96-900`°��lGl@�,��
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Council File # q �- q o �
Ordinance #
Green Sheet # 35244
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
Presented By
Referred To
Committee: Date
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Office of License Inspections and
FnvirorLmental Protection
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RESOLVED: That application, ID #47225, for a new Gambling Manaqer's License by
Steven P. Tibbetts DBA Chutch of the Zncarnation at Reaney's Bar, 870
Payne Avenue, be and the same is hereby approved.
���� n � n � Requested by Department of:
BY� 1 \ � , f-�ir-z�^.']�—
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Approved by Mayor: Date �(� a4
By: /"" �j i���`Ti�j
Form Approved by City Attorney
By: V � � � �//
�h OAMN�� � �-Vs-�O��
U
Approved by Mayor for Submission to
Council
By:
Adopted by Council: Date _� `l �°
Adoption Certified by Council Secretary
U'C_90o
DEPAFTMENT/OFFICE/CAUNCIL DATE INITIATED N� 3 5 2 4 4
LIEP � 3 G lqy GREEN SHEE _-
INITIAI/DATE INITIAVDATE
CONTACT PEqSON & PHONE O DEPAflTMENT DIqECTOFi � CIN CAUNCIL
William Gunther - 266-9132 ���N OCfTYATTOflNEY �CITYCLERK
MUST BE ON CAUNCIL AGENDA BY (�ATE) pU GFOR O gUDGEf OfRECfOF � FlN. & MGL SEAVICES DIR.
H2dI�II ' � O ��OF (OR ASSISTAN'n �
g•
TOTAL # OF SIGNATUR PAGES (CLIP ALL LOCATIONS FOR SIGNATUHE)
ACiION REQUESTED:
Steven P. Tibbetts DBA Church of the Incarnation requests Council approval of his applicatio
for a new Gambling Manager's License, ID �647225, at Reaney's bar, 870 Payne Avenue.
RECOMMENOA710NS: Approva (A) w Rejact (R) pERSONAL SERVICE CON7RACTS MUST ANSWER THE FOLLOWING �UESTIONS:
_ PLpNNMG CAMMISSION _ CIVIL SERVICE COMMISSION �� Has Mis perso�rtn ever worketl untler a contract for this tlepartmeM? -
_ CIB GOMMfTTEE YES NO
_ s7AFF 2• Has this person/firm ever been a City employee?
— YES NO
_ DIS7AIC7 COUR7 _ 3. Does this personffirm possess a skill not norma�l �
y possessed by any curtent city employee.
SUPPORTS WHICH CAUNCIL OBJECTIVE? YES NO
Explafn all yes answers on seperete sheM and attaeh to green sheet
INITIATING PFOBLEM, ISSUE. OPPOflTUNIT' (Who, What, W�en. Where, Why):
ADVANTAGESIFAPPROVED: �
DISADVANTAGES If APPROVED:
Gfl�3��� ��C�.'�9 C�R?�°
Ju�. � s �sss
�,�___
DISADVANTAGES IF NOTAPPROVED:
TOTAL AMOUNTOFTRANSACTION $ COS7/HEVENUE BUDGETED (CIHCLE ONE) YES NO
PUNDING SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION: (EXPLAIN)
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Greensneet #3.� 2 S<S� L.I.E.P. REVIEW CHECKLIST �ate: / 4 G— 90 6
In Tracker?_� aPP'n aeceived /�APP'n arocessea
License
Compan
Busines;
CoMact
Date to i
Public H
Notice S_.._ .,,
Notice Sent to Public:
Ward #:
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Department/ Date Inspections Comments
City Attorney
7 f����.�
Environmental
Heaith
,✓�,-/
Fire
/U f /%
License Site Plan Received:_
�ease aeceived:
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Police
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Zoning
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c.172
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Minnesota Lasuful Gambiing
Gambling Manager Application
❑ New
F�R OrriCE USE ONLY
EaSE UC s
SEO i
FEE �
CHK
DaTE
INI7
Give '�ate �at 7ie wo-Cay ganCLrg marager seminar was rampieted. !_/
Lncadon ot training
(dry}
� Renewal
USS NAME
Tibbetts
Give date ol vaining received wi4iln 7Nee Years pricr �o rie Eate of 3�e appGraeon ior renew�. 2/20 ! 90
Lo�asonotraining willmzr ?finaesota
.. . .. ..... ....I=�y) ,.,,.. ._.. µ.
ina er:In ar�rr[atiorz . ` , :;:.. ;;;..:<,
niiST NAME M.IDDLE hAME N,AIDEN Date of BiM �Sac• `.�errnty Number
Steven ?atrick 3/17/51 4ib-62-;869
46 14 th Ave. S
MEMeEnSHIP: Date gam6lir.g manager becane a member cf rie orcani:atlon ?/ 1 i�� Sez : f� Maie ❑ �emaie
�-OT . ... .. . � . .:.�...��.. , . . , ,
Name of Ckgani7aion Licensx Nunbec
Church of tie Incarnation 00639
ACdress CityrStaie Zip Code Fhone
3817 ?leas 4ve So '•S�::nea�olis ?L'� S:u09 �61? � fi2'_
Y --p 510,000 fideGty bond in lavor of the oryanizacon rusc he ccained for �e gambiing manager.
Name ot insuranee campany (do not use agenry name) U S r idel tv 6 Guar�ntBond Number �0-00 �0- � 0 i OS-°2-
1 dedate t�at
• 1 have read this appiicatlon and ail intormaoon submi:.ed s: : e toard;
• all infortnaCOn is 7ue, aau2te and eomplete:
• aU o�her requi2d infortnation has Seen lully �sdosed;
• I am the oniy gambGng manager o( the organaation; a it'ieensed. :o
•! wiil famTiarize myseit wic`i the iaws of ifinnesoa goveming iw'ti:I gxnt:ing and rutes of �e bcard and a5re_,
abide by �ose taws and rvles, induding amenc'ne.^.ts :o �em;
• any e4anges in znp��caccn infcmaticn w�il be subri:.ed :o :^•e Se�rtl and Icral unit �f gcvemment wid^in 10 c=ys oi ;he e^aroe;
• An afic'avit for gane�ir.g -ana�er `as �een cmcieteC <r:tl a-ac=ee, ar:C
• 1 uncert:and J:si failure 7o prviCe requirr! inicros.cn cr ,^rcvi:ir.q '.aise :n:crma::n m�y resuft m: e cen:si or rzvc�a=on o� � e
ficense.
SiSnamre o( Gambling
Date
!/23/°=
Serd :he qrp4e:<d apci{ca:icn and ail :ecuired attachmerns :o:
Gamhlir.g Control Hoard
£uite 300 S.
77�1 W. Caunty Aoad 8
P.osevilte, MN 55113
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��' �,3 ���a �.�t ��� a (. -q o 0
/ "��� ��� Gambling Manager Affidavit
(Attach to the Cambling ManagerAppllcatlon. Form LG212)
STA7EOF •dinnac�ta� ) AFFIDAVITOFQUALIFICATION
) ss. fOR G.;MBUNG MANAGER UCENSE
CAUNTYOF :�ennepin � pNDCANSENTSTATEMENT
(Pursuant to Minnesota Stat��te 3d9.t 6 Subd. 2(e)
and Minnesota pule 7861.00.30,Subp. 128(3))
t, Stevea P. Tibbetts ,underoathstatethat:
(type/print name)
t. ! have nevec been wnv�cted oi a telony.
2. 1 have not, wfthin five years, committed a viotation of Iaw or board rule that resufted in the
revocation of a license issued by the Lawful Gambiing Corttroi Board.
3. I have never been convicted of a criminal viol2tion involving traud, theft, tax evasion,
misrepresantation, or gambling.
4. I have never been convicted of assauft, a criminal violation involving the use of a fiteartn,
or making terroristic threats.
5. 1 am not an assistartt gambiing manager tor any other organization.
6. I am not a gambling man2ger for any other organization.
In addition, I understand, agree and hereby irtevocabiy consent thst suits and adions relating to the subjed
matter of the attached gambling manager license, or acis or omissions ar'sing trom such appiication, may
be commenced against my organization and i wili 2ccept the service of process for my organization in any
couR of corr�pet=nt jurisdiction in Minnesota by service on the Minnesota Secretary of State ot any summons,
process or pleading au2horized by the laws of Minnesota.
By signature of this dxumerrt, the undersigned authortzes the Department of Pubiic Safety to conduct a
criminai background cfieck or review and to share the resufts with the Lawful Gambiing Controi Board.
Failure fo provide required irdormation or providing false or misleading iniormatio� may resuft in tha denial
or revocation of the license.
Subscrbed 2nd swosn to betore me this
� 1 day of �'� v y 19 ��
�a���
County `
���, fi�'�`.r�._--�
Notary Public
My commission expires �� �� ' 4�
CLAY D. AMUNDSON
NOTARf PUBIIC - MINNESOTA
HENNEPIN COUNTY
►ry a�m� apue. siaae
�� ��'.�,�f
(Signature ot applicant - gambiing manager)
CBurcn of the Incarnation'
(Name ot organization)
00639�
License number
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