97-149Council File # `� " ` i 1
-.� r, p
, �\i
� ; � __
Ordinance #
Green Sheet # 35444
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Presented By
Referred To
Committee: Date
�!
RESOLVED: That application, ID #A-04568, for a State Claea A Gambling Premise Permit
by St. Paul Midway I,ions Club Foundation at W. 7th 5treet Bingo Hall, 1026
W. 7th Street (previously known at Midway Lions Club), be and the same is
hereby approved.
Requested by Department of:
Adoption Certi£ied by Council Secretary
MINNESOTA
• - -�,- �:._ .�= _�.
� .:��-� - •�
g �? �/. �
Form Approved by City Attorney
BY% � r `� �� r
\ gp; -�/ / vULC'�
Approved by Mayo : Date Z�, E
� Approved by Mayor for Submission to
BY. Council
By:
Adopted by Council: Date ��. �a \99�
` � r l —1`�`l
o��,.,�ro������ DAfE1NffIAT£D GREEN SHEE N° _35444
CONTACTPEFiSON&PHONE INRIAWATE � INRNUUA7E
� DEPAqTMQJT �IFECTOR � CT' COUNdL
. . ASSIGN OCRYATTOFNEY �CffYCLEAK
NUYBER FOR
MUST BE ON COUNCILAGENOA BY <QATE) pp�NG O BUM'iET DIfiECTOR O FM.6 MGT. SERVICES Olfi.
Hearin : a. � 9 ORDEfl Q Mqypq (OR ASSISTANT) ❑
TOTAL # OF SIG TURE PAGES (CLIP ALL LOCATONS FOR SIGNATUflE)
ACf70N REQUE5TED:
Sames Bellomo on behalf of St. Paul Midway Lions Club Foundation requests
Council approval of their application for a State C1ass A Gambling Premise Permit at
W. 7th Street Bingo FIall, 1026 W. 7th Street. (ID 4/A-04568) (previously Midway I,ions Club)
RECAMMENDAiIONS:App�rne(A)orReiea(R) pERSONALSEFiVICECONTRACTSMUSTANSWERTHEFOLLOWIN(i�UESTIONS:
_ PLANNING COMMISSION _ CIViL SEXVICE CAMM7SSION �• H3s tfus perSaNfirm ever worked undet a coMtact for this tlepartmeM? -
_ CIB COMMITfEE _ YES NO
_ SiAFF 2. Has Mis person/firm ever been a city empioyee?
— YES NO
_ DIS7qIC7 COURT _ 3. DOes ihis personHirm possess a skill not normall ossessed
y p by any current city employee?
SUPPOflTSMIHICMCOUNqLOeJECiIVE4 YES NO
Explain all yes anawen on separate aheet and attach to green sheet
INITIATING PROBLEM, ISSUE, OPPEIRTUNITY (Who, Whaq When, Where, Why): '� "– ;•
r �„
��.�� �� ����
,�,� ��
� � ,� y 's,�,�, :3 :. cv
:�
ADVANTAGES IFAPPROVEO: -
DISADVANTAGES IFAPPROVED:
B3VY�.�e� ��'.:�'ia�.��+�+iC Yt4i3�iL�'.�+7
�}�3V � +� f.7J�
_ ". . �..s_.-,/
DISAOVANTAGES IF NOT pPPROVEO: �
TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNpING SOURCE ACT{VI7Y NUMBER
FINANpAL INFORMATION: (EXPLAIN) �
35444 L.I.E.P. REVIEW CHECKLIST �ate: /�� — � y �
Greensheet # �P � �� � p,pp•� processed
In Tracker?�/3o
License ID # A-04568 (State) License 7ype: State Class A �ambling Premise Permit
Company Name: St Pau1 Midway Lions C1ub Foundatio DBA: St Paul Midway Lions Club Foundat
Business Addresss: 1026 W. 7th St. 55102 Business Phone: 454-7674
Contact Name/Addfess: 3ames Bellomo Home Phone: 454-7674
1857 Ea le Ridge Dr. Mendota Heights 55118
Date to Council Research: /T 3d�9� /
Public Hearing Date: ���' 12 � � y � 7 Labels Ordered: /f/ �
Notice Sent to Applicant: District Council #: 09
Notice Sent to Pubfic: Ward #: � —
DepartmeM/ Date Inspections Comments
City Attorney � �� �� � ' �
Environmental
Health
N / r/
E
Fire
n�� A
s�ta a�a� a��»��aa:_
License �ase aecerved:
/�' / I /
�
�" _ _� �, o�' ��anrza�� am�e y
Police f
�/ �
�
Zoning
���
6
a� - �yc
FOR BOAFD USE ONLY
BASE �
PP 3
FEE
Minnesota LawfuI GambIing CHECK
Premises Permit Appiication - Part 1 of 2 �NITlALS
OATE
<..::::: �->-,.-,,..::N<,.....«„�:.:H....,,�..�,.:w_.;,..�._,:�<.,:--,���-�:�:,>�...:�,;..>....:.:.,.�„....:w,;>
, ,�w ^ � "--� -r ,��. �,�,
�Pe a.f AFPlicafzorc, % '� .� ;r r ^3 a a s R
. s..
.. . . , , . .. . . H „fw�. , .. . . ». , ._....,� ._.
� Class ot premises permit
Renewai (cheek one)
Orsanization base ficense number � A(54Wj Puli-tabs, tipboards, �.ddlewheels, rf°xs, bingo
LG214
o7.2LS'.1
� New
Prenises permit number
�I B(5250) Pu0-Eabs, �pbcards, pad�+ewhee!s, a`�es
� C (5200) 61ngo only
❑ D �5150) liar7)es ony
tiar..e ot Organ¢a5on
ST Av� M�ow+�4 L.,onS �iVB �o nnanon
cu:ir.ess Address of Organiza6on - Steet or P. O Sox (Do not use the a�ress ot your ganbiirg manager)
SOO W. Co��nr�l (Zo �i 5u.re 33�
,ev i ux.
o( chief exxutive o�cer
mc� � EuAmo
mn SJtI� T5�
yo�r gambLng manac,er) ! �Title
1'RES � YJ tYIT
e ;.na�e nun5er
y 59=1 b7 4�
e ;hor.e n�^�ber
tt�iv Ss4-�r�?�}
of Iegal owner
s S i 02-.
Yow erganization own the buldry where the gambfin9 vr01 be mnducted? p YES � NO
If ra, attach the toAowinp:
' a copy ol the {¢ase (tam 1G202} witfi ferms Snr at teast o�e year.
• a mq of a sketeh of the floor pian with dmensions, sMwing what por6on is being Ieased
A lease and sketch are not reGu'ved (ot Ciass D appfieatons.
L` �pp2yzng for a class A or C permit, fill in days znd beg inni � 8 ending houxs of b:ngo occasiors:
\o more than seven bingo occasfons may be cbnducted by your orFanization per week
Day Beg+r.nSng/Ending Hours Day Bc�nntngJEnding Hours Day Beg(xuiing /Endir.g Y.ow-s
�- 5�,�ez^P.e-t�e� Sxtt� ss E. — Qesr�ri nvSee� �e� ��-
to [o to
to If bingo m�l not be conduefed, eheek here O
P.adress City Sute Z�p code
to2lo w sT SrPcw� m•-� SS�pZ
s
Is Lhe premises Iocated within dry Gmits? .�Yes O No If no, is township � organized 0 unuganized p uni�prporated
Ci.y and Cpuniy where gambfing premises is located OR Township and County where gambLng premises is �ocaled if outside ot ciiy fimits
]Sfirtnesota LaiU.fut Gambiinq
Premise Fernut Application - Part 2 of 2
�
Nd;�e
O�-tq I
Nunber
l� '1 i 1
17(o SnEwn� �� Sr(�a�u� mn �Slb�
� F�o mas �r.,ea.ct l lll t�wav ST -#�403 SrPav�mnSSi(� CDFbngUn6 YVl �✓��"2
� Sc+fus I b31 Jamrs �.4� Sr�� mn 5S 11f3 vY1 Fm6t"�
J�m�;s �it 185' En�� R�cr�e Drz M�,� Hzs mn SS l 1 A �2rSDt-]"�t"
.)�cm.� 1 rn,��n„ro�, 45c1t„ Art�nw Sz �r�a,�, mr,5S113 ��uor'eU�Y.�Z
1 hereby cnnsent that bc�J law enfiorcement offcars, the
board or a;ents of the board, or the commissioner of
ravenua or publ'�c safey, or agents oi the commissionars,
�'2y er<ter ;he pramises to enforca the law.
Ba-nk Records Information
The xard is a�lhorized to insped the bark rec�rds of tbe
Sam6ling z�unt wheaever r,ecesa,y to tuKill
r=quirenants oi current gzr„bling rules and law.
Oath
t c`edarethffi:
•i have rsad Ihis applicafan and alI iriorma�wn submiited
tc the bcard is true, a�urate and rampiete-
•=ft c;har required info has been fully dsclosed;
S+_naiure of chiei ezec",'Ne oHicer
�. The c^y'must sign this appl'rcation if the gambling prem-
ises is tocaed within city limiis.
2- The c�unty "AND township`• must sig� this applicaticn if
tFe gambling premises is bca;ed within a township.
3 � The bcal unit government (c'ry or county} must pass a
resolution speciticaliy approving or denying this appl'rcation.
C'b or Counry Name
Title ' " 1 Data Rea
l�r�--`7t,�•, �n4rt'cG*wo�.C � 1 1 b
Reier ta �{nsWdions for required attachments.
t " t �� Ta= Gnmbiinp ConVOI Smrd
flosewood PSan South.3rd Fbor
1771 W, Counfy Road 6
Rmevitle, AtN SS1S3
•1 am ihe chief exscutive o�cer of tha organ¢ation;
•I assume fuil resp�nsb7ty for the fzir and lavful opera-
tion of all ac;'rvlies to be c�nduded;
•I will famifiarize myself with the Izws ot Minnesota
governing lavful gambling and rules of the board and
agree, it licens�d, io a6ide by thcsa laus ard ru(es,
including arnendnsnts to them;
•sny changes in applicaticn intorna:icn will be suGn�:� _d
to the �ard and bcal uni[ of gcverr,rent wilfiin } 0 dzys
ci ;he chzn5e; znd
d unders.and thzt failure to provide reGuired intormaCqn
or providing fasa or misleading iniomaion m=y result in
the dznial or revocation of the licer,sa. .
D2te
4. A coov of the bcal unR of QovernmenYS resolution zo-
psovina this 2oo6cztion must be ariached to this aoplication
5. ti this appi'�cation is denied by the bcai unit ot government,
it shouid not be submitted to the Gambiing Contro� Board.
Township: By signature below, ihe township acknowiedges
that the organization is applying for a premises permit within
township limits.
Township Narne
Signature o( person receiving application
7de
� Date Recei�ed
LG2t<(Part 2)
�F..��sv��
Council File # `� " ` i 1
-.� r, p
, �\i
� ; � __
Ordinance #
Green Sheet # 35444
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Presented By
Referred To
Committee: Date
�!
RESOLVED: That application, ID #A-04568, for a State Claea A Gambling Premise Permit
by St. Paul Midway I,ions Club Foundation at W. 7th 5treet Bingo Hall, 1026
W. 7th Street (previously known at Midway Lions Club), be and the same is
hereby approved.
Requested by Department of:
Adoption Certi£ied by Council Secretary
MINNESOTA
• - -�,- �:._ .�= _�.
� .:��-� - •�
g �? �/. �
Form Approved by City Attorney
BY% � r `� �� r
\ gp; -�/ / vULC'�
Approved by Mayo : Date Z�, E
� Approved by Mayor for Submission to
BY. Council
By:
Adopted by Council: Date ��. �a \99�
` � r l —1`�`l
o��,.,�ro������ DAfE1NffIAT£D GREEN SHEE N° _35444
CONTACTPEFiSON&PHONE INRIAWATE � INRNUUA7E
� DEPAqTMQJT �IFECTOR � CT' COUNdL
. . ASSIGN OCRYATTOFNEY �CffYCLEAK
NUYBER FOR
MUST BE ON COUNCILAGENOA BY <QATE) pp�NG O BUM'iET DIfiECTOR O FM.6 MGT. SERVICES Olfi.
Hearin : a. � 9 ORDEfl Q Mqypq (OR ASSISTANT) ❑
TOTAL # OF SIG TURE PAGES (CLIP ALL LOCATONS FOR SIGNATUflE)
ACf70N REQUE5TED:
Sames Bellomo on behalf of St. Paul Midway Lions Club Foundation requests
Council approval of their application for a State C1ass A Gambling Premise Permit at
W. 7th Street Bingo FIall, 1026 W. 7th Street. (ID 4/A-04568) (previously Midway I,ions Club)
RECAMMENDAiIONS:App�rne(A)orReiea(R) pERSONALSEFiVICECONTRACTSMUSTANSWERTHEFOLLOWIN(i�UESTIONS:
_ PLANNING COMMISSION _ CIViL SEXVICE CAMM7SSION �• H3s tfus perSaNfirm ever worked undet a coMtact for this tlepartmeM? -
_ CIB COMMITfEE _ YES NO
_ SiAFF 2. Has Mis person/firm ever been a city empioyee?
— YES NO
_ DIS7qIC7 COURT _ 3. DOes ihis personHirm possess a skill not normall ossessed
y p by any current city employee?
SUPPOflTSMIHICMCOUNqLOeJECiIVE4 YES NO
Explain all yes anawen on separate aheet and attach to green sheet
INITIATING PROBLEM, ISSUE, OPPEIRTUNITY (Who, Whaq When, Where, Why): '� "– ;•
r �„
��.�� �� ����
,�,� ��
� � ,� y 's,�,�, :3 :. cv
:�
ADVANTAGES IFAPPROVEO: -
DISADVANTAGES IFAPPROVED:
B3VY�.�e� ��'.:�'ia�.��+�+iC Yt4i3�iL�'.�+7
�}�3V � +� f.7J�
_ ". . �..s_.-,/
DISAOVANTAGES IF NOT pPPROVEO: �
TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNpING SOURCE ACT{VI7Y NUMBER
FINANpAL INFORMATION: (EXPLAIN) �
35444 L.I.E.P. REVIEW CHECKLIST �ate: /�� — � y �
Greensheet # �P � �� � p,pp•� processed
In Tracker?�/3o
License ID # A-04568 (State) License 7ype: State Class A �ambling Premise Permit
Company Name: St Pau1 Midway Lions C1ub Foundatio DBA: St Paul Midway Lions Club Foundat
Business Addresss: 1026 W. 7th St. 55102 Business Phone: 454-7674
Contact Name/Addfess: 3ames Bellomo Home Phone: 454-7674
1857 Ea le Ridge Dr. Mendota Heights 55118
Date to Council Research: /T 3d�9� /
Public Hearing Date: ���' 12 � � y � 7 Labels Ordered: /f/ �
Notice Sent to Applicant: District Council #: 09
Notice Sent to Pubfic: Ward #: � —
DepartmeM/ Date Inspections Comments
City Attorney � �� �� � ' �
Environmental
Health
N / r/
E
Fire
n�� A
s�ta a�a� a��»��aa:_
License �ase aecerved:
/�' / I /
�
�" _ _� �, o�' ��anrza�� am�e y
Police f
�/ �
�
Zoning
���
6
a� - �yc
FOR BOAFD USE ONLY
BASE �
PP 3
FEE
Minnesota LawfuI GambIing CHECK
Premises Permit Appiication - Part 1 of 2 �NITlALS
OATE
<..::::: �->-,.-,,..::N<,.....«„�:.:H....,,�..�,.:w_.;,..�._,:�<.,:--,���-�:�:,>�...:�,;..>....:.:.,.�„....:w,;>
, ,�w ^ � "--� -r ,��. �,�,
�Pe a.f AFPlicafzorc, % '� .� ;r r ^3 a a s R
. s..
.. . . , , . .. . . H „fw�. , .. . . ». , ._....,� ._.
� Class ot premises permit
Renewai (cheek one)
Orsanization base ficense number � A(54Wj Puli-tabs, tipboards, �.ddlewheels, rf°xs, bingo
LG214
o7.2LS'.1
� New
Prenises permit number
�I B(5250) Pu0-Eabs, �pbcards, pad�+ewhee!s, a`�es
� C (5200) 61ngo only
❑ D �5150) liar7)es ony
tiar..e ot Organ¢a5on
ST Av� M�ow+�4 L.,onS �iVB �o nnanon
cu:ir.ess Address of Organiza6on - Steet or P. O Sox (Do not use the a�ress ot your ganbiirg manager)
SOO W. Co��nr�l (Zo �i 5u.re 33�
,ev i ux.
o( chief exxutive o�cer
mc� � EuAmo
mn SJtI� T5�
yo�r gambLng manac,er) ! �Title
1'RES � YJ tYIT
e ;.na�e nun5er
y 59=1 b7 4�
e ;hor.e n�^�ber
tt�iv Ss4-�r�?�}
of Iegal owner
s S i 02-.
Yow erganization own the buldry where the gambfin9 vr01 be mnducted? p YES � NO
If ra, attach the toAowinp:
' a copy ol the {¢ase (tam 1G202} witfi ferms Snr at teast o�e year.
• a mq of a sketeh of the floor pian with dmensions, sMwing what por6on is being Ieased
A lease and sketch are not reGu'ved (ot Ciass D appfieatons.
L` �pp2yzng for a class A or C permit, fill in days znd beg inni � 8 ending houxs of b:ngo occasiors:
\o more than seven bingo occasfons may be cbnducted by your orFanization per week
Day Beg+r.nSng/Ending Hours Day Bc�nntngJEnding Hours Day Beg(xuiing /Endir.g Y.ow-s
�- 5�,�ez^P.e-t�e� Sxtt� ss E. — Qesr�ri nvSee� �e� ��-
to [o to
to If bingo m�l not be conduefed, eheek here O
P.adress City Sute Z�p code
to2lo w sT SrPcw� m•-� SS�pZ
s
Is Lhe premises Iocated within dry Gmits? .�Yes O No If no, is township � organized 0 unuganized p uni�prporated
Ci.y and Cpuniy where gambfing premises is located OR Township and County where gambLng premises is �ocaled if outside ot ciiy fimits
]Sfirtnesota LaiU.fut Gambiinq
Premise Fernut Application - Part 2 of 2
�
Nd;�e
O�-tq I
Nunber
l� '1 i 1
17(o SnEwn� �� Sr(�a�u� mn �Slb�
� F�o mas �r.,ea.ct l lll t�wav ST -#�403 SrPav�mnSSi(� CDFbngUn6 YVl �✓��"2
� Sc+fus I b31 Jamrs �.4� Sr�� mn 5S 11f3 vY1 Fm6t"�
J�m�;s �it 185' En�� R�cr�e Drz M�,� Hzs mn SS l 1 A �2rSDt-]"�t"
.)�cm.� 1 rn,��n„ro�, 45c1t„ Art�nw Sz �r�a,�, mr,5S113 ��uor'eU�Y.�Z
1 hereby cnnsent that bc�J law enfiorcement offcars, the
board or a;ents of the board, or the commissioner of
ravenua or publ'�c safey, or agents oi the commissionars,
�'2y er<ter ;he pramises to enforca the law.
Ba-nk Records Information
The xard is a�lhorized to insped the bark rec�rds of tbe
Sam6ling z�unt wheaever r,ecesa,y to tuKill
r=quirenants oi current gzr„bling rules and law.
Oath
t c`edarethffi:
•i have rsad Ihis applicafan and alI iriorma�wn submiited
tc the bcard is true, a�urate and rampiete-
•=ft c;har required info has been fully dsclosed;
S+_naiure of chiei ezec",'Ne oHicer
�. The c^y'must sign this appl'rcation if the gambling prem-
ises is tocaed within city limiis.
2- The c�unty "AND township`• must sig� this applicaticn if
tFe gambling premises is bca;ed within a township.
3 � The bcal unit government (c'ry or county} must pass a
resolution speciticaliy approving or denying this appl'rcation.
C'b or Counry Name
Title ' " 1 Data Rea
l�r�--`7t,�•, �n4rt'cG*wo�.C � 1 1 b
Reier ta �{nsWdions for required attachments.
t " t �� Ta= Gnmbiinp ConVOI Smrd
flosewood PSan South.3rd Fbor
1771 W, Counfy Road 6
Rmevitle, AtN SS1S3
•1 am ihe chief exscutive o�cer of tha organ¢ation;
•I assume fuil resp�nsb7ty for the fzir and lavful opera-
tion of all ac;'rvlies to be c�nduded;
•I will famifiarize myself with the Izws ot Minnesota
governing lavful gambling and rules of the board and
agree, it licens�d, io a6ide by thcsa laus ard ru(es,
including arnendnsnts to them;
•sny changes in applicaticn intorna:icn will be suGn�:� _d
to the �ard and bcal uni[ of gcverr,rent wilfiin } 0 dzys
ci ;he chzn5e; znd
d unders.and thzt failure to provide reGuired intormaCqn
or providing fasa or misleading iniomaion m=y result in
the dznial or revocation of the licer,sa. .
D2te
4. A coov of the bcal unR of QovernmenYS resolution zo-
psovina this 2oo6cztion must be ariached to this aoplication
5. ti this appi'�cation is denied by the bcai unit ot government,
it shouid not be submitted to the Gambiing Contro� Board.
Township: By signature below, ihe township acknowiedges
that the organization is applying for a premises permit within
township limits.
Township Narne
Signature o( person receiving application
7de
� Date Recei�ed
LG2t<(Part 2)
�F..��sv��
Council File # `� " ` i 1
-.� r, p
, �\i
� ; � __
Ordinance #
Green Sheet # 35444
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Presented By
Referred To
Committee: Date
�!
RESOLVED: That application, ID #A-04568, for a State Claea A Gambling Premise Permit
by St. Paul Midway I,ions Club Foundation at W. 7th 5treet Bingo Hall, 1026
W. 7th Street (previously known at Midway Lions Club), be and the same is
hereby approved.
Requested by Department of:
Adoption Certi£ied by Council Secretary
MINNESOTA
• - -�,- �:._ .�= _�.
� .:��-� - •�
g �? �/. �
Form Approved by City Attorney
BY% � r `� �� r
\ gp; -�/ / vULC'�
Approved by Mayo : Date Z�, E
� Approved by Mayor for Submission to
BY. Council
By:
Adopted by Council: Date ��. �a \99�
` � r l —1`�`l
o��,.,�ro������ DAfE1NffIAT£D GREEN SHEE N° _35444
CONTACTPEFiSON&PHONE INRIAWATE � INRNUUA7E
� DEPAqTMQJT �IFECTOR � CT' COUNdL
. . ASSIGN OCRYATTOFNEY �CffYCLEAK
NUYBER FOR
MUST BE ON COUNCILAGENOA BY <QATE) pp�NG O BUM'iET DIfiECTOR O FM.6 MGT. SERVICES Olfi.
Hearin : a. � 9 ORDEfl Q Mqypq (OR ASSISTANT) ❑
TOTAL # OF SIG TURE PAGES (CLIP ALL LOCATONS FOR SIGNATUflE)
ACf70N REQUE5TED:
Sames Bellomo on behalf of St. Paul Midway Lions Club Foundation requests
Council approval of their application for a State C1ass A Gambling Premise Permit at
W. 7th Street Bingo FIall, 1026 W. 7th Street. (ID 4/A-04568) (previously Midway I,ions Club)
RECAMMENDAiIONS:App�rne(A)orReiea(R) pERSONALSEFiVICECONTRACTSMUSTANSWERTHEFOLLOWIN(i�UESTIONS:
_ PLANNING COMMISSION _ CIViL SEXVICE CAMM7SSION �• H3s tfus perSaNfirm ever worked undet a coMtact for this tlepartmeM? -
_ CIB COMMITfEE _ YES NO
_ SiAFF 2. Has Mis person/firm ever been a city empioyee?
— YES NO
_ DIS7qIC7 COURT _ 3. DOes ihis personHirm possess a skill not normall ossessed
y p by any current city employee?
SUPPOflTSMIHICMCOUNqLOeJECiIVE4 YES NO
Explain all yes anawen on separate aheet and attach to green sheet
INITIATING PROBLEM, ISSUE, OPPEIRTUNITY (Who, Whaq When, Where, Why): '� "– ;•
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ADVANTAGES IFAPPROVEO: -
DISADVANTAGES IFAPPROVED:
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DISAOVANTAGES IF NOT pPPROVEO: �
TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNpING SOURCE ACT{VI7Y NUMBER
FINANpAL INFORMATION: (EXPLAIN) �
35444 L.I.E.P. REVIEW CHECKLIST �ate: /�� — � y �
Greensheet # �P � �� � p,pp•� processed
In Tracker?�/3o
License ID # A-04568 (State) License 7ype: State Class A �ambling Premise Permit
Company Name: St Pau1 Midway Lions C1ub Foundatio DBA: St Paul Midway Lions Club Foundat
Business Addresss: 1026 W. 7th St. 55102 Business Phone: 454-7674
Contact Name/Addfess: 3ames Bellomo Home Phone: 454-7674
1857 Ea le Ridge Dr. Mendota Heights 55118
Date to Council Research: /T 3d�9� /
Public Hearing Date: ���' 12 � � y � 7 Labels Ordered: /f/ �
Notice Sent to Applicant: District Council #: 09
Notice Sent to Pubfic: Ward #: � —
DepartmeM/ Date Inspections Comments
City Attorney � �� �� � ' �
Environmental
Health
N / r/
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Fire
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s�ta a�a� a��»��aa:_
License �ase aecerved:
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Zoning
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FOR BOAFD USE ONLY
BASE �
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FEE
Minnesota LawfuI GambIing CHECK
Premises Permit Appiication - Part 1 of 2 �NITlALS
OATE
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� Class ot premises permit
Renewai (cheek one)
Orsanization base ficense number � A(54Wj Puli-tabs, tipboards, �.ddlewheels, rf°xs, bingo
LG214
o7.2LS'.1
� New
Prenises permit number
�I B(5250) Pu0-Eabs, �pbcards, pad�+ewhee!s, a`�es
� C (5200) 61ngo only
❑ D �5150) liar7)es ony
tiar..e ot Organ¢a5on
ST Av� M�ow+�4 L.,onS �iVB �o nnanon
cu:ir.ess Address of Organiza6on - Steet or P. O Sox (Do not use the a�ress ot your ganbiirg manager)
SOO W. Co��nr�l (Zo �i 5u.re 33�
,ev i ux.
o( chief exxutive o�cer
mc� � EuAmo
mn SJtI� T5�
yo�r gambLng manac,er) ! �Title
1'RES � YJ tYIT
e ;.na�e nun5er
y 59=1 b7 4�
e ;hor.e n�^�ber
tt�iv Ss4-�r�?�}
of Iegal owner
s S i 02-.
Yow erganization own the buldry where the gambfin9 vr01 be mnducted? p YES � NO
If ra, attach the toAowinp:
' a copy ol the {¢ase (tam 1G202} witfi ferms Snr at teast o�e year.
• a mq of a sketeh of the floor pian with dmensions, sMwing what por6on is being Ieased
A lease and sketch are not reGu'ved (ot Ciass D appfieatons.
L` �pp2yzng for a class A or C permit, fill in days znd beg inni � 8 ending houxs of b:ngo occasiors:
\o more than seven bingo occasfons may be cbnducted by your orFanization per week
Day Beg+r.nSng/Ending Hours Day Bc�nntngJEnding Hours Day Beg(xuiing /Endir.g Y.ow-s
�- 5�,�ez^P.e-t�e� Sxtt� ss E. — Qesr�ri nvSee� �e� ��-
to [o to
to If bingo m�l not be conduefed, eheek here O
P.adress City Sute Z�p code
to2lo w sT SrPcw� m•-� SS�pZ
s
Is Lhe premises Iocated within dry Gmits? .�Yes O No If no, is township � organized 0 unuganized p uni�prporated
Ci.y and Cpuniy where gambfing premises is located OR Township and County where gambLng premises is �ocaled if outside ot ciiy fimits
]Sfirtnesota LaiU.fut Gambiinq
Premise Fernut Application - Part 2 of 2
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Nunber
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17(o SnEwn� �� Sr(�a�u� mn �Slb�
� F�o mas �r.,ea.ct l lll t�wav ST -#�403 SrPav�mnSSi(� CDFbngUn6 YVl �✓��"2
� Sc+fus I b31 Jamrs �.4� Sr�� mn 5S 11f3 vY1 Fm6t"�
J�m�;s �it 185' En�� R�cr�e Drz M�,� Hzs mn SS l 1 A �2rSDt-]"�t"
.)�cm.� 1 rn,��n„ro�, 45c1t„ Art�nw Sz �r�a,�, mr,5S113 ��uor'eU�Y.�Z
1 hereby cnnsent that bc�J law enfiorcement offcars, the
board or a;ents of the board, or the commissioner of
ravenua or publ'�c safey, or agents oi the commissionars,
�'2y er<ter ;he pramises to enforca the law.
Ba-nk Records Information
The xard is a�lhorized to insped the bark rec�rds of tbe
Sam6ling z�unt wheaever r,ecesa,y to tuKill
r=quirenants oi current gzr„bling rules and law.
Oath
t c`edarethffi:
•i have rsad Ihis applicafan and alI iriorma�wn submiited
tc the bcard is true, a�urate and rampiete-
•=ft c;har required info has been fully dsclosed;
S+_naiure of chiei ezec",'Ne oHicer
�. The c^y'must sign this appl'rcation if the gambling prem-
ises is tocaed within city limiis.
2- The c�unty "AND township`• must sig� this applicaticn if
tFe gambling premises is bca;ed within a township.
3 � The bcal unit government (c'ry or county} must pass a
resolution speciticaliy approving or denying this appl'rcation.
C'b or Counry Name
Title ' " 1 Data Rea
l�r�--`7t,�•, �n4rt'cG*wo�.C � 1 1 b
Reier ta �{nsWdions for required attachments.
t " t �� Ta= Gnmbiinp ConVOI Smrd
flosewood PSan South.3rd Fbor
1771 W, Counfy Road 6
Rmevitle, AtN SS1S3
•1 am ihe chief exscutive o�cer of tha organ¢ation;
•I assume fuil resp�nsb7ty for the fzir and lavful opera-
tion of all ac;'rvlies to be c�nduded;
•I will famifiarize myself with the Izws ot Minnesota
governing lavful gambling and rules of the board and
agree, it licens�d, io a6ide by thcsa laus ard ru(es,
including arnendnsnts to them;
•sny changes in applicaticn intorna:icn will be suGn�:� _d
to the �ard and bcal uni[ of gcverr,rent wilfiin } 0 dzys
ci ;he chzn5e; znd
d unders.and thzt failure to provide reGuired intormaCqn
or providing fasa or misleading iniomaion m=y result in
the dznial or revocation of the licer,sa. .
D2te
4. A coov of the bcal unR of QovernmenYS resolution zo-
psovina this 2oo6cztion must be ariached to this aoplication
5. ti this appi'�cation is denied by the bcai unit ot government,
it shouid not be submitted to the Gambiing Contro� Board.
Township: By signature below, ihe township acknowiedges
that the organization is applying for a premises permit within
township limits.
Township Narne
Signature o( person receiving application
7de
� Date Recei�ed
LG2t<(Part 2)
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