97-1140 R I G� N A L Council File # ��� —{ ��
Green Sheet # ��- , O � � `�
RESOLUTION
Y OF �41N PAUL, MINNESOTA 1�/?
�f �
nresented By
Referred To
Committee: Date
RESOLVED, that the Licensee, SuperAmerica Group, Inc. dlb/a SuperAmerica #4414
(License ID No. 17999), located at 2065 Randolph Avenue in Saint Paul is hereby ordered to pay
a fine of $200.00 for the violafion of the sale of tobacco or tobacco products to a minor.
Said fine sha11 be paid to the Office of License, Inspections and Environmental Protection
within thirty (30) days of the adoption of this resolution by the Council and signature by the
Mayor.
This resolution and the action of the Council in this matter are based upon the facts
contained 'an the Notice of Violation letter to the licensee, the compliance report, and such
arguments as may haue been presented to the Council at the public hearing. The facts were not
contested by the licensee.
Requested by Department of:
Adoption Certified by Council Secretary
By: � d �- . � n� � .�_
Approved by Mayor: Date c'7 /'���i 7
By : �J ✓ �.-�
BY= l� N" /�+1J=�C
Form Approved by City Attorney
BY � `7�oi�✓,�, ./� V��t'�2('l
i
Approved by Mayor for Submission to Council
By:
Adopted by Council: Date �,Q�,a.(, F>�q�
��-«y
40�3�7
Office of LIEP
Clu'istine Rozek 266-9108
TOTAL # OF gIGNATURE PAGES
i-az-9� � GREEN SHEET
�NmwoA�e
� DEPARTMENT DIRECTOR � C1TY COUNCIL _
nssiox O CI7YATTORNEY � cm c�rm
�� � � Bl10GET DIREGTOR � FIN. 8 MCT. SERYICES OIR.
NOUTING
OPDEP O MAYOIi (QR ASSISTAkT) � . �
(CLIP ALL LOCATIONS FOR SIGNATUHE)
Concerning adverse acrion against licenses held by SuperAtnerica Group, Tnc., DBA SuperAmerica, located at 2Q65
Randolph Avenue. (Unco�ested)
OMMFNnATIffNS� Armrmxa (L1 m ho:un !Pl
_ PLANNING COMM�SSION _ qYiL SERVICE CAMMISSION
_ CIB CAMMITTEE _
_ STAFF � _
_DISTRICfCOURT _
SUPPORTS WF{ICH COUNCIL O&IECTIVEI
ISSUE, OPPORTUNI7Y
PEHSONAL SERVICE CONTHACTS MUST ANSWER THE FOLLOWING QUESTiONS:
1. Has this persOnttvm ever wurked under a conVac[ for this departme�t7
vES wo
2. Has ibi5 per5on/Firm ever been a ciry ampioyee?
YES NO
9. Dces this person7firm possess a skill not normally possessed by any curterrt ciry employeel
YES NO
Explafn a0 yes answera on sepnrate sheet anC ettach to green shest
c�.i.. � �s .�,w.,
ALAMOUNTOFTHANSACTION $
COSVREYENUE6UDGETEp(dRCLEONE)
YES NO
DIfBG SOURCE ACTIVITY NUMBER
ICIAL INfOflF5AT10N: (EXPLAIN)
OFFICE OF TF� CITY ATTORNEY
Trmothy E, Mar.x City Aaomey � �_���
l
CIT'Y OF SAINI' PAIIL Civil Divisron
Norm Co%man, Mayor 400 Ctty Hall Telephane: 611 2 66-8 71 0
IS West Kellogg Blvd Facsimile: 6l2 2985619
Saint Paut Mautesota 55702
' January 15, 1997
^31 �;�.�,���i: ��,-'.:'
NOTICE OF COL7NCIL FiEARING
Valerie J. Farks �� � ;Y
Senior Legal Assistant �^ `
SuperAmerica Group, Inc.
101 Jerrico Drive
Lexington, Kentucky 40509 �- - — ---
RE: Cigarette license held by SuperAmerica Group, Inc, d/b/a
SuperAmerica #4474 for the premises located at 2065
Randolph Avenue in St. Paul
License ID No. 17999
Our File Number: G96-0633
Dear Ms. Parks:
Please take notice that a hearing concerning the above-named
establishment has been scheduled for 4:30 p.m., Wednesday, February
5, 1997 in the City Council Chambers, Third Floor, Saint Paul City
Hall and Ramsey County Courthouse.
Enclosed are copies of the proposed resolution and other documents
which will be presented to the City Council for their
consideration. This is an uncontested hearing, in that the facts
contained in the report concerning the unlawful sale of cigarettes
have not been disputed. You will have an opportunity at the
Council hearing to present oral and/or written remarks as to the
penalty, if any, to be imposed. The recommendation of the license
office will be for a$200.00 fine.
If you have any questions, please call me at 266-8710.
Very truly yours,
`-�/ � !��
Virgini
Assistant City Attorney
cc: Jahn Kinzel, Area Manager, SuperAmerica, 1240 West 98th St.,
Bloomington, MN 55431 .
Kathy Schmidt, Manager, SuperAmerica, 2065 Randolph Ave., St.
Paul, MN 55105
Nancy Anderson, Assistant Council Secretary
Robert Ressler, Director, LSEP
Christine Rozek, LIEP
Kathie Tarnowski, Community Organizer, Macalester-Groveland
Community Council, 320 S. Griggs St., St. Paul, MN 55105
��1 -��`�
UNCONTESTED LICENSE HEARIIVG
Licensee Name: SuperAmerica Group, Inc, d/b/a SuperAmerica
#4414
Address: 2065 Randolph Avenue
Council Hearing Date: February 5, 1997
�olation: Sale of Cigarettes to a Minor
Minn. Stat. § 609.685
St. Paul Legislative Cade § 324.07
Date: December 7, 1996
Place: Licensed Premises
Presumptive Penaifiy; $2Q0.00 Fine
Recommendation of Assistant City Attorney on behaif of ctient, Office
of License, Inspections and Environmental Protection:
$200.00 fine {first offense)
Attachments:
1. Proposed resolution
2. Letters of licensee agreeing not to contest the facts
3. Notice of Violation
4. License intormation
5. Compiiance Report
6. City Attorney License Adverse Action Summary
��
SUPERAMERICA �
To: Virginia D. Paimer
Assistanf Cify Attomey
Dafe: December 26, 1996
Sub: Cigarette Violation
December 7, 1996
Dear �rginia D. Pa(mer
Assistant City Atfomey
Civil Division
400 City Hall
13 West Keilagg Bivd.
Saint Paui, Minnesota 55102
q'� - ��`l
.... �.
JOHN KINZEL ��C�����.
Mea A�artager
1244 West 98TH St
Bloami�gton, MN. 55431 � 27 ���j
Telephone t612} 887-6�95 ���� a�('��3��"
Far (612)$87-6�94 Vl� �
KaYhy Schmidt manager af the SuperAmerica locafed at 2065 Rando3ph Avenus
ID No. : 17999 received the Nofice of VioJation Friday at#emoan �ecember 20,
1996. Realizing that the five day notice was weii past due t called and taiked
with Virginia Palmer. ! was told that wifh the holidays the fardiness of fhe notice
was understandable. Virginia instructed that if a letter was sent immediately
December 26,19� that wau{d be acceptable.
fn regard to the facts: On December 7, 1996 an emptoyee soid cfgarettes to
a minor under #he age of 18 years in the ticensed premises. This is an
offense under Minn. Stat. 6fl9.685 and Saint Paul Legsstetive Code 324.07_
Kathy Schmidt manager, ,lohn iCinzei area manager and SuperAmerica do not
dispute the stated facts.
Virginia Paimer, if possible couid your depa[tment copy myseif to the above
fetterhead. This would expedite responses and action that needs to be taken.
Sincerely,
John Kinzel
Area Manager
�i�l - 11�
/ �°'�\
�
�
SUPERAMERICA.
VIA FACS(MILE (612a 29&5619
City of Saint Paul
Office of the City Attorney
Civil Division
w"vv 4L'est i�eilayg E�vd.
Saini Paui, MN 55102
Attn: Virginia D. Paimer
Assistant City Attorney
Dear Ms. Palmer:
December 20, 1996
Vaterie J. Parks
Senior Legal Assistant
Phone: (606) 357-7862
Fax: (606)357-7868
����� r ��
D�C 3 0 ]996
���� ��������
Subject: Cigarette License Held by SuperAmerica Group, tnc.
d/bta SuperAmerica #4414
For The Premisas Located at
2065 Randolph Avenue in St. Pau!
License ID No.: 17999
As discussed, SuperAmerica does not dispute the charges described in the December i2,
1996 Notice of Violation regarding seiling cigarettes to a minor ai ihe referenced {ocation. We
do not desire to have ihe matter heard before an Administrative taw Judge.
We wouid like to have the opportunity to appear before the City Council to discuss this incident
and describe the programs we have impiemented to prevent our empioyees from making these
types of mistakes. Piease send any further information in this regard to my attention or contact
me at 1-800-443-3698.
Very truiy yours,
r ',�
�'��s' �,:1 . �- �?,`!�
Valerie J. Parks
Senior Legal Assistant
VJPlirs
122096p2
cc: Wiiliam E. Bahi
Timothy J. Berry
John Kinzel
Deb Johnson
5A #aai4
SuperAmerica Group • 101 Jerrico Drive, Lexington, Kentncky • dQ5�4
AN ASNLAN� 1NC. COMPANY
OFFICF '�' Tf� CITY ATTORN£y
r�� t .ars, Ciry Arrorney
- ��-�\�
CITY OF SAIN'T PAUL
Norm Co7eman, Mayn>
Civil Divrsion
400 Ciry Hat!
IS West Ke!loggBhd
Saint FauZ Mnnesom 55101
Telephnrce: 612 266-8770
Facsm�i7e: 6lI 798-5619
December 12, 1996
NOTICB OF VIOLATION
ownerJManager
SuperAmerica Group, Inc.
2065 Randolph Avenue
Saint Paul, Minnesota 55105
RE: Cigarette license held by
SuperAmerica #4414 for the
Avenue in St. Paul
License ID No.: 17999
SuperAmerica Group, Inc. d/bja
premises located at 2065 Randolph
Dear SirJMadam:
The Director of the Office of License, Inspections and
Environmental Protection will recommend that adverse action be
taken against your cigarette license held at the above-named
premises. This recommendation is based on the following:
On December 7, 1996, you or aaother employee sold
cigarettes to a miuor under the age of 18 yeara ia the
licenaed premises, This is an offense under Minn. Stat.
�609.685 and Saiat Paul Legislative Code §324.07.
If you do not dispute the above facts, and send me a letter to that
effect within 5 days, the case will be set before the City Council.
You will have a chance to appear and make a statement before the
Council as to the groper penalty, if any, to be imposed.
If you do dispute the above facts, a hearing will be set before an
Administrative Law Judge. At that hearing both you and the City
will be able to appear and present witnesses, evidence and cross-
examine the other's witnesses. The Council will ultimately decided
the case. If this is your choice, please advise my legal assistant,
Peter Pangborn, within 5 days, and we will take the necessary steps
to set up that ALJ hearing. Fe can be reached at 266-871D.
Page 1
a �1- ���
If you have any questions, you may contact me at 266-8710.
Sincerely,
�L�4} � ��
Virginia D. Palmer
Assistant City Attorney'
cc: SuperAmerica Group, Inc., P.O. Box 14008, Lexington, KY 40512
Robert Kessler, Director, LIEP
Christine Rozek, LIEP
Kathie Tarnowski, Community Organizer, Macalester-Groveland
Community Council, 320 S. Griggs St., St. Paul, MN 55105
Page 2
��- ��y
STATE OF MINNESOTA
1 ss_ AFFIDAVIT OF SERVICE BY MAIL
COUNTY OF RAMSEY 1
JOANNE G. CLEMENTS, being first duly sworn, deposes and says
that on December 13, 1996, she served the attached NOTICE OF
VIOLATION on the following named person by placing a true and
correct copy thereof in an envelope addressed as follows:
Owner/Manager
Superamerica Group, Inc.
2065 Randolph Avenue
St. Paul, MN. 55105
Superamerica Group, Inc.
PO Box 14008
Lexington, KY 40512
St. Paul, MN. 55119
(which is the last known addresses
the same, with postage prepaid, in
Paul, Minnesota.
Subscribed and sworn to before me
this 13th day of December, 1996.
�I, .�s �f I�� �s�
. .-
.
.
flrra ra. ec�� � =o
� NOTARY P�=:1G C :_ =�G7A
RANiScY ree.�iar� L �s , �o�
k1yC°m"'.6w� •
of said person) and depositing
the United States mails at St.
�`1-1�y
Lic ID ...................
STAT .....................
Business Name............
Address ..................
Zip ......................
Doing Business As........
License Name .............
Exp Date .................
Insurance Carrier........
Ins. Policy Number..._...
InsuranCe Effective Date.
Ins. Expiration Date_....
NOTE AREA ................
Tax Id ...................
Worker Comp Exp Date.....
Telephone ................
17999
AC
SUPSRAMERICA GROUP INC
2065 RANDOLPH AVE
55105
SUPERAMERICA #4414
RESTAURANT (C)-LIMITED
GROCERY (C)
CIGARE2'TE
03/31/97
INSP CHANGE FROM 02 TO O1 ON 4/09/92
4-10-92;NEW TAX ID #2669124
11/15/95 FER GARY PECHMANN, CHANGE RESTAI3RANT D
LICENSE TO RESTAL3RANT C.
2669124
12J01/93
887-61Q0
Press 'C' to continue, `P' to print, or `R' to redisplay...
Alt-Z FOR HELP° VT102 ° FDX ° 9600 E71 ° LOG CLOSED ° PRINT OFF °
�� - ��`�
CZI'Y OF SAII1'I' pAUL
II MEMORA?4DUM
DA?'E :
TO:
F2O24:
RL:
December 9, 1596
Robert Kessler
Rich �ents .
Cigerette Co^nliance Cnecks
On December 7, 1556 betweea �*e hc�rs oi 9:00 a.m. and 12:00 p.m., a 16
decoy) and I cond�cteK cigGZette ccmpliGnce criecks on the following businesses
with the following resc'_ts:
2.D.k
1?959
1E57D
89633
162ii
1597.8
1968fi
65734
8921'I
56225
22189
16242
97163
19254
69689
17209
h'FV:
SuperArer:ca
Snyder �r;:�
FiaaServ=
TiiL'a::y Lot^oe
Int'1 Y7ines & L�iauors
Goby's Gr`___ � p�;p
Plums
Highland 65
Walgreen's
Rite Liauor
Liquor villege
Haskell's
Lund's
Zina M_ini !!erket
Tobak � ?:e::s
Address Results
2065 Rnncio3Fh YeS (!�",�.
2083 Ford Parkway yes �,;,,-�r
2i11 sord Parkway No Szle
2051 Ford P�rkway No Sale
710 So, Cleveland ?7o Sale
472 So. Snelling No S&le
480 So. Snelling No Sale
b85 So. Snelling No Sale
522 So. Snelling No Sa1e
fi45 So. Snelling No Sale
2289 Ford Parkway No Sale
2221 Ford Parkway No Sale
2128 Ford Parkway No Sale
43 West 7th No Saie
2140 Ford Parkway No Sa1e
��������
uEC 1 � 1996
�. ..E �.- f = 4` E�S Pa �,,L t`�,/
_ i �_. � E * � � �
2 naid a total of $6.95 ��- ci5�:E=�es.
RJ/lb
cc: Gary Pechmann
Ginger Palmer
?eter Panqhor::
_ p �-�.y
TOSI�CO COMPIIANCE CHECK fOf�A �/? 9 9y
DATE: �� 7 7�TIME: TAXI. D. NIfMBEtt
NAMEdFCOM EChECKER NAMEOFOFFlGER �����d���
tdAAMEANDADDAESSCJFt1C@JSEDYENOOh U/J.a,/rtY�'��"r w
u :l �� �
WAS 7HE TOBP�('A — SEtf SERVE7 ASSISTEDI MACHBJE�
SAIE WAS hiApE: YES N0: Bft4ND: !�' / li( V j� �
NAMEOFCLERK: '(,Y SEX: M F:
DESCRIPTION: (r� � �r'•-vti^ I�: / — W LI � �s. /�iL�,r�✓C�
CHECKABORTEt7. YES
ADDRIONAL CAM,AENTS:
�fiS
:��:,-.� - .-�,�
_ _ - _ _ =>' i;: :,: _
- - - ' - - - •..�;.:';:::'u
- '= — - - � " _�-:.:•
- - _ �.c�i-'_ ` _ _ _ - -
_ _ .�" ' _ ' " _
"�;=' '
.r.%.:, - - -
..-t'^ �. : �,:> '
' ' ,,,-� . " _ ' ' '
S '
Y".�:
' . '.�4. .xi
�4a
- >`}'�'i±���� a��
_ `+"'r'.�_ _ w.�ei. !'�'"-:.:t;:s:�•::6.«[..+"l �
0 R I G� N A L Council File # ��� —{ ��
Green Sheet # ��- , O � � `�
RESOLUTION
Y OF �41N PAUL, MINNESOTA 1�/?
�f �
nresented By
Referred To
Committee: Date
RESOLVED, that the Licensee, SuperAmerica Group, Inc. dlb/a SuperAmerica #4414
(License ID No. 17999), located at 2065 Randolph Avenue in Saint Paul is hereby ordered to pay
a fine of $200.00 for the violafion of the sale of tobacco or tobacco products to a minor.
Said fine sha11 be paid to the Office of License, Inspections and Environmental Protection
within thirty (30) days of the adoption of this resolution by the Council and signature by the
Mayor.
This resolution and the action of the Council in this matter are based upon the facts
contained 'an the Notice of Violation letter to the licensee, the compliance report, and such
arguments as may haue been presented to the Council at the public hearing. The facts were not
contested by the licensee.
Requested by Department of:
Adoption Certified by Council Secretary
By: � d �- . � n� � .�_
Approved by Mayor: Date c'7 /'���i 7
By : �J ✓ �.-�
BY= l� N" /�+1J=�C
Form Approved by City Attorney
BY � `7�oi�✓,�, ./� V��t'�2('l
i
Approved by Mayor for Submission to Council
By:
Adopted by Council: Date �,Q�,a.(, F>�q�
��-«y
40�3�7
Office of LIEP
Clu'istine Rozek 266-9108
TOTAL # OF gIGNATURE PAGES
i-az-9� � GREEN SHEET
�NmwoA�e
� DEPARTMENT DIRECTOR � C1TY COUNCIL _
nssiox O CI7YATTORNEY � cm c�rm
�� � � Bl10GET DIREGTOR � FIN. 8 MCT. SERYICES OIR.
NOUTING
OPDEP O MAYOIi (QR ASSISTAkT) � . �
(CLIP ALL LOCATIONS FOR SIGNATUHE)
Concerning adverse acrion against licenses held by SuperAtnerica Group, Tnc., DBA SuperAmerica, located at 2Q65
Randolph Avenue. (Unco�ested)
OMMFNnATIffNS� Armrmxa (L1 m ho:un !Pl
_ PLANNING COMM�SSION _ qYiL SERVICE CAMMISSION
_ CIB CAMMITTEE _
_ STAFF � _
_DISTRICfCOURT _
SUPPORTS WF{ICH COUNCIL O&IECTIVEI
ISSUE, OPPORTUNI7Y
PEHSONAL SERVICE CONTHACTS MUST ANSWER THE FOLLOWING QUESTiONS:
1. Has this persOnttvm ever wurked under a conVac[ for this departme�t7
vES wo
2. Has ibi5 per5on/Firm ever been a ciry ampioyee?
YES NO
9. Dces this person7firm possess a skill not normally possessed by any curterrt ciry employeel
YES NO
Explafn a0 yes answera on sepnrate sheet anC ettach to green shest
c�.i.. � �s .�,w.,
ALAMOUNTOFTHANSACTION $
COSVREYENUE6UDGETEp(dRCLEONE)
YES NO
DIfBG SOURCE ACTIVITY NUMBER
ICIAL INfOflF5AT10N: (EXPLAIN)
OFFICE OF TF� CITY ATTORNEY
Trmothy E, Mar.x City Aaomey � �_���
l
CIT'Y OF SAINI' PAIIL Civil Divisron
Norm Co%man, Mayor 400 Ctty Hall Telephane: 611 2 66-8 71 0
IS West Kellogg Blvd Facsimile: 6l2 2985619
Saint Paut Mautesota 55702
' January 15, 1997
^31 �;�.�,���i: ��,-'.:'
NOTICE OF COL7NCIL FiEARING
Valerie J. Farks �� � ;Y
Senior Legal Assistant �^ `
SuperAmerica Group, Inc.
101 Jerrico Drive
Lexington, Kentucky 40509 �- - — ---
RE: Cigarette license held by SuperAmerica Group, Inc, d/b/a
SuperAmerica #4474 for the premises located at 2065
Randolph Avenue in St. Paul
License ID No. 17999
Our File Number: G96-0633
Dear Ms. Parks:
Please take notice that a hearing concerning the above-named
establishment has been scheduled for 4:30 p.m., Wednesday, February
5, 1997 in the City Council Chambers, Third Floor, Saint Paul City
Hall and Ramsey County Courthouse.
Enclosed are copies of the proposed resolution and other documents
which will be presented to the City Council for their
consideration. This is an uncontested hearing, in that the facts
contained in the report concerning the unlawful sale of cigarettes
have not been disputed. You will have an opportunity at the
Council hearing to present oral and/or written remarks as to the
penalty, if any, to be imposed. The recommendation of the license
office will be for a$200.00 fine.
If you have any questions, please call me at 266-8710.
Very truly yours,
`-�/ � !��
Virgini
Assistant City Attorney
cc: Jahn Kinzel, Area Manager, SuperAmerica, 1240 West 98th St.,
Bloomington, MN 55431 .
Kathy Schmidt, Manager, SuperAmerica, 2065 Randolph Ave., St.
Paul, MN 55105
Nancy Anderson, Assistant Council Secretary
Robert Ressler, Director, LSEP
Christine Rozek, LIEP
Kathie Tarnowski, Community Organizer, Macalester-Groveland
Community Council, 320 S. Griggs St., St. Paul, MN 55105
��1 -��`�
UNCONTESTED LICENSE HEARIIVG
Licensee Name: SuperAmerica Group, Inc, d/b/a SuperAmerica
#4414
Address: 2065 Randolph Avenue
Council Hearing Date: February 5, 1997
�olation: Sale of Cigarettes to a Minor
Minn. Stat. § 609.685
St. Paul Legislative Cade § 324.07
Date: December 7, 1996
Place: Licensed Premises
Presumptive Penaifiy; $2Q0.00 Fine
Recommendation of Assistant City Attorney on behaif of ctient, Office
of License, Inspections and Environmental Protection:
$200.00 fine {first offense)
Attachments:
1. Proposed resolution
2. Letters of licensee agreeing not to contest the facts
3. Notice of Violation
4. License intormation
5. Compiiance Report
6. City Attorney License Adverse Action Summary
��
SUPERAMERICA �
To: Virginia D. Paimer
Assistanf Cify Attomey
Dafe: December 26, 1996
Sub: Cigarette Violation
December 7, 1996
Dear �rginia D. Pa(mer
Assistant City Atfomey
Civil Division
400 City Hall
13 West Keilagg Bivd.
Saint Paui, Minnesota 55102
q'� - ��`l
.... �.
JOHN KINZEL ��C�����.
Mea A�artager
1244 West 98TH St
Bloami�gton, MN. 55431 � 27 ���j
Telephone t612} 887-6�95 ���� a�('��3��"
Far (612)$87-6�94 Vl� �
KaYhy Schmidt manager af the SuperAmerica locafed at 2065 Rando3ph Avenus
ID No. : 17999 received the Nofice of VioJation Friday at#emoan �ecember 20,
1996. Realizing that the five day notice was weii past due t called and taiked
with Virginia Palmer. ! was told that wifh the holidays the fardiness of fhe notice
was understandable. Virginia instructed that if a letter was sent immediately
December 26,19� that wau{d be acceptable.
fn regard to the facts: On December 7, 1996 an emptoyee soid cfgarettes to
a minor under #he age of 18 years in the ticensed premises. This is an
offense under Minn. Stat. 6fl9.685 and Saint Paul Legsstetive Code 324.07_
Kathy Schmidt manager, ,lohn iCinzei area manager and SuperAmerica do not
dispute the stated facts.
Virginia Paimer, if possible couid your depa[tment copy myseif to the above
fetterhead. This would expedite responses and action that needs to be taken.
Sincerely,
John Kinzel
Area Manager
�i�l - 11�
/ �°'�\
�
�
SUPERAMERICA.
VIA FACS(MILE (612a 29&5619
City of Saint Paul
Office of the City Attorney
Civil Division
w"vv 4L'est i�eilayg E�vd.
Saini Paui, MN 55102
Attn: Virginia D. Paimer
Assistant City Attorney
Dear Ms. Palmer:
December 20, 1996
Vaterie J. Parks
Senior Legal Assistant
Phone: (606) 357-7862
Fax: (606)357-7868
����� r ��
D�C 3 0 ]996
���� ��������
Subject: Cigarette License Held by SuperAmerica Group, tnc.
d/bta SuperAmerica #4414
For The Premisas Located at
2065 Randolph Avenue in St. Pau!
License ID No.: 17999
As discussed, SuperAmerica does not dispute the charges described in the December i2,
1996 Notice of Violation regarding seiling cigarettes to a minor ai ihe referenced {ocation. We
do not desire to have ihe matter heard before an Administrative taw Judge.
We wouid like to have the opportunity to appear before the City Council to discuss this incident
and describe the programs we have impiemented to prevent our empioyees from making these
types of mistakes. Piease send any further information in this regard to my attention or contact
me at 1-800-443-3698.
Very truiy yours,
r ',�
�'��s' �,:1 . �- �?,`!�
Valerie J. Parks
Senior Legal Assistant
VJPlirs
122096p2
cc: Wiiliam E. Bahi
Timothy J. Berry
John Kinzel
Deb Johnson
5A #aai4
SuperAmerica Group • 101 Jerrico Drive, Lexington, Kentncky • dQ5�4
AN ASNLAN� 1NC. COMPANY
OFFICF '�' Tf� CITY ATTORN£y
r�� t .ars, Ciry Arrorney
- ��-�\�
CITY OF SAIN'T PAUL
Norm Co7eman, Mayn>
Civil Divrsion
400 Ciry Hat!
IS West Ke!loggBhd
Saint FauZ Mnnesom 55101
Telephnrce: 612 266-8770
Facsm�i7e: 6lI 798-5619
December 12, 1996
NOTICB OF VIOLATION
ownerJManager
SuperAmerica Group, Inc.
2065 Randolph Avenue
Saint Paul, Minnesota 55105
RE: Cigarette license held by
SuperAmerica #4414 for the
Avenue in St. Paul
License ID No.: 17999
SuperAmerica Group, Inc. d/bja
premises located at 2065 Randolph
Dear SirJMadam:
The Director of the Office of License, Inspections and
Environmental Protection will recommend that adverse action be
taken against your cigarette license held at the above-named
premises. This recommendation is based on the following:
On December 7, 1996, you or aaother employee sold
cigarettes to a miuor under the age of 18 yeara ia the
licenaed premises, This is an offense under Minn. Stat.
�609.685 and Saiat Paul Legislative Code §324.07.
If you do not dispute the above facts, and send me a letter to that
effect within 5 days, the case will be set before the City Council.
You will have a chance to appear and make a statement before the
Council as to the groper penalty, if any, to be imposed.
If you do dispute the above facts, a hearing will be set before an
Administrative Law Judge. At that hearing both you and the City
will be able to appear and present witnesses, evidence and cross-
examine the other's witnesses. The Council will ultimately decided
the case. If this is your choice, please advise my legal assistant,
Peter Pangborn, within 5 days, and we will take the necessary steps
to set up that ALJ hearing. Fe can be reached at 266-871D.
Page 1
a �1- ���
If you have any questions, you may contact me at 266-8710.
Sincerely,
�L�4} � ��
Virginia D. Palmer
Assistant City Attorney'
cc: SuperAmerica Group, Inc., P.O. Box 14008, Lexington, KY 40512
Robert Kessler, Director, LIEP
Christine Rozek, LIEP
Kathie Tarnowski, Community Organizer, Macalester-Groveland
Community Council, 320 S. Griggs St., St. Paul, MN 55105
Page 2
��- ��y
STATE OF MINNESOTA
1 ss_ AFFIDAVIT OF SERVICE BY MAIL
COUNTY OF RAMSEY 1
JOANNE G. CLEMENTS, being first duly sworn, deposes and says
that on December 13, 1996, she served the attached NOTICE OF
VIOLATION on the following named person by placing a true and
correct copy thereof in an envelope addressed as follows:
Owner/Manager
Superamerica Group, Inc.
2065 Randolph Avenue
St. Paul, MN. 55105
Superamerica Group, Inc.
PO Box 14008
Lexington, KY 40512
St. Paul, MN. 55119
(which is the last known addresses
the same, with postage prepaid, in
Paul, Minnesota.
Subscribed and sworn to before me
this 13th day of December, 1996.
�I, .�s �f I�� �s�
. .-
.
.
flrra ra. ec�� � =o
� NOTARY P�=:1G C :_ =�G7A
RANiScY ree.�iar� L �s , �o�
k1yC°m"'.6w� •
of said person) and depositing
the United States mails at St.
�`1-1�y
Lic ID ...................
STAT .....................
Business Name............
Address ..................
Zip ......................
Doing Business As........
License Name .............
Exp Date .................
Insurance Carrier........
Ins. Policy Number..._...
InsuranCe Effective Date.
Ins. Expiration Date_....
NOTE AREA ................
Tax Id ...................
Worker Comp Exp Date.....
Telephone ................
17999
AC
SUPSRAMERICA GROUP INC
2065 RANDOLPH AVE
55105
SUPERAMERICA #4414
RESTAURANT (C)-LIMITED
GROCERY (C)
CIGARE2'TE
03/31/97
INSP CHANGE FROM 02 TO O1 ON 4/09/92
4-10-92;NEW TAX ID #2669124
11/15/95 FER GARY PECHMANN, CHANGE RESTAI3RANT D
LICENSE TO RESTAL3RANT C.
2669124
12J01/93
887-61Q0
Press 'C' to continue, `P' to print, or `R' to redisplay...
Alt-Z FOR HELP° VT102 ° FDX ° 9600 E71 ° LOG CLOSED ° PRINT OFF °
�� - ��`�
CZI'Y OF SAII1'I' pAUL
II MEMORA?4DUM
DA?'E :
TO:
F2O24:
RL:
December 9, 1596
Robert Kessler
Rich �ents .
Cigerette Co^nliance Cnecks
On December 7, 1556 betweea �*e hc�rs oi 9:00 a.m. and 12:00 p.m., a 16
decoy) and I cond�cteK cigGZette ccmpliGnce criecks on the following businesses
with the following resc'_ts:
2.D.k
1?959
1E57D
89633
162ii
1597.8
1968fi
65734
8921'I
56225
22189
16242
97163
19254
69689
17209
h'FV:
SuperArer:ca
Snyder �r;:�
FiaaServ=
TiiL'a::y Lot^oe
Int'1 Y7ines & L�iauors
Goby's Gr`___ � p�;p
Plums
Highland 65
Walgreen's
Rite Liauor
Liquor villege
Haskell's
Lund's
Zina M_ini !!erket
Tobak � ?:e::s
Address Results
2065 Rnncio3Fh YeS (!�",�.
2083 Ford Parkway yes �,;,,-�r
2i11 sord Parkway No Szle
2051 Ford P�rkway No Sale
710 So, Cleveland ?7o Sale
472 So. Snelling No S&le
480 So. Snelling No Sale
b85 So. Snelling No Sale
522 So. Snelling No Sa1e
fi45 So. Snelling No Sale
2289 Ford Parkway No Sale
2221 Ford Parkway No Sale
2128 Ford Parkway No Sale
43 West 7th No Saie
2140 Ford Parkway No Sa1e
��������
uEC 1 � 1996
�. ..E �.- f = 4` E�S Pa �,,L t`�,/
_ i �_. � E * � � �
2 naid a total of $6.95 ��- ci5�:E=�es.
RJ/lb
cc: Gary Pechmann
Ginger Palmer
?eter Panqhor::
_ p �-�.y
TOSI�CO COMPIIANCE CHECK fOf�A �/? 9 9y
DATE: �� 7 7�TIME: TAXI. D. NIfMBEtt
NAMEdFCOM EChECKER NAMEOFOFFlGER �����d���
tdAAMEANDADDAESSCJFt1C@JSEDYENOOh U/J.a,/rtY�'��"r w
u :l �� �
WAS 7HE TOBP�('A — SEtf SERVE7 ASSISTEDI MACHBJE�
SAIE WAS hiApE: YES N0: Bft4ND: !�' / li( V j� �
NAMEOFCLERK: '(,Y SEX: M F:
DESCRIPTION: (r� � �r'•-vti^ I�: / — W LI � �s. /�iL�,r�✓C�
CHECKABORTEt7. YES
ADDRIONAL CAM,AENTS:
�fiS
:��:,-.� - .-�,�
_ _ - _ _ =>' i;: :,: _
- - - ' - - - •..�;.:';:::'u
- '= — - - � " _�-:.:•
- - _ �.c�i-'_ ` _ _ _ - -
_ _ .�" ' _ ' " _
"�;=' '
.r.%.:, - - -
..-t'^ �. : �,:> '
' ' ,,,-� . " _ ' ' '
S '
Y".�:
' . '.�4. .xi
�4a
- >`}'�'i±���� a��
_ `+"'r'.�_ _ w.�ei. !'�'"-:.:t;:s:�•::6.«[..+"l �
0 R I G� N A L Council File # ��� —{ ��
Green Sheet # ��- , O � � `�
RESOLUTION
Y OF �41N PAUL, MINNESOTA 1�/?
�f �
nresented By
Referred To
Committee: Date
RESOLVED, that the Licensee, SuperAmerica Group, Inc. dlb/a SuperAmerica #4414
(License ID No. 17999), located at 2065 Randolph Avenue in Saint Paul is hereby ordered to pay
a fine of $200.00 for the violafion of the sale of tobacco or tobacco products to a minor.
Said fine sha11 be paid to the Office of License, Inspections and Environmental Protection
within thirty (30) days of the adoption of this resolution by the Council and signature by the
Mayor.
This resolution and the action of the Council in this matter are based upon the facts
contained 'an the Notice of Violation letter to the licensee, the compliance report, and such
arguments as may haue been presented to the Council at the public hearing. The facts were not
contested by the licensee.
Requested by Department of:
Adoption Certified by Council Secretary
By: � d �- . � n� � .�_
Approved by Mayor: Date c'7 /'���i 7
By : �J ✓ �.-�
BY= l� N" /�+1J=�C
Form Approved by City Attorney
BY � `7�oi�✓,�, ./� V��t'�2('l
i
Approved by Mayor for Submission to Council
By:
Adopted by Council: Date �,Q�,a.(, F>�q�
��-«y
40�3�7
Office of LIEP
Clu'istine Rozek 266-9108
TOTAL # OF gIGNATURE PAGES
i-az-9� � GREEN SHEET
�NmwoA�e
� DEPARTMENT DIRECTOR � C1TY COUNCIL _
nssiox O CI7YATTORNEY � cm c�rm
�� � � Bl10GET DIREGTOR � FIN. 8 MCT. SERYICES OIR.
NOUTING
OPDEP O MAYOIi (QR ASSISTAkT) � . �
(CLIP ALL LOCATIONS FOR SIGNATUHE)
Concerning adverse acrion against licenses held by SuperAtnerica Group, Tnc., DBA SuperAmerica, located at 2Q65
Randolph Avenue. (Unco�ested)
OMMFNnATIffNS� Armrmxa (L1 m ho:un !Pl
_ PLANNING COMM�SSION _ qYiL SERVICE CAMMISSION
_ CIB CAMMITTEE _
_ STAFF � _
_DISTRICfCOURT _
SUPPORTS WF{ICH COUNCIL O&IECTIVEI
ISSUE, OPPORTUNI7Y
PEHSONAL SERVICE CONTHACTS MUST ANSWER THE FOLLOWING QUESTiONS:
1. Has this persOnttvm ever wurked under a conVac[ for this departme�t7
vES wo
2. Has ibi5 per5on/Firm ever been a ciry ampioyee?
YES NO
9. Dces this person7firm possess a skill not normally possessed by any curterrt ciry employeel
YES NO
Explafn a0 yes answera on sepnrate sheet anC ettach to green shest
c�.i.. � �s .�,w.,
ALAMOUNTOFTHANSACTION $
COSVREYENUE6UDGETEp(dRCLEONE)
YES NO
DIfBG SOURCE ACTIVITY NUMBER
ICIAL INfOflF5AT10N: (EXPLAIN)
OFFICE OF TF� CITY ATTORNEY
Trmothy E, Mar.x City Aaomey � �_���
l
CIT'Y OF SAINI' PAIIL Civil Divisron
Norm Co%man, Mayor 400 Ctty Hall Telephane: 611 2 66-8 71 0
IS West Kellogg Blvd Facsimile: 6l2 2985619
Saint Paut Mautesota 55702
' January 15, 1997
^31 �;�.�,���i: ��,-'.:'
NOTICE OF COL7NCIL FiEARING
Valerie J. Farks �� � ;Y
Senior Legal Assistant �^ `
SuperAmerica Group, Inc.
101 Jerrico Drive
Lexington, Kentucky 40509 �- - — ---
RE: Cigarette license held by SuperAmerica Group, Inc, d/b/a
SuperAmerica #4474 for the premises located at 2065
Randolph Avenue in St. Paul
License ID No. 17999
Our File Number: G96-0633
Dear Ms. Parks:
Please take notice that a hearing concerning the above-named
establishment has been scheduled for 4:30 p.m., Wednesday, February
5, 1997 in the City Council Chambers, Third Floor, Saint Paul City
Hall and Ramsey County Courthouse.
Enclosed are copies of the proposed resolution and other documents
which will be presented to the City Council for their
consideration. This is an uncontested hearing, in that the facts
contained in the report concerning the unlawful sale of cigarettes
have not been disputed. You will have an opportunity at the
Council hearing to present oral and/or written remarks as to the
penalty, if any, to be imposed. The recommendation of the license
office will be for a$200.00 fine.
If you have any questions, please call me at 266-8710.
Very truly yours,
`-�/ � !��
Virgini
Assistant City Attorney
cc: Jahn Kinzel, Area Manager, SuperAmerica, 1240 West 98th St.,
Bloomington, MN 55431 .
Kathy Schmidt, Manager, SuperAmerica, 2065 Randolph Ave., St.
Paul, MN 55105
Nancy Anderson, Assistant Council Secretary
Robert Ressler, Director, LSEP
Christine Rozek, LIEP
Kathie Tarnowski, Community Organizer, Macalester-Groveland
Community Council, 320 S. Griggs St., St. Paul, MN 55105
��1 -��`�
UNCONTESTED LICENSE HEARIIVG
Licensee Name: SuperAmerica Group, Inc, d/b/a SuperAmerica
#4414
Address: 2065 Randolph Avenue
Council Hearing Date: February 5, 1997
�olation: Sale of Cigarettes to a Minor
Minn. Stat. § 609.685
St. Paul Legislative Cade § 324.07
Date: December 7, 1996
Place: Licensed Premises
Presumptive Penaifiy; $2Q0.00 Fine
Recommendation of Assistant City Attorney on behaif of ctient, Office
of License, Inspections and Environmental Protection:
$200.00 fine {first offense)
Attachments:
1. Proposed resolution
2. Letters of licensee agreeing not to contest the facts
3. Notice of Violation
4. License intormation
5. Compiiance Report
6. City Attorney License Adverse Action Summary
��
SUPERAMERICA �
To: Virginia D. Paimer
Assistanf Cify Attomey
Dafe: December 26, 1996
Sub: Cigarette Violation
December 7, 1996
Dear �rginia D. Pa(mer
Assistant City Atfomey
Civil Division
400 City Hall
13 West Keilagg Bivd.
Saint Paui, Minnesota 55102
q'� - ��`l
.... �.
JOHN KINZEL ��C�����.
Mea A�artager
1244 West 98TH St
Bloami�gton, MN. 55431 � 27 ���j
Telephone t612} 887-6�95 ���� a�('��3��"
Far (612)$87-6�94 Vl� �
KaYhy Schmidt manager af the SuperAmerica locafed at 2065 Rando3ph Avenus
ID No. : 17999 received the Nofice of VioJation Friday at#emoan �ecember 20,
1996. Realizing that the five day notice was weii past due t called and taiked
with Virginia Palmer. ! was told that wifh the holidays the fardiness of fhe notice
was understandable. Virginia instructed that if a letter was sent immediately
December 26,19� that wau{d be acceptable.
fn regard to the facts: On December 7, 1996 an emptoyee soid cfgarettes to
a minor under #he age of 18 years in the ticensed premises. This is an
offense under Minn. Stat. 6fl9.685 and Saint Paul Legsstetive Code 324.07_
Kathy Schmidt manager, ,lohn iCinzei area manager and SuperAmerica do not
dispute the stated facts.
Virginia Paimer, if possible couid your depa[tment copy myseif to the above
fetterhead. This would expedite responses and action that needs to be taken.
Sincerely,
John Kinzel
Area Manager
�i�l - 11�
/ �°'�\
�
�
SUPERAMERICA.
VIA FACS(MILE (612a 29&5619
City of Saint Paul
Office of the City Attorney
Civil Division
w"vv 4L'est i�eilayg E�vd.
Saini Paui, MN 55102
Attn: Virginia D. Paimer
Assistant City Attorney
Dear Ms. Palmer:
December 20, 1996
Vaterie J. Parks
Senior Legal Assistant
Phone: (606) 357-7862
Fax: (606)357-7868
����� r ��
D�C 3 0 ]996
���� ��������
Subject: Cigarette License Held by SuperAmerica Group, tnc.
d/bta SuperAmerica #4414
For The Premisas Located at
2065 Randolph Avenue in St. Pau!
License ID No.: 17999
As discussed, SuperAmerica does not dispute the charges described in the December i2,
1996 Notice of Violation regarding seiling cigarettes to a minor ai ihe referenced {ocation. We
do not desire to have ihe matter heard before an Administrative taw Judge.
We wouid like to have the opportunity to appear before the City Council to discuss this incident
and describe the programs we have impiemented to prevent our empioyees from making these
types of mistakes. Piease send any further information in this regard to my attention or contact
me at 1-800-443-3698.
Very truiy yours,
r ',�
�'��s' �,:1 . �- �?,`!�
Valerie J. Parks
Senior Legal Assistant
VJPlirs
122096p2
cc: Wiiliam E. Bahi
Timothy J. Berry
John Kinzel
Deb Johnson
5A #aai4
SuperAmerica Group • 101 Jerrico Drive, Lexington, Kentncky • dQ5�4
AN ASNLAN� 1NC. COMPANY
OFFICF '�' Tf� CITY ATTORN£y
r�� t .ars, Ciry Arrorney
- ��-�\�
CITY OF SAIN'T PAUL
Norm Co7eman, Mayn>
Civil Divrsion
400 Ciry Hat!
IS West Ke!loggBhd
Saint FauZ Mnnesom 55101
Telephnrce: 612 266-8770
Facsm�i7e: 6lI 798-5619
December 12, 1996
NOTICB OF VIOLATION
ownerJManager
SuperAmerica Group, Inc.
2065 Randolph Avenue
Saint Paul, Minnesota 55105
RE: Cigarette license held by
SuperAmerica #4414 for the
Avenue in St. Paul
License ID No.: 17999
SuperAmerica Group, Inc. d/bja
premises located at 2065 Randolph
Dear SirJMadam:
The Director of the Office of License, Inspections and
Environmental Protection will recommend that adverse action be
taken against your cigarette license held at the above-named
premises. This recommendation is based on the following:
On December 7, 1996, you or aaother employee sold
cigarettes to a miuor under the age of 18 yeara ia the
licenaed premises, This is an offense under Minn. Stat.
�609.685 and Saiat Paul Legislative Code §324.07.
If you do not dispute the above facts, and send me a letter to that
effect within 5 days, the case will be set before the City Council.
You will have a chance to appear and make a statement before the
Council as to the groper penalty, if any, to be imposed.
If you do dispute the above facts, a hearing will be set before an
Administrative Law Judge. At that hearing both you and the City
will be able to appear and present witnesses, evidence and cross-
examine the other's witnesses. The Council will ultimately decided
the case. If this is your choice, please advise my legal assistant,
Peter Pangborn, within 5 days, and we will take the necessary steps
to set up that ALJ hearing. Fe can be reached at 266-871D.
Page 1
a �1- ���
If you have any questions, you may contact me at 266-8710.
Sincerely,
�L�4} � ��
Virginia D. Palmer
Assistant City Attorney'
cc: SuperAmerica Group, Inc., P.O. Box 14008, Lexington, KY 40512
Robert Kessler, Director, LIEP
Christine Rozek, LIEP
Kathie Tarnowski, Community Organizer, Macalester-Groveland
Community Council, 320 S. Griggs St., St. Paul, MN 55105
Page 2
��- ��y
STATE OF MINNESOTA
1 ss_ AFFIDAVIT OF SERVICE BY MAIL
COUNTY OF RAMSEY 1
JOANNE G. CLEMENTS, being first duly sworn, deposes and says
that on December 13, 1996, she served the attached NOTICE OF
VIOLATION on the following named person by placing a true and
correct copy thereof in an envelope addressed as follows:
Owner/Manager
Superamerica Group, Inc.
2065 Randolph Avenue
St. Paul, MN. 55105
Superamerica Group, Inc.
PO Box 14008
Lexington, KY 40512
St. Paul, MN. 55119
(which is the last known addresses
the same, with postage prepaid, in
Paul, Minnesota.
Subscribed and sworn to before me
this 13th day of December, 1996.
�I, .�s �f I�� �s�
. .-
.
.
flrra ra. ec�� � =o
� NOTARY P�=:1G C :_ =�G7A
RANiScY ree.�iar� L �s , �o�
k1yC°m"'.6w� •
of said person) and depositing
the United States mails at St.
�`1-1�y
Lic ID ...................
STAT .....................
Business Name............
Address ..................
Zip ......................
Doing Business As........
License Name .............
Exp Date .................
Insurance Carrier........
Ins. Policy Number..._...
InsuranCe Effective Date.
Ins. Expiration Date_....
NOTE AREA ................
Tax Id ...................
Worker Comp Exp Date.....
Telephone ................
17999
AC
SUPSRAMERICA GROUP INC
2065 RANDOLPH AVE
55105
SUPERAMERICA #4414
RESTAURANT (C)-LIMITED
GROCERY (C)
CIGARE2'TE
03/31/97
INSP CHANGE FROM 02 TO O1 ON 4/09/92
4-10-92;NEW TAX ID #2669124
11/15/95 FER GARY PECHMANN, CHANGE RESTAI3RANT D
LICENSE TO RESTAL3RANT C.
2669124
12J01/93
887-61Q0
Press 'C' to continue, `P' to print, or `R' to redisplay...
Alt-Z FOR HELP° VT102 ° FDX ° 9600 E71 ° LOG CLOSED ° PRINT OFF °
�� - ��`�
CZI'Y OF SAII1'I' pAUL
II MEMORA?4DUM
DA?'E :
TO:
F2O24:
RL:
December 9, 1596
Robert Kessler
Rich �ents .
Cigerette Co^nliance Cnecks
On December 7, 1556 betweea �*e hc�rs oi 9:00 a.m. and 12:00 p.m., a 16
decoy) and I cond�cteK cigGZette ccmpliGnce criecks on the following businesses
with the following resc'_ts:
2.D.k
1?959
1E57D
89633
162ii
1597.8
1968fi
65734
8921'I
56225
22189
16242
97163
19254
69689
17209
h'FV:
SuperArer:ca
Snyder �r;:�
FiaaServ=
TiiL'a::y Lot^oe
Int'1 Y7ines & L�iauors
Goby's Gr`___ � p�;p
Plums
Highland 65
Walgreen's
Rite Liauor
Liquor villege
Haskell's
Lund's
Zina M_ini !!erket
Tobak � ?:e::s
Address Results
2065 Rnncio3Fh YeS (!�",�.
2083 Ford Parkway yes �,;,,-�r
2i11 sord Parkway No Szle
2051 Ford P�rkway No Sale
710 So, Cleveland ?7o Sale
472 So. Snelling No S&le
480 So. Snelling No Sale
b85 So. Snelling No Sale
522 So. Snelling No Sa1e
fi45 So. Snelling No Sale
2289 Ford Parkway No Sale
2221 Ford Parkway No Sale
2128 Ford Parkway No Sale
43 West 7th No Saie
2140 Ford Parkway No Sa1e
��������
uEC 1 � 1996
�. ..E �.- f = 4` E�S Pa �,,L t`�,/
_ i �_. � E * � � �
2 naid a total of $6.95 ��- ci5�:E=�es.
RJ/lb
cc: Gary Pechmann
Ginger Palmer
?eter Panqhor::
_ p �-�.y
TOSI�CO COMPIIANCE CHECK fOf�A �/? 9 9y
DATE: �� 7 7�TIME: TAXI. D. NIfMBEtt
NAMEdFCOM EChECKER NAMEOFOFFlGER �����d���
tdAAMEANDADDAESSCJFt1C@JSEDYENOOh U/J.a,/rtY�'��"r w
u :l �� �
WAS 7HE TOBP�('A — SEtf SERVE7 ASSISTEDI MACHBJE�
SAIE WAS hiApE: YES N0: Bft4ND: !�' / li( V j� �
NAMEOFCLERK: '(,Y SEX: M F:
DESCRIPTION: (r� � �r'•-vti^ I�: / — W LI � �s. /�iL�,r�✓C�
CHECKABORTEt7. YES
ADDRIONAL CAM,AENTS:
�fiS
:��:,-.� - .-�,�
_ _ - _ _ =>' i;: :,: _
- - - ' - - - •..�;.:';:::'u
- '= — - - � " _�-:.:•
- - _ �.c�i-'_ ` _ _ _ - -
_ _ .�" ' _ ' " _
"�;=' '
.r.%.:, - - -
..-t'^ �. : �,:> '
' ' ,,,-� . " _ ' ' '
S '
Y".�:
' . '.�4. .xi
�4a
- >`}'�'i±���� a��
_ `+"'r'.�_ _ w.�ei. !'�'"-:.:t;:s:�•::6.«[..+"l �