96-1522 ��� i_` � � p ^ " "' � Council File # �� - �S �. �
�,• 6 �e i .. C a � ; i' ,
` _' Ordinance #`
Green Sheet# 35408
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA �7
Preaented By
Referred To Committee: Date
1 RESOLVED: That application, ID #20676, for a new Gambling Manager's License by
2 William R. Schwartz DBA Twin Cities Autism Society at Cab's Pub, 992
3 Arcade Street, be and the same is hereby approved.
4
5 Requested by Department of:
6 Yeas Nays Absent
7 B a ev ✓
8 Guer.in ✓ Office of License. Ins�ections and
9 H r
10 ! �— Lnvironmental Protection
11 ✓
12 T une ✓
Bostrom —T
Adopted by Council: Date
� By: �.�,1�,:, ��t,.�
Adoption Ce ified by C �e'� Secretary
Form Approved by City Attorney
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BI'� By: fh_ �,�.c�� �
Approved by May . Date �7/ �C`��
`�� I `����U „ Approved by Mayor for Submission to
�� � Council
By: (,v
By:
_ °��-1 saa-
P �NmA� GREEN SHEET N_ 3 5 4 0 8
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TOTAL�OF BKiNATURE P�AtiE8 (CUP/iLL LOCATION8 FOR 81GNATURE)
ACTION REGUE8TED:
William R. Schwartz DBA T�iin Cities Autism Society requests Council approval
of his application for a new Gambling Ma.nager's License, ID #20676, at Cab's Pub,
992 Arcade Street.
RE(lO�NOAT10Na'Approw(��°r Ry��R� PER�ONAL SHRVICE CONTRACTS MU8T ANSIMER TME FOLLOYWNO OUEBT10N8:
_PLANNINO COAAMISSION _.CN�3ERVICE f:OMh11681qV L Has this pe►son/firm eve/worlWd urlder a cOl�aCt fof tlds dap�l►t? -
_CIB COt�MAITfEE _ YES NO
_8T�FF _ 2. Hes this persoMkm ever bsen a cHy employee?
YES NO
_orernicr couar _ s. ooss m�s personinrm pasys a skill rat namellY P�M�Y���Y s�o?
su�oars wNx�oouNCa oe�ECrnez �s nw
Ezpido all yy�nsw�n on t�nt�d�t�nd�ch to yrNa shMt
� MN'19ATM10 PI40BLEM.1881��OPPORI'lN�111'Y(VVIw.VYhat.Whsn�WMro.YVhY)c
. RECErv��
H�� 02 �96
CITY
pTTORNEY
ADVANTAOEB iF APPRONED:
DISADVANTAOE8IF APPROVED:
DIBADVMITAOES IF NGT APPFWYED:
TOTAL AMOUNT OF TRANSACTION = COST/REVENUE SUDBETED(CIRCLE ONE) YES NO
FUNDING SOURCE ACTIVITY NUMeER
FMrAWC1AL MIFORMATION:(EXPl.A1N)
Greensheet # L.I.E.P. REVIEW CHECKLIST �ate: / �1 (�-Is aa
In Tracke►? App'n Fleceived / App'n Processed
License ID # 20676 Ucense Type: Gambling Manager
Company Name: William R. Schwartz pgq; Twin Cities Autism Society
Business Addresss: 992 Arcabe St. (Cab's Pub) Business Phone: 641-0709
Contact Name/Address: 12762 Dover Dr. Apple Valley 55124 Home Phone: 641-0709
Date to Council Research: /T�S���
Public Hearing Date: Qtc� 1� � 195L Labels Ordered: N/A
Notice Sent to Applicant: District Council #: 05
Notice Sent to Public: N/A Ward #: 06
Department/ Date Inspections Comments
�
City Attorney S{�n� � �/�� ��D!''/'JP� ���-19�c
OK �`����96 �
Environmental
Health
N/�
Fire
�l�
License ���8^�i��
Lease Received:
/� ��
Police R�Chyy+d �jhPC-IC.. �IT�C���-
Q � !�`�/��
Zoning
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,_ � `i (� -ISaa-
' LG272 FOR OFFICE USE ONLY
(Rev. 7/2/92)
• BASE L1C �
SEa it
Minnesota Lawful Gambling FEE
Gambling Manager Application cHK
DATE
INIT
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�New Give date that the rivo-day gambling manager seminar was completed.�/�/ `
Location of training � - �'^�
' (city)
� Renewal Give date of training received within three years prior to the date of the appiication for renewal._/ /
Location of training
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IAST NAME FIRST NAME MIDDLE NAME MAIDEN Date of Birth Soc.Securi Number
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Address State ip Code Daytime Phone
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MEMBERSHIP: Date gambling manager became a member of the organization �/�/ q� Sex: ale ❑ Female
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Name of Organization License Ny�ber
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Address Ciry State Zip Code Phone
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--A$10,000 fidelity bond in favor of the organization must be obtained for the ga lin, manager. �
�
Name of insurance company(do not use agency name) I� �_Bond Number e ��
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I dedare that:
• I have read this application and all infoRnatior�submitted to ihe board;
• all information is true,accurate and complete;
• all other required information has been fully disdosed;
• I am the only gambling manager of the organization;
• I will familiarize myself with the laws of tvGnnesota goveming lawful gambling and rules of tt�e board and agree,if licensed,to
abide by those laws and rules,induding amendments to them;
• any changes in applica6on infoRnation wilt be submitted to the board and local unit of govemment within 10 days of the change;
• An a�davit for gambling manager has been campleted and attached, and
• I understand that failure to provide required informabon or providing false information may result in the denial or revocation of the
license.
Signature of Gambling Manager �',� / ../� _ I �ate �17
.G
Send the completed application an I required attachments to:
Gambl(ng Control Board
Sufte 300 S.
1711 W. County Road B
Rosevllle,MN 55113
,�0���
,_ , �GZ,3 � Minnesota Gambling Contro! Board
�a�,a�ss Gambling Manager Affidavit,
� (� - 1 ���' °'�;
Attach to the Gar�bling Manager Application, Fonm LG212
STATE OF � I� )
AFFIDAVIT OF QUAUFICATION -
) s.s. FOR GAMBLfNG MANAGER LICENSE
COUNTY OF �,IM-�e � AND CONSENT STATEMENT
(Pursuant to Minnesota Statutes and Rules)
I,�N �,� `��� I�- �CI l�Q-f��)nder oath state that:
(type/print name)
1. I have never been convicted of a felony or a crime involving gambling.
.
2. I have not,within five years before the date of the license application, committed a violation of law or
Board rule that resulted in the revocation of a license issued by the Board.
3. I have never been convicted of a criminal violation involving fraud, theft, tax evasion, misrepresentation,
or gambling.
. .__ . _
4. I have never been convicted of(i) assault, C) a criminal violation involving the use of a firearm, or(ii� ` �'•
making terroristic threats.
5. I am not, nor ever have been connected with or engaged in an illegal business.
6. I do not owe $500 or more in delinquent taxes as defined in section 270.72. -
7. I have not had a sales and use tax permit revoked by the commissioner of revenue within the past two
years. '
8. I have never, after demand, failed to file tax retums required by the commissioner of revenue. .
in addition, I understand, agree and hereby iRevocably consent that suits and actions relating to the subject
matter of the attached gambling manager license application, or ads or omissions arising from such applica-
tion, may be commenced against my organization and I will accept the senrice of process for my organiza-
tion in any court of competent jurisdiction in Minnesota by service on the Minnesota Seeretary of State of any ..
summons, process or pleading authorized by the laws of Minnesota.
By signature of this document, the undersigned authorizes the Department of Public Safety to conduct a :
criminal background check or review and to share the results with the Gambling Control Board.
Failure to provide required information or providing false or misleading information may result in the denial or -
revocation of the license.
FURTHER AFFIANT SAYETH NOT, except that this Affidavit and Consent Statement are submitted in
support of the application for a gambling manager ticense from the Gambling Control Board.
NOTARY PUBLIC INFORMATION �.!j
Notary Public Seal must be current and correct.
Seal may not be altered. � (signature of applicant)
Subscribed and swom to before me this •
� day of ���G�/,Y. 19 ��v
-G� O
ORGANIZATlON INFORMATION
� � � �l/. Name of Organization `5� ��C �
�cv�h C�f��cS ��.f
�Ii1LJP W. 8WAN80N
wRi�w�W!L!C-MN�TA
M��i�w�oi+� Base License Number n�h(�
- - - - - d�awry�1, � _____� i�•