg � C�de Enforcement ��- � I P�p�blic Health � � � ��- � I I F�re Prevention �� I � � P{�lice R 1 � � i C�ity Attorney � I I S ;/, I I!� I � � �00 Foot Notice � I� I 1 � �icense Inspector's Commen s• � �HAVE BEEN GIVEN A COPY OF THIS NOTIFICATION AND UNDERSTAND THAT MY ATTENDANCE AT E PUBLIC HEARING IS REQUIRID. - . .s... . ..J,,.« .... .. .: ., � .;.� - � . .. . .� .:: . � �� 4 . � .. . . . ,.. . , . ... .. . . . � . . . � . � � . . . � , ' ' , . . '" .r". . . � '. CURRENT INFORMATION NEW INFORMATION Current Corporation Name: New Corporation Name: Current DBA: New DBA: Current Officers: Insurance: Bond: New Officers: Stockholders: I j � � ��/� •. � •. City of Saint Paul • ' Department ot Finance and Management Services i Division of License and Permit Registration INFORMA�,TION REQUIRED WITH APPLICATION FOR PERMIT TO CONDUCT CHAR.ITABLE GAMBLING GAME IN SAINT PAUL 1. Fulll and complete name of organization whfch is applying for license FRATERNA,�._ ORDER OF EAGLES AERIE #33 2. A�dress where games will be held 87 MAR I A ST. PAUL 55106 Number Street City Zip 3. Na�me of manager signing this application who wi11 conduct, operate and manage Ga�mbling Games (;ENE SWtNSON Date of Birth 4/g/29 (al) Length of time manager has been member ot apolicant organization 25 YRS. 4. Address of Manager 1618 N GROTTO ST ST , PAUL MN 55117 ; Number Screet Cicy Zip 5. Day, dates, and hours thfs applicatioa is ior YEAR OF 1987 6. I� the applicant or organization organized under the Iaws o= t�e State oi �II�i? YE S 7. Date of incorporation 1907 8. D3te when registered with the State o= Kianesota 6/28/1907 9. HQw long has organization been irc esistence? 89 YRS . 10. Hmw long has organization been in esistence in St. Pau�? 8� YRS. �--� 11. wt�at is the purpose of the organ=zat�on? WE ARE PEOF'LE HELP I NG PEOPLE. RA I SE � Fl1NDS FOR GHARITIES 12. Officers of applicant organization i Name (;FnRCE STFFFER V�e GENE SWENSON A�idress 2146 NORTON I A �adrzss 1618 N . GROTTO T�ttle PRFS T I�FNT DoB 1=r=e TRUSTEE �oB � Name p „I . R(1NNTN(; Name AL BIES address 1723 N, �A,�� :�d�r�ss o50 N . DALE Title �F(:RFTARY DOB T.itle TRUSTEE �OB � 13. Give names of officers, or any otZe- �ersc^s ano ?ajd cor serr�ces co �ne organi�at:on. N�me Vame Akidress :�ddre_s T�itle --=:e (Attach sepz*ate sna�. -.,� 3i::._--0::-- --�_a�. � 14. Attached hereto is a list of names and addresses of all members _ 15. In whose custody will organization`s records be kept? - - Name AER I E #33 Address 287 MAR I i 16. Persons who will be conducting, assisting in conducting, or oper Name (;F1UF CW�N�nN Date or B Address 1 �i1 S N . CRO�TO Name of Spouse PATR I C I A SWENSON Date of E Dates when sucn oerson �«ilI conduct, assist, or operate � ;1ame VERNON A NELSON Date of F 4ddress 2092 CASE AVE ST . PAUL , MN . Naae ot Spouse CAROLE J NELSON Date of B Dates u�en such persoa *aill concLCt, ass:st, O_ QD2_dCfl 17. Have you read a^c do ;rou t�oroughl;r understand the prov:sions o= and regulzticr.s ?OV8�i1j:7� Lt'12 operat_�n Oi Cha��[ab=e C2IIDi=_^.° c 13. A�tached hereto on the ��^: �ur^.ished bv cE�.e Cit� o� S�. Paul is W�I1Ci7 IC°:?:IZ25 .'.?; Tecei�C�� EY72IISe5, 3iQ CISDLI:'S�IIIEP_CS CL C112 SS W2_� 35 d_i O��ar.:zat'_ons GJ[1C i.ave :e^_e=red _unds �Or t[le 7r_ whicn ;�as bee� s:��e�, �repared, and va_�=;ed S� GENE Sv�ENS� 161�N. �C�[1LTn ST . PA�I� MN 55117 ��a_�5� who is the (;AMRI TN(; MANA�FR o= ��e z'.= `Jame o� ��`_�e 19. Operator of przm:ses a�ere �a�nes :�i1; �e he�d: Name ��NE��fFN�nN Busiaess �ddress 456 BURGESS xome Address 161 P, N . GRnTTO ST . 20. P,mounc of rent pa�e Sy app_:cs�� Organ:�ac'_cn ror re�c or �he ha paid per 4-hour se-s:on none . . � 7 - ��i.� 20. List license which you currently hold, or foziner�}r held, or mey have an intere in ('I ASS R RAFFI F�. PA(lfll F WHFFI �. T T P R(lAR(1�. PI II I TAR� 21. Have arry of the licenses listed by you in No. 20 ever been revoked. Yes No �_. Zf answer is "yes", list dstes and reasona: I �I 22; Do ou have an interest oY t in a o r Y ac�}r ype rry the busineaa or businesa prem3aes. If anawer is "yes", list business, business address and telephone number. ��n 23. If business is incorporated, give date of incorporation 6-2 8 19 �� and attach copy oP Articles of Incorporation and miuutes of first meeting. 2�+. List all officers of the corporation giving their aames, oPfice held, hame address, and home and business telephone numbers: _GtORGE STtFFER, PRESIDENT, 2146 NORTONIA, (612)739-3370 _JOHN ROLOFF, V I CE- PRES I DENT, 1001 -129t1'i AVE. N.E. (612) 571 -3962 ', �IDSEPH MARO .HFK. CHAP TN. 6 BATES AV� (612) 774-4865 � P_.1 , RUNN I NG, SEGRETARY, 1728 N . ABEL, (612) 488-4227 , DONALD KERR, TREASURER, 1190 VAN BUREN, (612) 646-4691 25. If business is partnership, list partner(s) address and telephone rnmbera: � Addrees T�el.Ao. _...�_ 26. Ie there ar�yone else who will have an i�erest in thia buainess or prencisesY Zf answer is "yes", give name, home addresa, telepho�e n�bers and in whst manner is tbeir interest: _�n 27.il Are you goinfz to operate this business peraonal]y Yr� i! not, r�rho xiZl vperate it: Rame GENE SWENS�N xorne aaclress 1018 N , CROTTCJ 1�e1,Ro.489-0584 Are y�u going to have a Mana�er or aseistant in this business? IP ans�+er is ��yes", give name and ho:ae address and home telephone rnzmber: Name Home adciress Te1.No. 29• Has arryone yau have named in questions 22 throu�h 25 ever been arrested? If answer is "yes", list name oP person, dates of arrest, where, cha.�ges, comic- tions a.nd sentence ?0• I , N �W j��QN understand this premise may be in- spected by the poZice, Pire, health a.nd other city officials at a�r and aIl times When the business is in aQeration. State of �nnesota) )SS County of Ramsey ) � / i _�� ing first duly sworn, deposes and says upon oath that he has read �Ize foregoing statement bearing his signature and l�m�rs the coatents thereof, and that the same is true of his own �o�+ledge exctpt as to those matters therein stated upon information and belieP and as to those matters he be- lieves them to be true. Su ribed and ss�orn to me ,�� / Signature oP Applicant - �t �� day of 19� / � , ��L� Notary Public, Ramsey ..ounty, Minn � a :was,,,d,�,,,,1r,,,�,,�,:,�,;..,v�€V,r..'ti.:r�r-�►.r±,t,�•r�e�' !�fy co�ission expires r - �;;,r,;;�:;_s r. . _'�`i!:.i..i��' g : :� ta -.:.. N�,fA" , rt :��, , �AI;;�iCSt"ir`, � ` � af '.'...iNi�°"i� ��L V?�i 1 �1 A r ...,..: f -' lySl � p "i�...i.•'-' r,ty Co��;m;saion txpires Mar 27�� w �., ��s •.. Gambling License Application Page 2 Type of Application: ❑Class A �Class B ❑Class C � ❑Class D ❑Yes�No 23. Is gambling premises located within city limits? �Yes�No 24. Are all gambling activities conducted at the premises listed in #19 of this application? If not, complete a separate application for each premises(except raffles)as a separate license is required for each premises. - �lYes No 25. Does organization own the gambling premises?If no,attach copy of the lease with terms of at least one year. DYes O No 26. Does the organization lease the entire premises?If no,attach a sketch of 27. Amount of Monthl Rent the premises indicating what portion is being leased.A lease and sketch S � is not required for Class D applications. • DYes C�No 28. Do you plan on conducting bingo with this license? If yes,give days and times of bingo occasions: Deys rmes I�,Yes�No 29. Has the S 10,000 fidelity bond required by Minnesota Statutes 349.20 been obtained?Attach copy of bond. 30I.I In�urance Company Name _,^_ s . � , 1 __ 31. BondNumber � J4i� S - :1v� ! � � .i.�:i :. ✓�i�l"r; tt,.:; .� � .:-rv•i`T 32. Lessor Name 33. Address 34. City, State,Zip 35. Gambling Manager Name 36 .Address 37_ Giiy,.State,Zip;_. _ . .:�v: � _. i _ ., i . .. i � .J u � _i<'Ui_ , i. l . , 38. Gambling Manager Business Phone 39. Date gambling manager became ( � member of organization: 7 ;�;7 ,' ;�; � GAMBLING SITE AUTHORIZATION By my signature below,local law 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 gambling and to enforce the law for any unauthorized game or practi�Ce. BANK RECORDS AUTHORI2ATION By my signature below,the Board is hereby authorized to inspect the bank records of the General Gambling Bank Account whenjever necessary to fulfill requirements of current gambling rules and law. OATH . I hereby declare that: 1. I have read this application and all information submitted to the 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 of all activities to be conducted; 6. I will familiarize myself with the laws of the State of Minnesota respecting gambling and rules of the Board and agree, if licensed,to abide b those laws and rules, includin amendments thereto. 40. bfficial,Legal Name of Organization 41. Signature(must be signed by Chief Executive Officer) ;_ _ , T _ - - ;, - X _. ; ; .-;,---;',`. Title of Signer Date - J r ,� ` �� . J?' C"� R.�. f ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING.BODY I her�by acknowledge receipt of a copy of this application. By acknowledging receipt, I admit having been served with notic�e that this application will be reviewed by the Charitable Gambling Control Board and if approved by the board, will become effective 30 days from the date of receipt(noted below),unless a resolution of the local governing body is passed which specifically disallows such activity and a copy of that resolution is received by the Charitable Gambling Control Boarti within 30 da s of the below noted date. 42. Name of City or County(Local Governing Body) If site is located within a township,item 43 must be completed,in addition to the county signature. '++ f � 7a, 1 Signature of person receiving application 43. Name of Township x �� Ah r c:o � � � � ( � ,-* ", Title Date received(30 day period Signature of person receiving application begins from this date) , �A. �'/10/8i x 4..^ �ame of Person efivering application to Local Goveming Body Title CG-OQ01-02 (8/86) White Copy-Board Canary-Applicant Pink-Local Governing Body � i `�/MITE - C17r CIERK PINK - FINANCE � CANARV - OEPI�RTMENT GITY OF SAINT PALTL Counci , BI.UE -MAVOR ' FIIG NO• � � Council Resolution Presented By Referred To Committee: Date _. Out of Committee By Date RESOLVED: That application (I.D.#35433) for renewal of a Class B State Gambling License (Raffles, Paddlewheels, Tipboards, and Pulltabs) by St. Paul Aerie #33 Fraternal Order of Eagles at 287 Maria Ave. be and the same is hereby approved. COUNCILl4lEN Requested by Department of: Yeas Nays in Favor Against BY Form Approved by City Attorney Adopted by Council: Date Certified Passed by Council Secretary ' BY By. Approved by Mavor: Date Approved by Mayor for Submission to Council By BY . � . _, �'�`-` �-��/� • "��cu��n,�o�i •v--=�9'. •, :.,` ��{DUh��?2�� Charitable Gambling Control Board i FOR BOARD USE ONLY '•.4�� Room N-475 Griggs-Midway Building " u��N�� •� 1821 University Avenue � K`:� � St. Paul, Minnesota 55104-3383 PAID (612) 642-0555 AMT �'j�'�.. CHECK# ' DATE GAMBLING UCENSE APPLICATION INSTR�JCTIONS: A. Type or print in ink. B. Take completed application to local governing body,obtain signature and date on all copies, and leave 1 copy.Applicant keeps 1 copy and sends original to the above address with a check. C. In�omplete applications will be retumed. Type of Application: ❑Class A — Fee S 100.00 fBingo,Raffles,Paddlewheels,Tipboards,Pull-tabs) C1Ctass B — Fee S 50.00(Raffles,Paddlewheels,Tipboards,Pull-tabs) Makecheckspayab�eto: �? �Cla s C — Fee S 50.00(Bingo only) Minnesota Charitabk Gambling Control Board ❑Cla�s D — Fee S 25.00(Raffles only) �Yes�No 1. Is this application for a renewal? If yes,give complete license number � - 0 - �0 ❑Yes�No 2. If this is not an application for a renewal,has or anization been licensed by the Board before? If yes,give base 1 license number�middle five digits) ❑YesC]No 3. Have Internal Controls been submitted previously?If no,please attach copy. 4. Applicant(Official,legal name of organization) 5. Business Address of Organization ;'--. � . • ' ,-' _ r— . � , : _- — -�:- �� . n . vi ti ��i ' ! ':,�. !'�� a' 6. Ci,hty,State,Zip 7. County 8. Business Phone Number _ � ' : , - J �'J� �1 1 �� , j��,� f� 9.J Type of organization: C]Fraternal ❑Veterans ❑Religious ❑Other nonprofit" •If organization is an"other nonprofit"organization,answer questions 10 through 13.If not,go to question 14."Other nonprofit"organizations ust document its tax-exempt status. �Yes No 10. Is organization incor orated as a nonprofit organization?If yes,give number assigned to Articles or page and book number: Attach copy of certificate. �Yes�No 1 1. Are articles filed with the Secretary of State? ❑YespNo 12. Are articles filed with the County? �Yes b No 13. Is organization exempt from Minnesota or Federal income tax?If yes,please attach letter from IRS or Department of " � Revenue declaring exemption or copy of 990 or 990T. ❑YesONo 14. Has license ever been denied,suspended or revoked?If yes,check all that a ly: ❑Denied ❑Suspended ❑Revoked Give date: - - 15. Number of active members 16. Number of years in existence Note: If less than four years,attach , _ , evidence of three years � i -� _ existence. 17. Name of Chief Executive Officer 18. Name of treasurer or person who accounts for other revenues of the organization. V'�.�/i,',J� .' I �1�.� ._.. ^1 ii � �T' .� . :ty ! . . .r. � . . �.� Title Title �7�`� - —��_ . _�.. `. •��j � � �'\�v_.��i:;s ! cJ.�'.,��1.�1 :�i\ . Business Phone Number Business Phone Number ',� l. 1 _ _ ► / I'�-, 31 i�� 19. Name of establishment where gambling will be 20. Street address(not P.O.Box Number) .,_cnAducted __ _ ; __, _ „ _ _ , :�I: � . __.. . .�.i _ ��t J . r�J r �_ � ._../� . I i�:\�. . . ... - 21. �ity,Stste,Zip 22. County(where gambling premises is located) -•�' - �:�, - ifr �r':' . ci , • � . . _, . . /.. ,. .. . , CG-0001-02(8/86) White Copy-Board Canary-Applicant Pink-Local Governing Body I i � � 7_ �/�� , . i A G E N D A M A T E R I A L � j- . _ ._ . _ . COUNCIL ID�� - ( DATE RECEIVED � Z3 I � AGENDA DATE AGENDA ITEM �� , SUBJECT w � �� ' � ORIGINATOR � CONTACT ��1��e_o�-c� RESEARCH STAFF ASSIGNED / DATE SENT TO CLERK '��,� I COUNCIL ACTION IMAST , . _ ER FILE INFO AVAILABLE � �-- __ ' . I ORD'IRESOL. �� DATE FILE CLOSED I . � i i I I � j `�