96-173Council File # q � - � r �,3
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's..'- E ��i E! ti t �!
Ordinance #
Green Sheet � ����/
Presented By
Referred To
Committee: Date
1 RESOLVED: That application (ID #86151) for a new Gambling Manager's License by Steven
2 Tibbetts DBA Church of Incarnation at Erick's Bar, 949 East 7th Street, be
3 and the same is hereby approved.
4
`' Reguested by Department of:
6 ea Nays Absent
7 B akTey �
8 Guerin �—
9 � Harri � s
1� Re t� man �
12 Thune
73 Bostrom
15 � � �
16 Adopted by Council: Date �.\ �\�q S�
17
18 Adoption Certified by Council Secretary
19
20
21 By: a- . ,�,,, /�
23 Approved by Ma r: Date ��I G r
24 `
25 L , _�%�
26 By: G��.Zi�L� ��1�'L�"
27
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
G�
Office of License Insvections and
Environmental Protection
BY= �lM-� Y�/ /7 ��,(
Form Approved by City Attorney
1d� ,
sy: Y�s� ..u,�c � .� �.,�o�.
Approved by Mayor for 5ubmission to
council
By:
a L -��t3
OEPARTMENTlOFFIC£JCqUNCIL DATEINiT1ATED GREEN SHEE N� 3 4 9 31
LIEP ^ � - - - - "
CANTACT PEp50N 8 PNONE INRIAVDATE INRIAVOATE
� DEPARTMENTDIREGTOR � CRV COUNpL
C ristine R zek - ^u��" �CITYATfORNEY �CIT'CLERK
MUST BE ON CAUNCIL AGENDA BV AT� pU O BUDGEf DIflECTOR � FIN. & MGT. SEflVICE$ Diq.
��� n/- ORDER a M0.YOR (OR q$SISTANn �
'1 �(J
TOTAL # OF SICaNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE7
ACTION REDUESTED:
Steven Patrick Tibbetts DBA Church of Incarnation requests Council approval of
his application for a new Gambling Manager's License at Erick`s Bar 949 East 7th Street
( ID11 86151)
RECOMMENDATIONS: Apprwe (A) or Reject (R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUESTIONS:
_ PLANNING CAMMI$$ION _ CNIL SERVICE COMMISSION �� Hes Mi5 pefsonflirtn eve� w0iked undBY 2 COnhaCt fOf ihi5 depa�trtlBM? -
_ CIB COMMITfEE YES NO
_ STAF� — 2. Has this person/Firm ever been a ciry employee?
— YES NO
_ DISTRIC7 CAUR7 , 3. Does this person�rm possess a skill not normall �
y possessetl by arry curceM city employee.
SUPPORTSWHICHCOUNGILO&IECTIVE7 YES NO
Explafn all yes enswers on saparete sheet and attech to green shee[
INITIATINCa PROBLEM, ISSUE, OPPEIRTUNITY (Who, What, When. Where, Why):
ADVANTAGES IFAPPROVE�:
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�EB 48 �6
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DISA�VANTAGES IFAPPROVED:
`
DISADVANTAGES IF NOTAPPROVED:
g,' '�aa'� b�c-'.���'�
� i� 2 1 d '^, �
TOTAL AMOUNT OF7RANSACTION $ COST/HEVENUE BUDGETED (CIHCLE ONE) YES NO
FUNDING SOUBCE ACTIVITY NUMBER
FINANCIAL INFORMATION� (EXPLAIN)
Greensheet #�_
In 7racke�?
License ID # B-00639
L.I.E.P. REVIEW CHECKLIST
NEW Gambling Manager License
9 � -��t 3
MP'n Received / APP n Processed
Company Name: S Az�Pn Parr; � Tihhattc �BA�—Chu.r.c]a—er��e.a�.�a��e�
Busi�ess Addresss: 949 East 7th Street (Erick's Bar) gUSiness Phone: (612) 823 1031
Contact Name/Address: �ai � Ploac�nt e., Go—Mg� s, M���1,g9Home Phone: �y
Date to Council Research:
Public Hearing Date:� �? r (_e _
Notice Serrc to Applicarrt:
Notice Sent to
Labels Ordered:
District Council
Ward #:
Department/ Date inspeciions Comments
Ciry Attorney
��
Environmental
Health
� ��
Fire
�fC/
License Si4e Plan Received:
Lease Received:
�- (� Z { r � �1,c,
Police
D�
Zoning
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LG212
(Rev. 7l2/92)
Q Naw
� Renexal
Minnesota LmyficI Gambltng
Gambling Man.ager Agplication
f-0R OFFICE USE ONLY
BASE 11C e`
SEO 7t �,
FEE
CHK
DATE
INR
Caive �te �iat ihe two-day gamh6ng manager seminar was pmpleted. / /_
Location of ttaining
Give dam af training received wiNin three years pr'or ro the date of t�e application for renewal. 2/20 / 90
L,ocationofvaining Willmar �linnesota
LAST NAME F1RST NAME MiDDtE NAME MAIDEN { Date of Bicth
Tibbetts Steven Patrick I 3/17/51
Address State Zip Code
4633 14th Ave. So. �finneapolis _'SN 55407
MEMBERSHIP: Date gamhGng managec became a member of �he organiza5on 2/ 1%/ 79
Name of Crganizaton
Church of the Iacarnation
Address
3817 Pleasaat Ave. So.
Soe.Seeuriry Num6er
476-62-�869
DayGme Phone
(61?� 823-1031
Sez : t� Ma(e � ' 'remale
.,:�:';:�.-'�_;;`i _ .......
License Numbet
CityiState Zip Cade Phone
eaDnlis :4v �:409 �612 �
3
::.... ...... . .. , ,.
_ti . ,. . ., .,.., , , ;
Bbn� I�rrria 'ort ' ' ` ,.; , -.. -•:;
. , _. ... ,.._. �..,.. ,
--A $10.000 fideliry bond in favor of the organizacon musi be obained for the gambling manager.
Name of insurance company {do not use agenry name) U. S. r idelitv S Guarant3ond Number �0—•")030—'t0705—°2-7
t x•; : - -. . . . _ ., .. .... _ :
��1�C�C7i.0YYJ�2[� C1i� � � ' .- -.:. ._�. . �; - -- - � - '. � t ...:-�
�'..
1 dedare Ciat:
• I have read ffiis aoplip6on and all informarion submitted to ihe board;
• aii infwma6on is true, aeairate and camplete;
• all other required information has been fuity disdosed;
• I am the only gambling manager af the aganizadon;
• I wiil familiarize myself with the laws of Minnesota goveming lawtul garnbling and ruies of the boarci and agree, ii :icensed, :o
abide by ihose laws and rules, induding amendments to them;
• any ahsnges in applica0on i�fortnation wiil be su6mitted to the board and local unit of govemment within 70 cays ci Ne cnanae:
• An aifidavit for garn6ling manager has heen compieted and attached, ar:d
- I understand that failure to pmvide required iniortnadon or providing ralse inicrmaticn may result in �e eenial or rewcaecn �t �e
license.
Signature of Gamoling
Da�e
!; 22/°�
Serd :he cample?ed applicaticn and ail reouired attacnments .o:
Gambling Control 8oard
Suite 300 S.
17��'N. County Road B
P.oSeville, MN 55173
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LICENSED GAMBLING ORGANIZATIONS
...........................•••. ................................. . ... . . . ... . . . ... . . . . ......... . ..... . . ..... . . ... . ..... . . .....
eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee2eeee�
° NAME: INCARNATION CHURCH NUMBER OF SITES: 0°
° ADDRESS: 3817 PLEASANT AVE SO MPLS MN 55409 °
° STATE LICENSE �:00639 PHONE �: LIC CLASS: B STATUS: OB °
0 0
° CEO I,AST NAME: MONAGI3AN FIRST : FR ROBERT °
° ADDRESS: 3817 PLEASANT AVE SO MPLS ' 55409 °
° HOME PHONE: 822-2101 BUSINESS PHONE: 822-2101 DOB: / J °
o p
° TREASURER LAST NAME: FIRST: °
° ADDRESS: �
° HOME PAONE: BUSINESS PHONE: DOB: // °
0 0
° MANAGER LAST NAME: TIBBETTS FIRST: STEVEN °
° ADDRESS: 3817 PLEASANT AVE SO MPLS 55409 °
° HOME PHONE: BUSINESS PHONE: 822-2101 DOB: // °
0 0
° LAST RECORD CHECR: / / �
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