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Presented By
Referred To
RESOLUTION
CITY OF SAINT PAUL, M
Council File # �� � • �
Green Sheet # 29353
p yY
Committee: Date
RESOLUED: That application, ID #35389, £or a new Gambling Manager's License by
William C. Petersen DBA Rice Street Athletic C1ub at Jeraldine's Bar,
605 Front Avenue, be and the same is hereby approved.
�.-1r� ,.�___� Requested by Department of:
Office of License, Insoections and
Environmental Protection
By: l�,trl..t.�.� j�- /�-�.•�,�',
Adopted by Council: Date
Adoption Certified by Council
By:
appr
By:
Form Approved by City Attorney
By: � �!'�.
Approved by Mayor £or Submission to
Council
By:
9sy��
OEPARTMENT/OFFICE/COUNQL DATE INITIATED N� 2 9 3 5 3
LIEP GREEN SHEE
INITIAVDATE INIiIAL/DATE
CONTApi PERSON & PHONE O DEPARTMES37 DfRECTOR � CITY CAlSNdI
C ristine Rozek - 266-9108 b��GN � CINATfORNEV O CITYCLERK
NUMeEBFOP
MUST BE ON CAIINQL AC+ENDA BY (DATEj R�� O BUDGET DIRECTOR � FIN. & MGi SEfiVICES OIR.
'� n J ORDER � MAYO� (OR ASSISTAN'n O
Hearin : �
TOTAL # OF SIGNATORE PAGES (CLIP ALL �OCATIONS FOR SIGNATURE)
ACTION REQUESTED:
William C. Petersen DBA Rice Street Athletic Club requests Council approval of
his application for a new Gambling Manager's License, ID �/35389, at Jeraldine's Bar,
605 Front Avenue.
RECOMMENDATIONS: qoprove (A) or Reiect (R) PERSONAL SEflVICE CONipACTS MUST ANSWEfl THE FOLLOWING OUESTIONS;
_ PLANNING COMMISSION _ CIVIL $ERVICE COMMISSION �� Has this personqirm 0ver worked under a contract for this department?
_ CIB CoMMI7TeE _ �'ES NO
2. Has this personRirm ever been a ciry empl0yee?
_ STAFF — YES NO
_ DISTRIC7 COUR7 _ 3. Does this person/firm possess a skill not normally possessed by any current ciry employee?
SUPPORTS WNICH COUNCI� O&IECTIVE� YES NO
Explain all yes answers on separate sheet and attach to green sheet
INITIATING PROBLEM, ISSUE, OPPORTUNIN (Who, What, When. Where, Why):
C V�6es� ��� UG?SIP�
RUG 3 1995
ADVANTAGES IF APPROVED.
DISADVANTAGES IF APPROVED:
DISAOVANTAGES If NOT APPROVEO
TOTAL AMOUNT OF TRANSACTION 5 COST/FiEVENUE BUDGETED (CIRCLE ONE) VES NO
FUNDIIdG SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION. (EXPLAIN)
Greensneet # 29353 L.I.E.P. REVIEIN CHECKLIST Date: / gSy �7
In 7racke�? App'n Received /.�p Processed
LicenselD # 35389 New Gambling Manager's License
Company Name: William C. Petersen pgq: Rice Street Athletic Club
Business Addresss: 605 Front Ave. (Jeraldine's) Business Phone: 482-011 l
Contact Name/Address: 3024 Valento Lane Home Phone: 482-011l
Little Canada, MN 55117
Date to CouncU Research:
Public Hearing Date: �'� «Oj�f 5�
Labeis Ordered:
Notice Sent to Appiicant:
Notice Sent to
District Council #: 12
Ward #:
Department/ Date Inspections Commerrts
City Attomey
��25��1� O�.e.
Environmernal
Heaith
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Fire
N(�}'
License site Pian aeceived:
Lease Received:
���Cf� C�/�
Pofice
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Zoning
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� (Rev.7/?J92j
Mirznesota Lau�fuI Gambiing
Gambling Manager Apglicat3on
FOA OPF{CE USE ONLY
BASE L1C t
SEQ �
FEE
CHK
DA7E
INIT -_ - -
New Give date thaf the two-day gambGng manage� seminar was qmpleted. -7 !a6 / 9s
Location of training ��"' /T�S
(uiYT
� Renewal Give date of training received wichin three years prar to the date of the appG�Son for renewal. _/ /
Location of training
LAST NAME FIRST NAME MIDDLE NAME MAIDEN Date of Birth Soc..Sewriry Number
� LCJfI L/� � � �-�� ��J��
MEMBERSHIP: Date gambling manager became a membct of the organizatlon 1/_!�
�
Name of Organizalion
� (b'� YS-z -o//i
Sex : 1� ❑ Femele
l:wense Number
Address CityiState Zip Code Phone
/�`IY iv /.t�1�m�� S�9/�tc� myJ s �i � ( b�L ) S�Y- ZfZOS-
,
:..:.n...r...... r.....n...�.:�..a:......�..h"::�>.�...�..��.:c:>::.^.:i:'i�:n.%..n:..�i.:y`::..t...:i:_..n..::�.p:.o:n%!�..).':....,�.:..i...'n':3�:.•:....<::':SV��::n
`�$OTIC� IR�O7'fflYltLOit� � —
-- A$70,000 fidelity bond in favor ot the organization must be obtained for the gambGng manager.
Name of insurance company {do not use agenq name) '�� S .-� U2 �Y./ Bond Number -; .� / 7 L, �7y% �,
� I i.�
I dedare tbat.
• � have read this appiicabon and aII infortnauon submined to tfie bcard;
• a0 inSortnaSon is true, accu2te and compfete;
• ali other required infortnation has been fuliy disdosed;
• I am the only gambling manager of the aganizaoon;
• i wi� (amiliarize myself with the laws of NGnnesota goveming lawtul gambling and rules o( the board and agree, if licensed, to
abide by those �aws and rules, induding amendments to tfiem;
• any changes in appfica6on information wiA be submitted to the board and local unit of govemment within 70 days oi the change;
• An a�dav�t for gam6ling manager has been compieted and attached, and
• t understand tbat failure to pmJde teq�ired informaDOn or providing false informa5on may resull m the denial or revoca5on ot the
license.
Signatu2of Gambling N�a °
lilj�/O-- l f 1
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I Date
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Send the completad zpplication and ail required attachments to:
- ; Gamblfng Control Boatd
.. -�. - - - - --. - SuHe300S: ., .. .
1711 W. County Road B.
- , - flosevllle, MN 55113 � � �
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