96-647ORIGI�,�.�
Council File � � �
ordinance ,�
Green Sheet $ 34954
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NESOTA
Presented
Referred To
Committee: Date
37
RESOLVED: That application, ID 59577, for a new Gambling Manager's License by
Jacqueline M. Osborne DBA West Side Booster Club at Awada's On Plato, 199 E.
Plato Blvd., be and the same is hereby approved.
Adopted by Council: Date �
Adoption Certified by Council Secretary
Requested by Department of:
OfPice of License, Inspections and
Environmental Protection
♦.� r,
Form Approved by City Attorney
BY� �ar-�.. � . � By: I / i�, n.rncJl,�� �� \�� ,, o�
Arrroved by Mayor: Date �1 i(�
�� `( Approved by Mayor for Submission to
$y . Council
By:
9G-Gy'7 `�
OEPqRTMENT/pFFICEICAUNCIL DATEINITIATED �REEN SHEET "O 34954 •
LIEP - - --
CqNTACT PER$pN & PHONE INITIAVDATE INITIAVDA7E
� DEPARTMENT DIRECiOR a CITY CAUNCIL
William Gunther - 266-9132 ^�" cmnrroRNev CRYCLERK
MUST 8E ON CpUNCIL AGENDA 8Y (DATE� pO��FOfl Q BUDGET DIFECTOR O FIN. & MGT. SERVICES DIR
Hearin : -� /cj - 9� OpDER Q MAVOfl (OR ASSISTANT) ❑
TOTAL # OF SIGNATURE PAGfiS (CLIP ALL LOCATIONS FOR SIGNATUR�
ncnor+aeouesreo:
Jacqueline M. Osborne DBA West Side Booster Club requests Council approval of
her application for a new Gambling Manager`s License at Awada's on Plato, 199 E. Plato Blvd.
(ID 4F54577)
fiECOMMENDAnONS: npprove (A) m Reject (R) pERSONAL SEFiVICE CONTRACT'S MUS7 ANSWER TNE FOLLOWINCa aUEST10NS:
__ PLANNING COMMISSION _ CIVIL SERVICE COMMISSION �� Has this perso�rtn ever worketl untler a contrect for Nis department? -
_C18COMM7TfEE YES "NO
_ srAFP 2. Has this psrsonMirm ever been a city employee?
— YES NO
_ �iSTqIC7 COUFli � 3. Does this persoNfirm possess a skill not normaliy possessed by any curtent ciry emplayee?
SUPPORTS WHICH CAUNC0. O&IECTIVE? YES NO
Exptain all yas snswers on seperaie aheet antl attach to green ahaet
INITIATING PROBLEM, ISSUE.OPPOfiTUNffY (Wha, What, When, Where. Why):
ADVANTAGES IFAPPROVE�.
DISADVANTAGES IF APPpOVED:
DISAOVANTAGES IF NOT APPROVE�:
TOTAL AMOUNT OF TRANSACTION $ COST/pEVENUE BUDGETED (CIpCLE ONE) YES NO
FUNDING SOURCE ACTIVITY NUMBER
FINANCIAI tNFOHMATION� (EXPLAIM)
Greensheet # 34954 L.I.E.P. REVIEW CHECKLIST Date: / �L' L y 7
In Tracker? .�-_ �— 9�i npp'n Recaived / App'n Processed
License ID # 59577 License Type: Gambling Manager
Company Name: Jacqueline M. Osborne pgq West Side Booster Club
Business Addresss: �99 E. Plato Blvd. (Awada's On Plato) Business Phone: Z22-�451
Contact Name/Address: Same Home Phone:
207 E. Wyoming St. 55107
Date to Council Research:
Public Hearing Date:� .> l2�1�9L Labels Ordered:
Notice Sent to Applicant: District Council #: 03
Notice Sent to Public: Ward #: 02
Departmentf Date Inspections Comments
City Attorney
Environmentat
Health
Fire
License Site ptan Psc�ived:_
Lease Received:
Police �
�L' � h Cl t�/11 �P C�
Zoning
q� STATE OF XZHNESOTA FOR BDARD USE O
GAMBLZNG CQXTROL BOARD AMT. PAID
GR!lBLING MANAGER LZCENSE RENEWAL APPLZCATZON CHECR #�
LG212GMR PRINTED: 09/OS/95 DATE
LICENSE NUMBER: 6-02589 002 EFFECTIVE DATE: 07/02/94 EXPIRATION DATE: 02J29/46
NAME OF ORGANIZATION: Sooster St Paul West Side Club
GAMBLIN6 MANAGER INFORMATION
Jacqueliae Marie Osborne DATE OF BZRTH: 07/25/62
207 E Wyomiag St SEX: F
St Paul 1II7 55107 SOCIAL SECURZTY NUMBER: 4�4-80-6882
DAYTIME PHONE NUMBER: 612-222-7451
MEMBER 5INCE: 12/13/91
LAST DATE YOU ATTENDED A GAHBLING MANAGERS SEMINAR/CONTZNUING EDUCATION CLASS: 12/14/93
BOND INFORMATION
BOND COMPANY NAME: Western Suretp Co BOND NU23BER: 68361035
ACR704iLEDGMEtiT
I DECLARS TSATt
• I HAVE READ THIS APPLICATION AND ALL INFORMATION SUBHITTED TO THE GAMBLZNG CONTROL BOARD7
• ALL INFORMATION IS TRUE� ACCORATE AND COMPLETE;
• ALL OTHER REQUIRED INFORMATION HAS BEEN FULLY DISCLOSEDp
• I AM THE ONLY GAMBLING MANAGER OF THE ORGANIZATION;
• I HAVE BEEN A2i ACTIVS MEMBER OF' THE ORGANIZATZON FOR AT LEAST TWO YEARS;
• I WILL FAMILZARIZE MYSELF WITH THE LAWS OF MINNESOTA GOVERNZNG LAWFUL GAMBLING AND RULES OF
THE GAMHLING CONTROL BOARD AND AGREE� IF LZCENSED� TO ABIDE THOSE LAWS AND RULES,
INCLUDING AMENDMENTS TO THEM;
• ANY CKANGES IN APPLICATION IIiFORMRTZON WILL BE SUBMITTED TO TEiE GAMBLZNG CONTROL BOARD AND
LOCAL UNIT OF GOVERNMENT WITAIN 10 DAYS OF THE CHANGEy
• AN AFFIDAVIT FOR GAMBLINC MANAGER HAS BEEN COMPLETED AND ATTACHED� AND
• I UNDERSTAND THAT FAZLURE TO PROVIDE REQ"(TIRED INFOAY.ATIOti OA PROVIDING FALSE OR MZSLEADZFIG
INFORMATION MAY RESULT SN THE DENIAL OR REVOCATION OF THE LICENSE.
OF 6AMSLZN6 DSANAGER DATS
�;C.Q�,�/n.2� `��'�l � ��., l 02 9 ' C Y S �
REFER TO T8E CHECRLIST FOR REQUIRED ATTACHMENTS
MAIL TOS GAMHLZN6 CONTROL BOARD
1711 WEST COUNTY ROAD B, SUITS 3005
ROSEVILS.B�" 1tItibIESOTA 55113 -'� "-
THIS FORM WILL B8 MADE AVAILABLS I1i�ALTERNATIVE FORMAT {Z.E. LARGE PRINT, BRAILLE) UPON REQUEST.
�9 S77