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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 .: :. :................ ...... <.: , _ . :._ . ..;: . .:::.«. •::.: .:•:::>:<•?;;:::»�•�•::::::,>;':>;;:,>::.::>;::.::•�>::,:<:..::::s<::�.:::;:;::.:;:z>ss>:::::::>::�::>:<.::>::::<:::>;>;••;:.:::;:>.;z:;;•;:.»:.:>z>;,:>::::>r�::: 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.�