97-510council Fi1e # � S ��
Ordinance #
Green Sheet # 35333
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.�- r -.. � � ,
Presented By,
Re£erred To
RESOLUTION
OF SAINT PAUL, MINNESOTA
�Z
Committee: Date
RESOLVPD: That application, ID #63514, for a new Gambling Manager's License by
Kathleen Kirchoff DBA Royal Guard Jr. Drum & Bugle Corps at T. J. Bell�s,
1201 Jackson Street, be and the same is hereby approved.
� n �� Requested by Department o£:
Office of License Insoections and
Environmental Protec ion
By
�
By:
� � S�uvc�
By: `1��:n �' �
Form Approved by City Attorney
: i/[/291�—"—' �� hn�i�
U
proved by Mayor £or Submission to
uncil
By:
q'1-Sio
DEPARfMEM/OPFlCE./COUNdL DATE INRIATED r REEN SHEE �O 3 5 3 3 3
LIEP �� iNmnvonre --- - . _.— irvrrinwxre
CONTACT PEfl50N & PHON � DEPARIMEM DIRECTOfl O CT' CAUNCIL
ASSIGN CflYATTOFNEY Cf(YCLEflK '
William F. Gunthex — 266-9132 NUYBEPFON �
MUST BE ON COUNCIL AGENDA BV (DATE) pp�� � BUOGET DIRECTOfl � FIN. & MGT. SEflVICES Dlp.
OflDEft � MpVOF (ORASSISTANT) O
earin :
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION REQUESiEO:
Sathleen Rirchoff DBA Royal Guard Jr. Drum 5 Bugle Corps requests Council
approval of hex application for a new Gambling Manager's License, ID /�63514> at
T. J. Bell's, 1201 Sackson Steet.
RECOMMENDATIONS: Approve (A) or Reject (fi) PEiiSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWINCa QUESTIONS:
_, PLANNING CAMMISSION _ CIVIL SERVICE COMMISSION S- Ha5 iFtis pOTGOi1(E11m 0Ve[ WOiked UntlO( e CAntrAG fOf M15 depa(hllenl? -
YES NO
_ CIB COA1MfTTEE _
2. Has this person/firm ever been a city employee?
— ST� — YES NO
_ DISTRICT CAUFiT _ 3. DoBS this person/firtn po5se5s a skill not normally po55e5setl by any curteM city employee?
SUPPOFiBWM�CHGOUNpLO&IECTIVE? YES NO
Explain all yes answers on aeparate sheet and attach to green sheet
INITIATMG PROBLEM, ISSUE, OPPOHTUNITY (WIro, Whaq WhBn, WM1are, Whyf: _ --
REtEIV`��
APR 1 � �97
Ct�°� ��T�RNEIf
ADVANTAGESIFAPPROVED:
DISAOVANTAGES IF APPROVED:
C�l. �.,� �'G� � �.._ .
� a *;�a;'�t
APR 21 1997
_ � �_____.,�... � � .R. . _r
DiSADVANTAGES IF NOT APPROVED:
TOTAL AMOUNT OF TRANSACTION $ COSTIREVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIHG SOURCE ACTIVITY NUMBEH
FINANCIAL INFORMATION: (EXPLAIN)
Greensneet # q L.I.E.P. REVIEW CHECKLIST oate: /
fn TraCke�'?__ ����� APP'n aeceived / App'n Processed
63514 Gamblin Mana er �� +� �
License ID # License Type: g g
Company Name: Rathleen Rirchoff pgp Royal Guard Jr. Drum & Bugle Corps
Business Addresss: 1201 Jackson St. (T. J. Be11's) BUSiness Phone: 644-5810
Contact NamelAddress:_?144 Eidridge AVe. E. 55109 Home Phone: 644-5810
Date ta Council Research:�ld"
Public Hearing Date: �.a� '� , !R9'7
Notice Sent to Applicant: � l��/ g r /
Labels Ordered: NJA
District CouncN #: 06
Notice Sent to Public:
Ward #: OS
Departmentj Date Inspections Comments
City Attorney � f, J �� g � , C:-/� /�' ` �� 7�����
jIZ
Environmental
Health -t �
/V,oO
Fire
/V1rl
License ��e �� �����
Lease Received: ^
�1�
Police `p j��1L��J �ieCd�"� ���� /Ts+�C'�YIP�
�r� i
4�
Zoning
�'l�
97-510
East STATE OF MINNESOTA � POR BOARD USE Oh`Z,y
GAMBLING CONTROL BOARD AMT. PAID
- �� GRMBLING MANP.GER LZCENS,E RENEWAL APPLSCATION CHECK r
LG212GMR PRINTED: 10/30/95 DATE
LICENSE NUMBERo G-03146 004 EFFSCTZVn DATE: 10/O1/94 EXPZRATZON DATE: 04/30�96
NAMF OF ORGANIZATION: Drum And Hug1e Corps St Paul Royal Guard Sunior
GAMBLItIG MANAGER INFORMATIOH _
Kathleen Baren Kirchoff DATE OF BIRTH:
=�°°s--=-==a°��� a/yY e7d�c`� �. � sEx:
.Ma 1-e -MN 551�9 S� �� I����� SOCZAL SECURZTY NUM3ER:
DAYTIME PHONE NUMBER: 612-298-4480
MEMBER SINCE: 09/O1/86
LASS DATE YOU ATTENDED A GAMBLING MANAGERS SEMINAR(CONTINUING EDUCATION CLASS:
BOND INFORMATION
BOND COMPANY NAME: United Fire & Casual BOND NUMBER: 51082820
07/17/42
F
476-44-6863
11�15/94
I DECLARE THAT:
• I HAVE READ THIS APPLICATSON AND ALL TNFORMATION SUBMITTED TO THE GAMBLING CONTROL BOARD;
• ALL INFORMAT20N IS TRUE, ACCURATE AND COMPLETE;
• ALL OTHER REQUZRED INFORMATION HAS BEEN FULLY DZSCLOSED;
• I AM THE ONLY GAM&LING MANAGER OF THE ORGANSZATIONj
• I HAVE BEEN AN ACTIVE MEMBER OF THE ORGANIZATION FOR AT LEAST TWO YEARS;
• I WILL FAMIlZARIZE MYSELF WITH THE LAWS OF MINNESOTA GOVERNING LAWFUL GAMBLING AND RULES OF
THE GAMBLING CONSROL BOARD AND AGREE, IF LICENSED, TO ABZDE THOSE LAWS AND RULES�
INCLUDING AMENDMENTS TO TFSEM; ?
• ANY CHANGES IN APPLICATION INFORMATION WILL BE SUBMITT$D TO THE GAMBLING CONSROL BOARD AI��
LOCAL UNIT OF GOVERNMENT WITHIN 10 DAYS�OF THE CHANGE;
• AN AFFIDAVIT FOR GAMBLING MANAGER HAS BEEN COMPLETEA AND ATTACHED; AND
• 2 UNDERSTAND THAT FAILURE TO PROVIDE REQUIRED INFORMATZON OR PROVZDING FAT.SE OR MISLEADING
INFORMATION MAY RESULT IN THE DENZAL OR REVOCATION OF THE LSCENSE.
SIGNATUE2E � G MADTA
��
- . � � - :.:. RE
t,.-
�: ,
SHIS FORM��WILL��BEJ�MADE��FiVA
. .t�':i`c rz� ., ?v ` . �f"�5''<,�'
' - . .. }: � F' ?w'::�
' . . �. . .. . . .. iA z r��`
DATE
a_ �s- 9�
R�TO THE CHECXI.IST FOR REQUIRED ATTACHF�NTS
;" _MAIL' TO:; GAMBLING" CONTROL� BOARD _,' i: "-' =- -.: :`
�1711 WEST.�COUNTY_ ROAD,�B, � SUITE 3005 -�.-� -: . - - ` -
�< ROSEVILLE��, MINNESOTA 55113 =-�r - _ _ � - .. �
. :. ..' . -. �- - �
BRAILLE) UPON�REQIIEST:�-�
Y ; _
�. . -e
_ � _ _ .� _ r -, Y _
_ "� _ �/ . .. .„ v�-;a"=,=
. . -,-a.:.. �' 'In .,���� _' �_ ��', `�Y`�
LG213 Mfnnesota Gambling Confrol Board
ov�a�ss Gambling Manager Affidavif
Atfach to the Gamb4ing Manager Application, Form LG212
STATE OF ��� j ,�1 �
Gt1—Sl0
' �� AFF(DAVIT OF QUALIF(CATION
) s.s.
COUN7Y OF ,�-J��� �
�
i, c,�ry� / K1J���0��� , Under oath staie ihaf:
' (type/print name)
FOR GAMBLING MANAGER LICENSE
AND CONSEt1T STA7EMENT
(Pursuant to Minnesota Statutes and Rules)
1. i have nevef heen convicfed of a fefony or a crime involving gambling.
2. I have not, within five years bafo�e fhe date of fhe license application, committed a viofation of faw or
Board rule that resuited in the revocation of a license issued by the Board.
3. 1 have never been convicted of a crimina{ viofation involving fraud, theft, tax evasion, misrepreseniation,
or gambling.
4. i have never been convicted of (i) assaulf, (i) a criminal violation involving the use of a firearm, or (iii)
making terzoristic threats. '
5. i am not, nor ever have been connected with or engaged in an illegal business.
6. I do not owe $500 or more in delinquent taxes as defined in section 27�.72,
7. I have not had a sales and use tax permit revoked by the commissioner of revenue within the past two
years.
8. I have never, after demand, failed to fife tar retums required by the commissioner of revenue.
1n addition, 4 undersfand, agree and hereby irrevocably consent that suits and actions relating to the subject
matter of the attached gambling manager ficense applicafion, or acts or omissions arising from such appiica-
tion, may be commenced against my organization and I will accept the service of process for my organiza-
tion in any court of competentjurisdiction in Minnesota by secvice on ths Minnesota Secrefary of State of any
summons, process or pleading authorized by the laws of Minnesota.,
_�:
By signaiure of this document, the undersigned authorizes the Deparfinent of Public Safety to conduct a
criminal background check or review and to share the resufts with the Gambling Controi Board..
Failure to provide required information or providing false or misleading information may result in the denial or
revocation of the license. =
�
PURTHER AFFIANT SAYETH NOT, except that this A�davit and �
support of the application for a gamb4ing manager license from the
, - - °- -�: r_ _.
h/F1TdOV �/ IO/ In Ine�nn�tnri�al � t . - ~/
. . - - ,-; (sfgn tur
� .._ -—. .%:`
_ ' �- -� S.j�:. "
�
of �
e i'. �.. ' -' x,:c� = ,�
- - = ';;�; ORGANIZ.4
_ -- ^= Name of Organization
. .: = _ ��- :`=
�� _:.��:;ny;�=�_r�- =�"
— r_
`�.' � n':''' :='/1
Base t
��a. A
/'. ./ � �-y - � L
tted in� - �
, '�. :-_ . ._ _
�.Y
� ;
:.. t3�' . ._ iS.. : r ,• � _ .
JFORMATlOh!' `=�='r ;=` :. ,
..-_ _ . , .. ,:.f:;= ._ ___ -
r::c:�;'_� :;_..:-:s
� . -
council Fi1e # � S ��
Ordinance #
Green Sheet # 35333
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13
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.�- r -.. � � ,
Presented By,
Re£erred To
RESOLUTION
OF SAINT PAUL, MINNESOTA
�Z
Committee: Date
RESOLVPD: That application, ID #63514, for a new Gambling Manager's License by
Kathleen Kirchoff DBA Royal Guard Jr. Drum & Bugle Corps at T. J. Bell�s,
1201 Jackson Street, be and the same is hereby approved.
� n �� Requested by Department o£:
Office of License Insoections and
Environmental Protec ion
By
�
By:
� � S�uvc�
By: `1��:n �' �
Form Approved by City Attorney
: i/[/291�—"—' �� hn�i�
U
proved by Mayor £or Submission to
uncil
By:
q'1-Sio
DEPARfMEM/OPFlCE./COUNdL DATE INRIATED r REEN SHEE �O 3 5 3 3 3
LIEP �� iNmnvonre --- - . _.— irvrrinwxre
CONTACT PEfl50N & PHON � DEPARIMEM DIRECTOfl O CT' CAUNCIL
ASSIGN CflYATTOFNEY Cf(YCLEflK '
William F. Gunthex — 266-9132 NUYBEPFON �
MUST BE ON COUNCIL AGENDA BV (DATE) pp�� � BUOGET DIRECTOfl � FIN. & MGT. SEflVICES Dlp.
OflDEft � MpVOF (ORASSISTANT) O
earin :
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION REQUESiEO:
Sathleen Rirchoff DBA Royal Guard Jr. Drum 5 Bugle Corps requests Council
approval of hex application for a new Gambling Manager's License, ID /�63514> at
T. J. Bell's, 1201 Sackson Steet.
RECOMMENDATIONS: Approve (A) or Reject (fi) PEiiSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWINCa QUESTIONS:
_, PLANNING CAMMISSION _ CIVIL SERVICE COMMISSION S- Ha5 iFtis pOTGOi1(E11m 0Ve[ WOiked UntlO( e CAntrAG fOf M15 depa(hllenl? -
YES NO
_ CIB COA1MfTTEE _
2. Has this person/firm ever been a city employee?
— ST� — YES NO
_ DISTRICT CAUFiT _ 3. DoBS this person/firtn po5se5s a skill not normally po55e5setl by any curteM city employee?
SUPPOFiBWM�CHGOUNpLO&IECTIVE? YES NO
Explain all yes answers on aeparate sheet and attach to green sheet
INITIATMG PROBLEM, ISSUE, OPPOHTUNITY (WIro, Whaq WhBn, WM1are, Whyf: _ --
REtEIV`��
APR 1 � �97
Ct�°� ��T�RNEIf
ADVANTAGESIFAPPROVED:
DISAOVANTAGES IF APPROVED:
C�l. �.,� �'G� � �.._ .
� a *;�a;'�t
APR 21 1997
_ � �_____.,�... � � .R. . _r
DiSADVANTAGES IF NOT APPROVED:
TOTAL AMOUNT OF TRANSACTION $ COSTIREVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIHG SOURCE ACTIVITY NUMBEH
FINANCIAL INFORMATION: (EXPLAIN)
Greensneet # q L.I.E.P. REVIEW CHECKLIST oate: /
fn TraCke�'?__ ����� APP'n aeceived / App'n Processed
63514 Gamblin Mana er �� +� �
License ID # License Type: g g
Company Name: Rathleen Rirchoff pgp Royal Guard Jr. Drum & Bugle Corps
Business Addresss: 1201 Jackson St. (T. J. Be11's) BUSiness Phone: 644-5810
Contact NamelAddress:_?144 Eidridge AVe. E. 55109 Home Phone: 644-5810
Date ta Council Research:�ld"
Public Hearing Date: �.a� '� , !R9'7
Notice Sent to Applicant: � l��/ g r /
Labels Ordered: NJA
District CouncN #: 06
Notice Sent to Public:
Ward #: OS
Departmentj Date Inspections Comments
City Attorney � f, J �� g � , C:-/� /�' ` �� 7�����
jIZ
Environmental
Health -t �
/V,oO
Fire
/V1rl
License ��e �� �����
Lease Received: ^
�1�
Police `p j��1L��J �ieCd�"� ���� /Ts+�C'�YIP�
�r� i
4�
Zoning
�'l�
97-510
East STATE OF MINNESOTA � POR BOARD USE Oh`Z,y
GAMBLING CONTROL BOARD AMT. PAID
- �� GRMBLING MANP.GER LZCENS,E RENEWAL APPLSCATION CHECK r
LG212GMR PRINTED: 10/30/95 DATE
LICENSE NUMBERo G-03146 004 EFFSCTZVn DATE: 10/O1/94 EXPZRATZON DATE: 04/30�96
NAMF OF ORGANIZATION: Drum And Hug1e Corps St Paul Royal Guard Sunior
GAMBLItIG MANAGER INFORMATIOH _
Kathleen Baren Kirchoff DATE OF BIRTH:
=�°°s--=-==a°��� a/yY e7d�c`� �. � sEx:
.Ma 1-e -MN 551�9 S� �� I����� SOCZAL SECURZTY NUM3ER:
DAYTIME PHONE NUMBER: 612-298-4480
MEMBER SINCE: 09/O1/86
LASS DATE YOU ATTENDED A GAMBLING MANAGERS SEMINAR(CONTINUING EDUCATION CLASS:
BOND INFORMATION
BOND COMPANY NAME: United Fire & Casual BOND NUMBER: 51082820
07/17/42
F
476-44-6863
11�15/94
I DECLARE THAT:
• I HAVE READ THIS APPLICATSON AND ALL TNFORMATION SUBMITTED TO THE GAMBLING CONTROL BOARD;
• ALL INFORMAT20N IS TRUE, ACCURATE AND COMPLETE;
• ALL OTHER REQUZRED INFORMATION HAS BEEN FULLY DZSCLOSED;
• I AM THE ONLY GAM&LING MANAGER OF THE ORGANSZATIONj
• I HAVE BEEN AN ACTIVE MEMBER OF THE ORGANIZATION FOR AT LEAST TWO YEARS;
• I WILL FAMIlZARIZE MYSELF WITH THE LAWS OF MINNESOTA GOVERNING LAWFUL GAMBLING AND RULES OF
THE GAMBLING CONSROL BOARD AND AGREE, IF LICENSED, TO ABZDE THOSE LAWS AND RULES�
INCLUDING AMENDMENTS TO TFSEM; ?
• ANY CHANGES IN APPLICATION INFORMATION WILL BE SUBMITT$D TO THE GAMBLING CONSROL BOARD AI��
LOCAL UNIT OF GOVERNMENT WITHIN 10 DAYS�OF THE CHANGE;
• AN AFFIDAVIT FOR GAMBLING MANAGER HAS BEEN COMPLETEA AND ATTACHED; AND
• 2 UNDERSTAND THAT FAILURE TO PROVIDE REQUIRED INFORMATZON OR PROVZDING FAT.SE OR MISLEADING
INFORMATION MAY RESULT IN THE DENZAL OR REVOCATION OF THE LSCENSE.
SIGNATUE2E � G MADTA
��
- . � � - :.:. RE
t,.-
�: ,
SHIS FORM��WILL��BEJ�MADE��FiVA
. .t�':i`c rz� ., ?v ` . �f"�5''<,�'
' - . .. }: � F' ?w'::�
' . . �. . .. . . .. iA z r��`
DATE
a_ �s- 9�
R�TO THE CHECXI.IST FOR REQUIRED ATTACHF�NTS
;" _MAIL' TO:; GAMBLING" CONTROL� BOARD _,' i: "-' =- -.: :`
�1711 WEST.�COUNTY_ ROAD,�B, � SUITE 3005 -�.-� -: . - - ` -
�< ROSEVILLE��, MINNESOTA 55113 =-�r - _ _ � - .. �
. :. ..' . -. �- - �
BRAILLE) UPON�REQIIEST:�-�
Y ; _
�. . -e
_ � _ _ .� _ r -, Y _
_ "� _ �/ . .. .„ v�-;a"=,=
. . -,-a.:.. �' 'In .,���� _' �_ ��', `�Y`�
LG213 Mfnnesota Gambling Confrol Board
ov�a�ss Gambling Manager Affidavif
Atfach to the Gamb4ing Manager Application, Form LG212
STATE OF ��� j ,�1 �
Gt1—Sl0
' �� AFF(DAVIT OF QUALIF(CATION
) s.s.
COUN7Y OF ,�-J��� �
�
i, c,�ry� / K1J���0��� , Under oath staie ihaf:
' (type/print name)
FOR GAMBLING MANAGER LICENSE
AND CONSEt1T STA7EMENT
(Pursuant to Minnesota Statutes and Rules)
1. i have nevef heen convicfed of a fefony or a crime involving gambling.
2. I have not, within five years bafo�e fhe date of fhe license application, committed a viofation of faw or
Board rule that resuited in the revocation of a license issued by the Board.
3. 1 have never been convicted of a crimina{ viofation involving fraud, theft, tax evasion, misrepreseniation,
or gambling.
4. i have never been convicted of (i) assaulf, (i) a criminal violation involving the use of a firearm, or (iii)
making terzoristic threats. '
5. i am not, nor ever have been connected with or engaged in an illegal business.
6. I do not owe $500 or more in delinquent taxes as defined in section 27�.72,
7. I have not had a sales and use tax permit revoked by the commissioner of revenue within the past two
years.
8. I have never, after demand, failed to fife tar retums required by the commissioner of revenue.
1n addition, 4 undersfand, agree and hereby irrevocably consent that suits and actions relating to the subject
matter of the attached gambling manager ficense applicafion, or acts or omissions arising from such appiica-
tion, may be commenced against my organization and I will accept the service of process for my organiza-
tion in any court of competentjurisdiction in Minnesota by secvice on ths Minnesota Secrefary of State of any
summons, process or pleading authorized by the laws of Minnesota.,
_�:
By signaiure of this document, the undersigned authorizes the Deparfinent of Public Safety to conduct a
criminal background check or review and to share the resufts with the Gambling Controi Board..
Failure to provide required information or providing false or misleading information may result in the denial or
revocation of the license. =
�
PURTHER AFFIANT SAYETH NOT, except that this A�davit and �
support of the application for a gamb4ing manager license from the
, - - °- -�: r_ _.
h/F1TdOV �/ IO/ In Ine�nn�tnri�al � t . - ~/
. . - - ,-; (sfgn tur
� .._ -—. .%:`
_ ' �- -� S.j�:. "
�
of �
e i'. �.. ' -' x,:c� = ,�
- - = ';;�; ORGANIZ.4
_ -- ^= Name of Organization
. .: = _ ��- :`=
�� _:.��:;ny;�=�_r�- =�"
— r_
`�.' � n':''' :='/1
Base t
��a. A
/'. ./ � �-y - � L
tted in� - �
, '�. :-_ . ._ _
�.Y
� ;
:.. t3�' . ._ iS.. : r ,• � _ .
JFORMATlOh!' `=�='r ;=` :. ,
..-_ _ . , .. ,:.f:;= ._ ___ -
r::c:�;'_� :;_..:-:s
� . -
council Fi1e # � S ��
Ordinance #
Green Sheet # 35333
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
.�- r -.. � � ,
Presented By,
Re£erred To
RESOLUTION
OF SAINT PAUL, MINNESOTA
�Z
Committee: Date
RESOLVPD: That application, ID #63514, for a new Gambling Manager's License by
Kathleen Kirchoff DBA Royal Guard Jr. Drum & Bugle Corps at T. J. Bell�s,
1201 Jackson Street, be and the same is hereby approved.
� n �� Requested by Department o£:
Office of License Insoections and
Environmental Protec ion
By
�
By:
� � S�uvc�
By: `1��:n �' �
Form Approved by City Attorney
: i/[/291�—"—' �� hn�i�
U
proved by Mayor £or Submission to
uncil
By:
q'1-Sio
DEPARfMEM/OPFlCE./COUNdL DATE INRIATED r REEN SHEE �O 3 5 3 3 3
LIEP �� iNmnvonre --- - . _.— irvrrinwxre
CONTACT PEfl50N & PHON � DEPARIMEM DIRECTOfl O CT' CAUNCIL
ASSIGN CflYATTOFNEY Cf(YCLEflK '
William F. Gunthex — 266-9132 NUYBEPFON �
MUST BE ON COUNCIL AGENDA BV (DATE) pp�� � BUOGET DIRECTOfl � FIN. & MGT. SEflVICES Dlp.
OflDEft � MpVOF (ORASSISTANT) O
earin :
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION REQUESiEO:
Sathleen Rirchoff DBA Royal Guard Jr. Drum 5 Bugle Corps requests Council
approval of hex application for a new Gambling Manager's License, ID /�63514> at
T. J. Bell's, 1201 Sackson Steet.
RECOMMENDATIONS: Approve (A) or Reject (fi) PEiiSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWINCa QUESTIONS:
_, PLANNING CAMMISSION _ CIVIL SERVICE COMMISSION S- Ha5 iFtis pOTGOi1(E11m 0Ve[ WOiked UntlO( e CAntrAG fOf M15 depa(hllenl? -
YES NO
_ CIB COA1MfTTEE _
2. Has this person/firm ever been a city employee?
— ST� — YES NO
_ DISTRICT CAUFiT _ 3. DoBS this person/firtn po5se5s a skill not normally po55e5setl by any curteM city employee?
SUPPOFiBWM�CHGOUNpLO&IECTIVE? YES NO
Explain all yes answers on aeparate sheet and attach to green sheet
INITIATMG PROBLEM, ISSUE, OPPOHTUNITY (WIro, Whaq WhBn, WM1are, Whyf: _ --
REtEIV`��
APR 1 � �97
Ct�°� ��T�RNEIf
ADVANTAGESIFAPPROVED:
DISAOVANTAGES IF APPROVED:
C�l. �.,� �'G� � �.._ .
� a *;�a;'�t
APR 21 1997
_ � �_____.,�... � � .R. . _r
DiSADVANTAGES IF NOT APPROVED:
TOTAL AMOUNT OF TRANSACTION $ COSTIREVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIHG SOURCE ACTIVITY NUMBEH
FINANCIAL INFORMATION: (EXPLAIN)
Greensneet # q L.I.E.P. REVIEW CHECKLIST oate: /
fn TraCke�'?__ ����� APP'n aeceived / App'n Processed
63514 Gamblin Mana er �� +� �
License ID # License Type: g g
Company Name: Rathleen Rirchoff pgp Royal Guard Jr. Drum & Bugle Corps
Business Addresss: 1201 Jackson St. (T. J. Be11's) BUSiness Phone: 644-5810
Contact NamelAddress:_?144 Eidridge AVe. E. 55109 Home Phone: 644-5810
Date ta Council Research:�ld"
Public Hearing Date: �.a� '� , !R9'7
Notice Sent to Applicant: � l��/ g r /
Labels Ordered: NJA
District CouncN #: 06
Notice Sent to Public:
Ward #: OS
Departmentj Date Inspections Comments
City Attorney � f, J �� g � , C:-/� /�' ` �� 7�����
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East STATE OF MINNESOTA � POR BOARD USE Oh`Z,y
GAMBLING CONTROL BOARD AMT. PAID
- �� GRMBLING MANP.GER LZCENS,E RENEWAL APPLSCATION CHECK r
LG212GMR PRINTED: 10/30/95 DATE
LICENSE NUMBERo G-03146 004 EFFSCTZVn DATE: 10/O1/94 EXPZRATZON DATE: 04/30�96
NAMF OF ORGANIZATION: Drum And Hug1e Corps St Paul Royal Guard Sunior
GAMBLItIG MANAGER INFORMATIOH _
Kathleen Baren Kirchoff DATE OF BIRTH:
=�°°s--=-==a°��� a/yY e7d�c`� �. � sEx:
.Ma 1-e -MN 551�9 S� �� I����� SOCZAL SECURZTY NUM3ER:
DAYTIME PHONE NUMBER: 612-298-4480
MEMBER SINCE: 09/O1/86
LASS DATE YOU ATTENDED A GAMBLING MANAGERS SEMINAR(CONTINUING EDUCATION CLASS:
BOND INFORMATION
BOND COMPANY NAME: United Fire & Casual BOND NUMBER: 51082820
07/17/42
F
476-44-6863
11�15/94
I DECLARE THAT:
• I HAVE READ THIS APPLICATSON AND ALL TNFORMATION SUBMITTED TO THE GAMBLING CONTROL BOARD;
• ALL INFORMAT20N IS TRUE, ACCURATE AND COMPLETE;
• ALL OTHER REQUZRED INFORMATION HAS BEEN FULLY DZSCLOSED;
• I AM THE ONLY GAM&LING MANAGER OF THE ORGANSZATIONj
• I HAVE BEEN AN ACTIVE MEMBER OF THE ORGANIZATION FOR AT LEAST TWO YEARS;
• I WILL FAMIlZARIZE MYSELF WITH THE LAWS OF MINNESOTA GOVERNING LAWFUL GAMBLING AND RULES OF
THE GAMBLING CONSROL BOARD AND AGREE, IF LICENSED, TO ABZDE THOSE LAWS AND RULES�
INCLUDING AMENDMENTS TO TFSEM; ?
• ANY CHANGES IN APPLICATION INFORMATION WILL BE SUBMITT$D TO THE GAMBLING CONSROL BOARD AI��
LOCAL UNIT OF GOVERNMENT WITHIN 10 DAYS�OF THE CHANGE;
• AN AFFIDAVIT FOR GAMBLING MANAGER HAS BEEN COMPLETEA AND ATTACHED; AND
• 2 UNDERSTAND THAT FAILURE TO PROVIDE REQUIRED INFORMATZON OR PROVZDING FAT.SE OR MISLEADING
INFORMATION MAY RESULT IN THE DENZAL OR REVOCATION OF THE LSCENSE.
SIGNATUE2E � G MADTA
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SHIS FORM��WILL��BEJ�MADE��FiVA
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DATE
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R�TO THE CHECXI.IST FOR REQUIRED ATTACHF�NTS
;" _MAIL' TO:; GAMBLING" CONTROL� BOARD _,' i: "-' =- -.: :`
�1711 WEST.�COUNTY_ ROAD,�B, � SUITE 3005 -�.-� -: . - - ` -
�< ROSEVILLE��, MINNESOTA 55113 =-�r - _ _ � - .. �
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BRAILLE) UPON�REQIIEST:�-�
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LG213 Mfnnesota Gambling Confrol Board
ov�a�ss Gambling Manager Affidavif
Atfach to the Gamb4ing Manager Application, Form LG212
STATE OF ��� j ,�1 �
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' �� AFF(DAVIT OF QUALIF(CATION
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COUN7Y OF ,�-J��� �
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i, c,�ry� / K1J���0��� , Under oath staie ihaf:
' (type/print name)
FOR GAMBLING MANAGER LICENSE
AND CONSEt1T STA7EMENT
(Pursuant to Minnesota Statutes and Rules)
1. i have nevef heen convicfed of a fefony or a crime involving gambling.
2. I have not, within five years bafo�e fhe date of fhe license application, committed a viofation of faw or
Board rule that resuited in the revocation of a license issued by the Board.
3. 1 have never been convicted of a crimina{ viofation involving fraud, theft, tax evasion, misrepreseniation,
or gambling.
4. i have never been convicted of (i) assaulf, (i) a criminal violation involving the use of a firearm, or (iii)
making terzoristic threats. '
5. i am not, nor ever have been connected with or engaged in an illegal business.
6. I do not owe $500 or more in delinquent taxes as defined in section 27�.72,
7. I have not had a sales and use tax permit revoked by the commissioner of revenue within the past two
years.
8. I have never, after demand, failed to fife tar retums required by the commissioner of revenue.
1n addition, 4 undersfand, agree and hereby irrevocably consent that suits and actions relating to the subject
matter of the attached gambling manager ficense applicafion, or acts or omissions arising from such appiica-
tion, may be commenced against my organization and I will accept the service of process for my organiza-
tion in any court of competentjurisdiction in Minnesota by secvice on ths Minnesota Secrefary of State of any
summons, process or pleading authorized by the laws of Minnesota.,
_�:
By signaiure of this document, the undersigned authorizes the Deparfinent of Public Safety to conduct a
criminal background check or review and to share the resufts with the Gambling Controi Board..
Failure to provide required information or providing false or misleading information may result in the denial or
revocation of the license. =
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PURTHER AFFIANT SAYETH NOT, except that this A�davit and �
support of the application for a gamb4ing manager license from the
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