96-1347 0 ^
Council File # � 3 y�
�% y F2 Y �s"�� � �'��� �� � Ordinance #
Green Sheet # 34997
RESOLUTION
CI AINT PAUL, MINNESOTA 59
Presented By
Referred To Committee: Date
1 RESOLVED: That application, ID #42603, for a new Gambling Manager's License by
2 Thomas R. Farrell DBA Midway Lions Club at J. R. Mac, 1920 7th St. W.,
3 be and the same is hereby approved.
4
5 Requested by Department of:
6 � Nays Absent
7 Bae,y
9 G�s � Office of License, Inspectiona and
10 Me ar � Environmental Protection
11 e t ta .�
12 une
Bostrom �
Adopted by Council: Date � By' �"°-°"° '� ��
Adoption Ce ified by o n 1 ecretary
Form Approved by City Attorney
By: � ( � By, �
Approved by May . Date � ��/ ��
Approved by Mayor for Submission to
sy: �,�
° Council
By:
� a►re u�m u o �� '''� 1
LIEp �REEN SHEET N_ 3. 9 9 7
d �DEPARTMENT DIRECTOR�� �CITY COUNCIL INtTIAUDATE
William F. Gunther - 266-9132 p��� ❑cmrn�rtoaacr �cmrc��m
ta► ) � �BUDQET DIRECT�OR ��.a�:sERV�s aR.
Hearin : !0 3 °�e" ❑"""r°"�°p"ss�sr""n �
T�OTAL#E OF SWNA RE PAOEB (CLIP AL��OCATIONS ROR SKiNATUq�
ACf10N REGUESTED:
, Thomas R. Farrell DBA.Mfdway Lions Ciub requests Council approval of his
application for a new Gambling Manager's License �.t J. R. Ma.c, 1420 7th St. W. (ID �42603).
'��lAl°f�0�(p) PERSONAL SEHVICE CONTRACTS MUST ANSWBR TNE FO�LOWINQ OUE=t10NS:
_PLANNINO COMM�A18610N _CIV1L SERVICE 001AMI681�1 1. H8a ihla person/fkm a1ler worked und�r 8 ob�tfact f�MdY dp�tllmlfwrt? �
_����E _ YES NO
2. Has this porson/flrm e�ror been a city amployee,4
—�� — YES NO
_D18TAICT COURT _ 3. Doms Mi8 p�rsoNflrm posaese e akHl rrot nonnelh�Doe�bY�Y�u��Y e���
BUPPORTB WMK�1 CaINCIL 08JECTIVE7 YES NO
Facplaln all ya�nsrwn on a�pi��M�t and Naoh to�n�n�hMt
INITIATMIO PRO�E�A.168UE.a+POR7UN�TY MRw.What�VYhsn.Wh«s.WhY).
_ RECEIVED
� A� �� �
T'[Oi�NEY
tITY A
ADVANTAOE8IF APPiIOVED:
DISADVMITAOES IFAPPROVED:
�CiN f1GJR� Yw��
AUG 2 81996
�����:
,. _
TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BtlDGETED(CIRCL�E ONE) YH8 NO
FUNDIWG 80URCE ACTIVITY NUMSER
FINANCIAL INFORMATION:(EXPLAIN)
Greensheet # L.I.E.P. REVIEW CHECKLIST �ate: /
In Tracket? App'n Received / App'n Processed
9 � •I�y ']
License ID # Q License Type: /?'!6�//1 �ilC P...f'
Company Name: /'he DBA: �S' ���-
Business Addresss: s • - . � Business Phone: �o�� — �o I3 f�
Contact Name/Address:�///�ll.l�G� • �� 3�//� Home Phone: �D �d � b/3�
Date to Council Research:
Public Hearing Date: d c,� �3; 199.( Labels Ordered: /'?�/�7
Notice Sent to Applicant: District Council #: f� 9
Notice Sent to Public: Ward #: �OZ
Department/ Date Inspections Comments
�
City Attorney �•/a3 /4�
D�C `s��
Environmental
Health
/V�/'!
Fire
/v��
License Stte Pian�ece�ved:
L.ease Received:
/� �
Police �eC01"CL ls/�'e��`-� ���
�� 8 ` _ /q� /��
�°`�`�
�'/� ., /� S�Piri`�
°Y
Zoning
/1� �
LG212 � FOR OFFICE USE ONLY
�Re�' ��?J92� � BASE UC#�
r
SEQ # � �
Minnesota La.wfui Gambiing FEE
Gambling Manager Application cH►c
DATE
INIT
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e o >:A i ::..;:.;::. :;:.:;>.;..:.:;...;;;;.::;...::, :
;:T�m �' ppI cat:orz > :..:::.:::.::..::.::.. :,<:>::::<;:<:>::::::< : .
�] New Give date that ihe rivo-day gambling manager seminar was completed.�/_,,_,/
Location oi 7aining
(���Y)
[] Re�ewal Give date of training received within three years prior W the date o(the application tor renewal.,_//
Location of training �
,.:,:.:.;..;;:.;::..:.:; :..: ,.. ,:. ��!�Y);>::.::::::::::::.:.:...:..;:.:..,:::::::.::::.::
::.. : . :: .:
GambiiR' M ,, a er In o . �a ion ; �; ::
, : __. . . _ .. .
LAST NAME FIRST NAME MIDDLE NAME MAIDEN Date c�Birth 5oc.Searity Number
Farrell Thomas R . '9J9 /37 468-48-p433
Adc�r�si I E 1 w a y S t r e e t �t 4 0 3 S t . P a u 1 Stat�N Zi��ode 6 Daytime Phone
� � ( 61 � 6-� 6-6134
MEMBERSHIP:�ate gambling manager became a member of t�e organization ��i�/�� Sex: �Male ❑ Female
Or` anizat' �`'X orin tio� !'
Name ot Organizadon License Number
Midway Lions Club Pending
Address City/State Zip Code Phone
I 173 Edgcumbe Road St . Paul MN 55 105 ( 6 1 2 )776-7303
and li�formation
--A$t0,000 fideliry bond in tavor ot ihe organizadon must be obtained for t�e gambiing manager.
Name of insurance company(do not use agenry name) Bond Number
.; . : .
, _ ,.: ..: ;, ;
' ; ` ' •.�:. � _. :
::•:
.����.v,�edgmertt � �
��eaa�e d,ec:
• I have read this application and atl information submitted to the board;
• all iniormation is bve,accurate and complete;
• all otfier required information has been fully disdosed;
• I am tfie oniy gambling manager of the organization;
• I wili fami�iarize myself with the laws of Minnesota governing lawful gambling and ruies of the board and agree, if licensed,to
abide by those laws and rules, induding amendments to them;
• any changes in appiication in(ormation will be submitted to the board and tocai unit ot government.within 10 days o(the change;
• An affidavit for gambli�g manager has been campteted and anached,and
• I understand that faiiure to provide required information or prouiding false inlormation may result in t�e denial or revoca6on of the
liCense.
Signature of Gamblin Manager ( Date
- �%i'� ,,f `� .�i'c�r�'� ;,Z - r 3 - � S
�d the�.rompleted appiication and ali required attachments to:
Gambling Co�trol Board
Suite 300 S.
1711 W. County Road B
Rosevllle,MN 55113
��26 0.�