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92-383 ��t��ll. ` q2- 3�3 ✓ ( � �'tiCouncil File #` \_.�-�; Green Sheet # 19242 RESOLUTION CI� OF SAINT UL, MINNESOTA � � Presented By Referred To Committee: Date RESOLVED: That applications for renewal of various State Class A Gambling Premise Permits by the following organizations at the addresses stated, be and the same are hereby approved: ID #A-00863-001 Msgr Ravoux Assembly 408 Main Street ID #A-00269-002 St. Casimir Church 1324 E. Rose Phalen Hall ID #A-03146-002 Royal Guard Jr. Drum 1324 E. Rose & Bugle Corps Phalen Hall ID #A-00484-003 Blessed Sacrament Home & 1494 N. Dale St. School Ideal Hall Yeas Navs Absent Requested by Department of: uerin �— on —T acca ee � License & P rmit Division es i /� � e man r /,�. un e /� i son � BY� !� Adopted by Council: Date 1992 Form Approved by City Attorney Adoption Ce ' ied y CounciL�Sec etary � � � By. � � Z-ZI- '�/Z By: � � � {� ';�� Approved by Mayor for Submission to Approved by o : Date �R � " Council .�u��, By: By: ��,�� I�it �;- 5�� + ` �2.3g�3 ✓ DEPARTMENT/OFFICE/COUNCIL DATE INITIATED Finance/License GREEN SHEET N° 19242 CONTACT PERSON&PHONE INITIAUDATE INITIAL/DATE �DEPARTMENT DIRECTOR �CITY COUNCIL Christine Rozek-298-5056 ASSIGN �CITYATTORNEY �CITYCLERK MUST BE ON COUNCIL AGENDA BY(DATE) NUMBER FOR �BUDGET DIRECTOR �FIN.&MGT.SERVICES DIR. ROUTING ORDEH MAYOR(OH ASSISTANT) �.��,{� Cit Clerk B : ,3- �D a 0 0 TOTAL#OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION REQUESTED: . Renewal of various State Class A Gambling Premise Permits (ID 4�'A-00863-001, ��'A-00269-002, 4�A-0314b-002, - " E' & ��A-00484-003) . Notification: Hearin Date: RECOMMENDATIONS:Approve(A)or ReJect(R) PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING�UESTIONS: _PIANNINO COMMISSION _CIVIL SERVICE COMMISSION �• Has this person/firm ever worked under a contract for this department? _CIB COMMITTEE _ YES NO 2. Has this person/firm ever been a city employee? _STAFF — YES NO _ DISTRICT COURT _ 3. Does this person/firm possess a skill not normally possessed by any current city employee? 3UPPORTS WHICH COUNCIL OBJECTIVE? YES NO Explaln all yes answers on separate sheet and attech to green shset INITIATINO PROBLEM,ISSUE,OPPORTUNITY(Who,What,When,Where.Why): Request for Council approval of the renewal of various State Class A Gambling Premise Permits as listed. All applications have been submitted. All required Divisions have reviewed the applications and have agreed that the License Division may now forward them to the Saint Paul City Council. The License Division's recommendation is for approval ADVANTAOES IFAPPROVED: DISADVANTAGES IF APPROVED: RECEIVE� � NEUR 0 3 1992 �ITY C��i�K DISADVANTAOES IF NOTAPPROVED: Any applicant not given Council approval will be unable to operate lawful gambling in Saint Paul. C�3�l�'{�I� ��r�"�`�;.�°i �'�!t�L'I° t�� 0 2 1992 TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUD(iETEp(CIRCLE ONE) YES NO FUNDING SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION:(EXPLAIN) )� Q NOTE: COMPLETE DIRECTIONS ARE INCLUDED IN THE GREEN SHEET INSTRUCTIONAL MANUAL AVAILABLE IN THE PURCHASING OFFICE(PHONE NO.298-4225). ROUTING ORDER: Below are correct routings for the five most frequent types of documents: CONTRACTS(assumes authorized budget exists) COUNCIL RESOLUTION (Amend Budgets/Accept. Grants) 1. Outside Agency 1. Department Director 2. Department Director 2. City Attorney 3. City Attorney 3. Budget Director 4. Mayor(for contracts over$15,000) 4. Mayor/Assistant 5. Human Rights(for contracts over$50,000) 5. Ciry Council 6. Finance and Management Services Director 6. Chief Accountant, Finance and Management Services 7. Finance Accounting ADMINISTRATIVE ORDERS(Budget Revision) COUNCIL RESOLUTION (all others,and Ordinances) 1. Activiry Manager 1. Department Director 2. Department Accountant 2. City Attorney 3. Department Director 3. Mayor Assistant 4. Budget Director 4. Ciry Council 5. City Clerk 6. Chief Accountant, Finance and Management Services ADMINISTRATIVE ORDERS(all others) 1. Department Director 2. City Attorney 3. Finance and Management Services Director 4. City Clerk TOTAL NUMBER OF SIGNATURE PAGES Indicate the#of pages on which signatures are required and paperclip or flag each of these pages. ACTION REQUESTED Describe what the projecVrequest seeks to accomplish in either chronologi- cal order or order of importance,whichever is most appropriate for the issue. Do not wrfte complete sentences. Begin each item in your list with a verb. RECOMMENDATIONS Complete if the issue in question has been presented before any body,public or private. SUPPORTS WHICH COUNCIL OBJECTIVE? indicate which Council objective(s)your project/request supports by Ifsting the key word(s)(HOUSING, RECREATION, NEIGHBORHOODS, ECONOMIC DEVELOPMENT, BUDGET, SEWER SEPARATION). (SEE COMPLETE LIST IN INSTRUCTIONAL MANUAL.) PERSONAL SERVICE CONTRACTS: This information will be used to determine the city's liability for workers compensation claims,taxes and proper civil service hiring rules. INITIATING PROBLEM, ISSUE, OPPORTUNITY Explain the situation or conditions that created a need for your project or request. ADVANTAGES IF APPROVED Indicate whether this is simply an annual budget procedure required by law/ charter or whether there are specific ways in which the City of Saint Paul and its citizens will benefit from this projecUaction. . DISADVANTAGES IF APPROVED What negative effects or major changes to existing or past processes might this project/request produce if it is passed (e.g.,traffic delays, noise, tax increases or assessments)?To Whom?When? For how long? DISADVANTAGES IF NOTAPPROVED What wiii be the negative consequences if the promised action is not approved?Inability to deliver service?Continued high traffic, noise, accident rate?Loss of revenue? FINANCIAL IMPACT Although you must tailor the information you provide here to the issue you are addressing, in general you must answer two questions: How much is it going to cost?Who is going to pay? � Minnesota La.wfui Gambling qZ-�3g3 � Premise Permit Application - Part 2 of 2 ..::.:::::.:.:::: ., .�::::>::::>:<:>:«;:::«:;>:::;<::>::>;:::::«: _ >:::::;�::>:>::;:<:>::: : :.:... , . _ ,. - ::. , : ; _ :;; .:.: . >:� <:Ba :::Account n o ahon:<:>::>:�:<:::»><::_>::»»>:>�::»>::�>::::>�:::>::»::»;::;::;:::<�::::>:::<:>:«:::>::::>:;::::;>:.::::::<>:::::::::::::<:>::::>>::>:<>:;»>:�::<::>::»�::::>:::;:>::>:<'::»::>::�::::<:�::>: .GambItnq. . nk_ _ _ _f rm ..............................._............................ ...... . Bank Name Bank Axount Number Commercial State Bank 09-526-5 nk Address City State ip o - 5th Street at St. Peter St. Paul MN 55102 � _ _. «::;>. >,.:,, _ ,..::: >,;.. .::... _ .;:. ,.:. ,;,...::..:...;:.: .::. :,.......».:.,..:,.:..:,..:.::,: ::::::::>;:::::<:::?:::�:<:..:.... .::.:;::: d , anz ; arad ttidtawals:>:::>.:::::>:::::::::;,:>:<:::>:>:::::<:::<:::::::::>:::::>: ::::::.::::.:::::::::.:::::.::::,:::::Name,.;�ddr.ess<:aat.::l�tis;cf.persorJS,aU�+...:..ed3�:�:s�sec�isar�d�nake,.�3'ep�sms:....:..�►+n...................::.�:::.::::::::.:::::<.�:;..:.:......::, .:::.<;>;;:;:>.;:<::;;.;,�.;:.;:.::.;;:::::::;:;::.;;.>;:.;>:.::::>::;»::»:::;.;;�.>::;:.:_>:>:.:<.>�;.>:.::;<>:<;:::<:..:.:::::,.�::::.:;:>:::-;:.>:.;:.;:.;;;;:::.>-�:.�:»;:>..:::;;:;:::::,:: ..... ...:.:..:.�.........:::::.:::.:.........................:........ .,...;....,_:... ::<.�:��:._,:.:,::::.�::.::_:::.::;�::::.::::::::::::.�::.,.:::..:..:,.::::.:::::.�:.:.,::::.:..... :::.:::,:::.r:.;•.;�::::�.�:::•::.:�::::::::.::.::.;::.:.;::;•;>;;;:;.;;;;:::.:;;;;•>;;;:Ora rrau , : ::no>�randl .,......_.. ... ..... .. .,..... arr ars b�easurer t e aarn�in ; � >: <` . _ .,.<, . :::: ,,,,.:. ... :...... . , _:. ame odress ' e Gambling Matt R. Hammerschmidt 1908 So. Greeley ST. , Stillwater, MN 55082 Treasurer _ Roy P. Klatt ` 722 So. Everett St. , Stillwater, MN 55082 Trustee vt::.v;;�.::, .. :.».:.: :.:t>::�:v::».:»:::>:::::::::;::�>�>::>:::<;::;:�<:;;::::;;:::::;;:v:::>::<::<:::»:<:>::�>;:;�:�:::>:::>::::�:::�:_:::�:::::�<.::;<:x::.;:�::<::::»:::�>,>: � :,,....,K...w.v::nr,N:..::,.;:.:;.::.::.>:.>::.>:.;:.>.v.::<.»:.;:.;::.:r:.Y:.;::>::::.;:.;�<:::;:;.:::::..:::::.:....::.: - ::.v:>:.: .�:::::::::::::::,.::::.. .....:::.. i:il�iiii}'ri:i:C:i:'�i'r.�i:)i$ii:4i{:$:i}:}::::�' 3i:t>ili4:iti�" .: ........ .... :.... .....:.::::.........:......................n.......r•r.�:::::.f••:.�... .............v..l:iiiiY::;!::::::::::::::::w::. .::::::ii::::s::?x�ii:;: v. .... .......vfi.... .n ..�.................. .............................. r �.::�::•:itiC•::•ii:i•i"•::. r:.':•:::r.r�:i•i:::::n�:r:.r....... n{{:{:.;....ii'::::::::.: .r{....•::rv}iiiiiii:r .{A.•:v�::!:.....5..,-�::.:.M1 v. :. . . .; . . .. .. . . v:::::::::::.�:.::::::::::::::::::::x:..nn...... :::::�:::::nw.•:i}:?r:ii:•i:::i:iiii::.�::::0}iiii%ti••::x:r:ii:Yii:4i'T�?iiiiiiiii:L::ii}.4ii:i•i:•ix:fi•}....r..v } ...{.,-.:-}"::::::ni:::::.:�...::v•.�{..::::......:w::........;....:�:{•;;.....�:m::::x}v. :i•i4hi}:.�.'.•:ii �:�:i4:{i>�i:+:i:�}Si•{:••i:::�::::.::5....::};.........::r.r. :::$ .. . � ::::::::.�:.:�::::::.�::::. .... n.}::':+ . ..� . � ..........v........:.:v.. ...................................v.......... 3 eme t:.:::::::..::::::::..:..:::........,......:..:......:....::.>..::.�:::::.... ...{.n�:i•:�:•i::�i:�?:i•i:•i:�::�:ti�j'�i::ii:.v.,+.� Acknow ed n .. ..::::;.,.v.....:.:...:::v:::::::::;.;:::<.,::::::::;.:.:<.::.:::;:::....::.,::. . . ...................................................._...........,,........... ...................,..........;.::.::.;::.::..;;;;::::,;.>;:;::�::<.>:<.;:.�.::.:::.:.::::....�.:::::...:�.;:.::..::,:::::�::: .�g:::::._::::.�:::.�::::::::::.�:::.:::::.:::::.:..:::.�::::::.:::,. .,,,. ..� >::<.;::.>:.::.>:::..>:�::.:::<:.::;;.:.: .... ..... ..................::.:.:..:�..««::<.>..;:.�«;;;.:;.::::..:.:�:.::::::<:.::�.::.:::<:;;,:...::<.:.::.::.::.::.::..:;.::;.<:;.::.::.:<.:.:<:.:>::.:�<:::.:«.>:.:::�.::.::..::::::::::.::.::.::::.:::«.>�.:�;«.>::.<::,... .... ... Gambling Site Authorizatioa •I am the chief executive officer ot the organization; I hereby consent that bcal law enforcement officers,the •I assume full responsibility for the fair and lawful opera- board or agents of the board,or the commissioner of tion of all activities to be conduded; revenue or public safety,or agents oi the commissioners, •I will familiarize myself with the laws oi Minnesota may enter the premises to eniorce the law. governing lawful gambling and rules of the board and Bank Records Information agree, 'rf licensed,to abide by those laws and rules, The board is authorized to insped the bank records of the including amendments to them; gambling axount whenever necessary to iuffill •any changes in application information will be submitted requirements of current gambling rules and law. to the board and bcal unit of government wiihin 10 days _ Oath oi the change;and I declare that: •I understand that tailure to provide required information •I have read this application and all informafion submitted or providing talse or misleading iniormation may result in to the board is true,accurate and complete; the denial or revocaiion of the license. � •all other required information has been fully disclosed; Si ure ot chief execu2iwe-0t#+ser Date _ _� � , � 1-21-92 ;::<.<,::;.;:.;:::<.;:..>:.:;.;� :..�:.;:>...;.„�..:..:;..::::::.>::.,,.... . .::..::. . .. . .. ..n..:>;:.::.:>;>. ;.;. r:.}..::.>::�.:::.:.;,;:.::::<:::.:::,; .>:.>:.>�:;::::�;::.::.;::;::., ,..............,....::.;:::....... .�:.::.. .3%. ::�:k�•.'•.�:t;:?G:;.•;.:'.:i%�^'tc:?�::,�:•�..,.......,..+....t.......... r.��:.k�.....,M1.k�:.. t;. ::. .. � :�::::.: :: .;:..;_, .. . . .. ..:.. .:::.. .. ...:.. �.:•.:o-.,.::: ......,:•::::.:� : :::\+:::v:.:..},.::::•..:•:...: '�i4:•`.+r:•ii::::....:::r. 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'�: 1. The city'must sign this application if the gambling prem- 4. A coov of the local unrt of aovemmeM's resolution a�- - ises is located within city limits. ��vina this a��lication must be attached to this a�olication. 2. The county••AND township•'must sign this appl'ication if 5. H this application is denied by the local unit of government, - the gambling premises is bcated within a township. �should not be submitted to the Gambling Control Board. 3. The bcal unft government(city or county)must pass a Township: By signature below,the township acknowledges resolution specif'�cally approving or denying this application. that the organization is applying ior a premises permit within township limits. � � - J Clt * or Count *• Townshi '• � - Ciry or County Name Township Name . Si a of p� son receivi ppGca Signature ot person reoeivinp application �- - � � �Tide I ate Received Tide I Date Received , �e�' �n �� . �:�-:< � : �Reier to the instruUions for required atiachments. _ �y�„r`�.•�' �^°"?_ �r a� ,� M a i l to: Gam b l ing C onUo l Boar d ;:;;x.:`:;�,: Rosewood Plasa South,3rd Floor ',��- ;��'.�,,, 1711 W.County Road B ;; ��'.`: Rosevllle,MN 55113 LG214(Part 2) � • �;;� �-�:: �A.,��rz�� .��` ',;�. ( / J �� FOR BOARD USE ONLY � LG214 �� SASE# ��1 _ PP# � FEE � Minrtesota Lawfui Gambling CHECK Premises Permit Application - Part 1 of 2 �NITIALS DATE ��►:<�=::<::�::<:><� :.;>:.;:;:.;:.:;.;:.::;:.;:.;:::;;;:.;:;��.: .<=:<:::>,';::::;:;?::`:::<:<?<:>:::<�::<::<`�:>:::<::;<:>::>:::<::«:>:�;:�_<:::<:::::>:>::;`:::;::::r,:>:::�:<;«:»ri:>::::::�::`:�::>::�:»:=:<>�;::::<=;`:<::::�:<::::::<::�:>::>::<:::::':`:::::::«::::�:>::>::�'::<:::::;<>:>::,;.::::,,:;,:>':<:::>:<:::>:<>:�:>:�::>�;<�`:;':;:;?:;:>�:::>:> .:.....,.:....::........,.......:., .: .::::;::.:..:::::..::::.::,�::.�::.;:. : ....;�::.:.�::::::.:,.::.:::..�:... .: , .<;:<r:«.;�;.>:;>;; .;.::::,:. . .,. .. .:::::.�:::.::::::::::....:.::;. <::::::::::::.:::.�::::::::::::::::::.�::.;�,::::::�.:::..:.:.... ..:>:::::>�::>:::«::::::::::::::::>::>a>::>::::>:�: :.. >::A TtGQ�10Jt;;:.:�;:;::;_:.;;::<:::>.>:�:<::>:>:->::;:«:r«<:::>�:::.:•::.;;:.,::•;:•;:•:;>:::<>::�:>:<::::::><:>:s:�<>:::>�:::.>.::;:<::.:<::>::::::::<:>>:::>::>:�:<_>;;:,;:::><::;:;::;•:::.::�•;:;.:..�.:::<�:��:>;:::•::<.:•.,:.,:,_.:;:.:.;::;.::.�::.;:.;;;:;>:;:;;>:::;:: <...: :e,v ;:.:::. . .::::::::...................................r. . . .. . _ . ......... Class oi premises permit DX Renewal A-00863-001 i��k one) Organization base I'�cense number � A($400) Puli-tabs,tipboards,paddlewheels,raffles,bingo Premises permit number � B(5250) Pull-tabs,tipboards,paddlewheels,raffles � New ❑ C($200) Bingo oniy ❑ D($150) Raffles only +.T:KtxnY:rtx;xrm y,:�{i^:i.vw:¢x;xq�. •.v rvwr :rr�v:.i'v;;y.xn.r:n•:r.v�::i:i•i:•i:i;{n?:•:ii:n;r{r.;{.;{{.;yv,:{.{r.:i�•:v�i:::r.;;{rs.,x.;ymrx.;{r,.;{r.yri.r{.ii:.w:.:ro.i'•::N.M.%{.;{r{ny,x�;�;.{.y,nv{:.};m{.,w,.•.}::'v:p};;•}:i?F•:i??.i:??.:::..:...... iM,.ii^:{;...M.Y�;7;..,, .. .v:,l. . ..i ..nf { f �.'.. ,+,�'i�,.;};r.n ^.ry......::v::::::::::::r: i:;} � .x.w:w::...... •..:::.i'::v•..... .3:ti??:4...::::. �.�........... r:w•:,'r,'...r . ................Y.......:..�:..�..:::: ..... ..n........�.........................::.........:.v::......:. . .:.�v:::•.....v.........r...............::i•ii:�i:•ii:.yrr.i.:•:::•i:•i::::::;ii:.i..:.:r::.yx{.::.. ..:/.w::}.w:::::x •:•\•::x.�::n�:n v::::ii::ii'r.+ . :4:4i:nr•iiii+iiiiY•i:i:iiii:tiitiIX•y.} •xQn?vi:w{:;x:�::.•`:r:.•ny.i'•:Y•iv .. .:::::. :w:::::t..r:x:. •::5:•:..� :.:!,•:::...:...... . :. . , . . . ::a� � ...... ... ....;...... :• ., •.:'rr•`.:;..:%o::'t�:R�r;n�..:x:�•.::•:x•,.'-:•:;::•:::.s;::�.'•'•,'•.`::ir�3 � v.::;,F.?;'1,.;:;•{:5::•i}:}}..;.........w:..�!2L)::iii:C:;:Y::�i:i::......... atzan<:> o :; . a ct. o�t<:.>::::::::<::..<:>::»::>>::::<�:>:<::«::>:«:>:<:<:,<:::><::::>>>::>:.;<;;.::.: . �r r� ..�. .r.rr� :� � :::::::..:.<.:;::::<:>;:<:::>:<..:::<:.;.;.;::.;:... :. : . . . . ...... :...............................................,.....,.......................:.: . ... . .:r.:::::.::::::..:.:�:<r.:::<:>::>::>:.::>::>:>:>:>:: ..............,.......,.,,..:..::.<..:.....,::.,.....::.,....,:...........................:...:....:...:... r................................ r...::.. ..:............,...................... ............. ........... . . . . ............... ..,...:.:,::..::::::::..::....:.::..::::::::::::,:,:,:,.:...:. Name of Organization Monsignor Ravous Assembly Business Address oi Organization-Street or P.O Box(Do not use the address of your gambling manager) 408 Main St. Ciry State Zip Code County Daytime phone number St. Paul MN 55102 Ramsey ( 61a 228-1087 Name oi chief executive o�cer(cannot be your f}ambling manager) Titie Daytime phone number Anthony D. Phillippi Faithful Navigator�: � 612� 771-1212 �'� Bingo Occasions __ - - If applying for a class A or C pernnit, fill in days and beginning&ending hours of bingo occasions: No more than seven bingo occasions may be conducted by your organization per week Day Begisming/Ending Hours Day Beginning/Ending Hours Day Begl�sning/Ending Hours Mon. 7:30PM to11 :30PM to to to to to ;;.` _ -" to If bingo�vill not be conduct�d.chcck here � ._ -:. .._ _�_ f,��4°.�'., t�._,.°ro.«•'n��°°r°..,.,,�..,,; ��3o-�..,�...�'.',?`a�s"`a? "•`.%.?�`FS:t',r"..S,t : k;ftt;k�i;P<,x J ��.w.;:X?;?Ky't.�'t�.,Yn�?vr;.,'�'.""'°"'.::�y�+';�,i:Y'v:h; . . . C3`•4C•n1cr.".'.w.'. �p ,�+.� a. . 4.W::�.fi�'. { ._ >.. rrr�� tl !��y y��y:}�. �> Y 4��iT�^: '}` dc ""!Y>,.��'��5.�{��'.�i:Y,.H;.:::;Cn%};W. } � -Y��iY,'•jvi'•?.}�'•'r+iiii'v'yi� . . � �•Oi�il::. 1`:x .f:..y v.k .�J,rryL. v e,G{.�y't r •L.!;i¢{}.;::j::^ii:.i:+:.i:r..;y:}rl•:?%�i:+'•i..++•:{.:::•in h.�:'. . . XM.��. . ::��3.. ��V i.}?rY.t•ii:it:i.:i':`;•J.�n•�}1T....?� r.f•'•vYn x�/? {.:',+}.i•S:•r: •::}h•�.•:+.�'a••:::::t:v.3:r ::5:r:•:?r:S:r• x:ri .:.•: N .. . ........n.�..::•.. .............. ............x:.:::::n::::::..:.............:::nn....:..............v... v...ri:.F...n...�fi�....4:»i?^]:•'i$�:•::.......:f•'v,•::iSi�•::i:^}:?......{�\S..ri.J.......{...:i:!.r.{,....{...... . r.nv.n.v.vn.....n�s..............v..n...n..n........{.........................................................v::..:.�.v.....:...L...................n.::.....n..............�.:....................}.....................�...._.......r........�.'�. - Aame o esta is ment w re 9am�linp wiT conduct treet Ad ess( not use a post o �ce box numberj Knights of Columb�us Hall 408 Main St. , St. P�ul, MN 55102 Is the premises located within city Gmits? (�]Yes �No If no,is township �organized � unorganized p unincorporated City and County where pambGnfl premises is IocaDed OR Township and Couny where gambGng premises is located it outside of city Gmits St. Paul � Ramsey " Name and address oi lepal owner o(premises City State Zip Code .�:_ Kroll Reality Partnership 212 W. 9th St. , St. Paul , MN 55102 ;; Does your organizaton own the buildnfl where the pamblinfl will be conducted? p YES �j NO If no,attach the followinp: • a copy of the lease(form LG202)with terms for at least one year. ' a copy of a sketch of the floor plan with dirnensions,showing what portion is being leased. A lease and sketch are not required tor Class D appfcatians. :;-�_ ��..a:�iY,''.! .,:�y,,,,�y.co�q.. .�i �`�#� �,� ..0 ;. ,�",,.� ^.�:�^'n.'. .<:o�q•x<y, .wk, .y;st;t;<,t{:;�:<.72 ' +:'�:2C',.R .,• + ^p+�.°{.� �` �..%'K#4z�'` ., �i' :�;' �.'�.�...�..'.� ,{•�s . s•.::. .;,�.:�(.�.�.?�Yi ''...�� '.r�'''"•`.�°..;.. { ........o > ...,�..,s�..;«w;u.yh;.,;. <� f.�.•.>». ..�......�.�,•+t.�..�.'��.� r,.�' >.�u'.. ..:,.,.}+a.,'�k',.fy.µ,..v,:,v,\•,•,•;Y};x• }'.•y:;:i�:a ��.. :;A.':'S, r�.•. q.� � > .°{:9.*... i� � av �;ri.<.�''•r�• {::� "�,.. ��' �►dc��s..'::>o.f:sto:.:.. e:::;s ac�.��' �mblin k.e.. aate�t;.��:.:�:�t��a��o.�x::�;�,��. �v>�:�:�`;::;:k;;�:::f;,��:<,:� ... . ... ... .... .... . .... . ...:: .................. r-�� .. ....::.:.... . , . �_��.„�y � :. Address Ciy State Trp code . "`��408 Ma i n St. , St. Paul MN 55�02 , . � � �� rr, � ~ �� y. :�„�-nrt� r'R`.� 'Y3'y=�.k,' �'�'�,7� _ . .�.�'4,? "i ,. �Y.. ,kr' �x;f•^.�i- %:: ,�, , q2-3�3 E/ DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE v��`�9�, / INTERDEPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by . �An�n �D/►%Cl��ud Applicant �0/1 S f �l�VOCL �►76� Home Address /�"Q�/�Q/� �' .S^_5'/�'02� qnor X y Business Name��pr- avoux r4ss�ml�lY Home Phone o1�/O�'� Business Address �}�� Ql�'I �J�Jr�Do2 Type of License(s) �'� �CtSS � (�/xa`!!l�/ _ ✓ Business Phone o�o��-�O�f �j��yj(�'� �e�`/Yj��f - I�e�e�4� Public Hearing Date �,�� 19a,.. License I.D. � j�- �0�6��-00� at 9:00 a.m. in the Council Chambers, 3rd floor City Hall and Courthouse State Tax I.D. 4� �` fL $�/� Date Notice Sent; Dealer � ��/9 to Applicant Federal Firearms �� Public Hearing �'v'"7' /� �� t/ ,��o-9a DATE INSPECTION REVIEW VERFIED (COMPUTER) CO1rIlKENTS A roved Not A roved Bldg I & D I N j q- Health Divn. � n�f� I Fire Dept. � �r� � Police Dept. �� I °1��{,�� License Divn. � ( 75�0 ��-�-��-v o% ��I�a I City Attorney � °�'a��ti�- � ai� Date Received: Site Plan �Jl3 ! �� To Council Research � [ a- �t L Lease or Letter Date from Landlord o2 I 3 q d � qZ-3�� ✓ DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE o�-�a'�� / INTERDEPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by C Lic En� A�d�a� - F�-t�� l n E-�eh so h� / c; Applicant �• �as'fd1'1//- �J�-�Lf'�h Home Address �f< E. �,y,ehZl�l�LG�'J 1`7��i �� Business Name . C'l7Sl l9?f I-- �Gl/�!� Home Phone '7'7�-O�� 2 Ps9 ! n 1_ / J " Business Address E, CLSP �tu�F� ��dType of License(s) c�"�T� �`a-� ��d`�'� Business Phone 77� Q�(�,� Lr�v�j �rem c� �err�� '- �-°��/ Public Hearing Date � t� �a- License I.D. � � —,('Qv2��-00;,7. at 9:00 a.m. in the Council Chambers, 3rd floor City Hall and Courthouse State Tax I.D. 4� ,��,�i 7�� Date Notice Sent; Dealer � /C/`�' to Applicant Federal Firearms � /✓�/� Public Hearing C��7�� DATE INSPECTION REVIEW VERFIED (COMPUTER) COrIl�tENTS A roved Not A roved Bldg I & D I ��A' Health Divn. � �� Fire Dept. � u J,� � Police Dept. �l�al q� License Divn. 3� � ��70 �nu��/G.... '�9� I City Attorney � ��ail a�c_ � Date Received: Site Plan � I��,qa, To Council Research a 3- Lease or Letter ate from Landlord � la� �1L � . ;� : Z- 3g3 �� FOR 80ARD USE ONLY � LG214 �c=' i:� P�� PP� F� --'� Miratesota Lawful Gambling : �'�'� � , grernises Permit Application - Part 1 of 2 p��s :§ ; . : _ �; a � - - - � ' _ _ - . -. . � � . . .. ;•:w::•::•::•:r.<•::::e+�s:.,..y�.•.:�.;:...a:,:w+ . .. �e � r..,..y.•:r:c:,.>n:�x<•rx.a.,c+.x:•- <cr.»••:::.�.. ,.•,:.r, � . ,w..:.e.,:>..s?os.�. +}...r.:�.c....................�...... ..:..;,,:�•:: Jxn.. . �w"r� ,...�.... . • ,.........................,................:.::............,...:..,-.....:.........:.,...><:.�:5:: •.. •....,�-.:•�:!::+::::�.2:�:�,:::::......::::::.�•::•::.,..,'k,`�'�y,.,,..;,-,�,1.....,:;:;.::;;"'i::::` x�.......;z.;.;;....... .::::::.... ......................,.......:.:..::::,_::•::::,:::::•:.::�•.:.::r:,::::::::•::�:::•........ ,�... . ...,....,...,........ ..... ................,........,., . . > ..S`....:. .r.,. •:...:....::::::.:�::::::::.:::�,,.,...:::�:::............:.�t:•.:.:.:. ..... ......... . 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"!.v:rr.f;r.;?y�.__: v.4:ti�9?<O:•..:".�#.��' nti4::•.L.:�^:..:::..�:iiiC;:•:iii::�ii .. . ::., ...............x:::.�::::::::: ' .. ��\riii�V�:.:ri}iiY.4?:i":Ci::�' iT:?} l.:.i:-'a.i }t.:T:i?::^r{:v}?:M^.i.`^r^.^v:};:{:4:5!... ...4 �........ .....:.......... w::nvw.:_:.�:� ...... . e:::� <:>� :.: . ......... .:. �.::;:.....,:::;.;;.:•:. .,.. --.h-..�`�.�.. ::.{... _ .::.:........ :...., ...:.... .::.: :.::.:.:::::..�::.;.. :::.: . .....,.:...:�.::� �.,. c��P��S�� Renewai ` :, .. '.(checit one) ' :- ' ` . : , ' , Organization base 1'�cense number � � �� A(5400) Pu!{-tabs,6pboards,��wt�eels,raffles,bingo i .. .•--., ,> . .:_. . . _ . Prem�ses permit number �G`c� ZL`� -i L . � B�S2so� Pun-rabs,tipboards,p�3ewheels,raftles � a -. New ❑ C(5200) Bingo only i . , -- . _. s . i _. _ : ❑ �tS�� BS Oflh/ . i . . . . . � � ,.,;{..;.�.y:;:�-•-v.c:;•.y.y,.;v.::.;q,,;.,;. .t�.. :<:a;c:..,.y..;:.ye. �:{;..;,�.:::.,:..x.;;r.o-;x•::ox., . :NKNLM:�?+.^:•"" �p ..'"Ci'vY'�"f'•�i� �.'�. . . 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'�:S�i'.;':'•r:;::'i:i:�!t4ii%i�iii::'r'.;ii::j':i; . # � .n.... • � . .... .. . . ... .. .........n.�. . .. ... . .... ......... . , Name of Or�aniz�ticn � - i c� � � / �,!��S! /N i�12- � 1 Ct ✓ • 1 � -` Business Address of Organitation�Street or P.O Box(Do not use the ad�ess of yaur gambl�ng manager) _ 3c � �-� _ _ City �� State Z�p Code unty �y�me phone number - r .i .�� I 11/�r S'sic � � ��fc� c%v 7� -r:. � � _ Name of chief executive o�cer.(cannot be your gambling manager) e GzySme phone number � � ; . ��..: ._�u � I'1 � � %L�lJ��Lil1/ /�,I/olZ �L)7��-C��3� i - Bingo Occasions _ . , ` :-.If applying for a class A or C permit. flll in days and beginning&ending hours of bingo occasions: ; � No more than seven bingo occasions may be conducted by y�our�r�anization per�erk. 1 , � Day ; ..Beglnning/Ending Hours " Day Begtrusing/Ending Hours _ Day - B�ing/Ending Hours - . . �>'r ;. ..... . _, r ., t , � . �.�� 3E � _ .�� _ �: 4 _ _ � � ? j--�-.� --�-�-� . - - - _ - � - � � - - _ � ; _{ � _ _ .. � . � •tn :�If biago a�l not be condneted,check here =� .` : � ; ; ` , �- . J. � .. ..��y�l.w a�viQK4"t9��+i?r9F,C•;,S {u<rwa�x ��y < �.� t <�ca+a< {�f,a ��,eo�+y,r�f . y[�'_� Y �� r'�,a : '(<' �.S�<^MF - . �Sr.tjw�k YF fib+A'hi ..: _ ' . ��y� _ ��Q {�� 1 /� d f� x �, � .t /� ��y.�;c ;MfM� u �rr�f�<r < > . . ' '" . ��L1j1L� .... �:��iiY�:��:��1�a'��Y�..........;h.>Th�Fj�ii:�� ....��it�,.r,} .hffii...v:}:.:::.+. "'_. ..N!'.+i;4Y�.?� ,{ ,j . � .�. ;:.::::::.:�::•:::•:��.�::::•.,.,...:.: .: ....... ..............:..........�::•:::.:..:.:.:..... ..::: .. ......,t..r...-..... .,.. .. ... . . ..._. .. ' N e of establis�me t w re gamb mg will be condu: t Ad�ess( not use a posi o ae Oac rwmberj , � _. , ._. . .... . � �v� F�I ( 13.��1 �� s c.� , Is tfie premises located within city limits? ��Yes O No If no,is mwnship �organued � unorganized v unincorporated � • City and Coun where gambling premises is located OR Township and Couniyy where gambHn�premises is bcatied i axside of aty Gmits � < .. � - -- - . _ =�`5-�. ;��1, = �r�,..: l �•� I .. �- - � � � : _ � N� and addre s of legal owner of premis s . Ciry _ State Zp Code �.. — ., . . .. ., ,-, : , . . . - ' ,/ / � , �' / H�-.f%� t - � / i-( � �..�I G� /J i � � ' 1�'.'1� � oes your organizaSon own the building where e gambling wlf be conduaed?' p YES O �� - If no.attach the to0owing: _ . . . : �� ;� <•� :" . : . . • a capy of the lease{fam LG202)with terms for at least one year. . " ' a copy of a sketch of tt�e floor plan wifh d�mensions,showing what portion is being ieased. "�-^ A lease and sketch are not required tor Class D appGcations. . - : � : :..: . ,.,,,.•r:.:.,...•.....,::.,:,.:.,.. q . . ,,:a+:x� ...:tn}�>r,r.A,:,}:::::. ...n.u,;:;:,;.;y:;;•r ..;f.qr;�'r::S.•:?�;Y!!::'.•'^.'iY.. ...9?•:�p+� �:"d;�:�.";�'^.-r9FFf.•�'.^.'�- ?�",:^'.R?ot:t;;y.• ,^,.:G �tY'.•..::?"• 0..... ...C...a::�•>�a;�:•:tcs::..... :.�`t•i'`'ii:::i5.""�'.,° . .:r% .;?:-.' ..:�;.a,�.f::4�'.`:4:: :.wl„ !!;•?�...• .. ��, .•�'.?:•..�,::: ..... ..........:�...:::.•:,:::,.,-;.;..�:....:::. ...��:o-.::•,.. . r-,.,;.;:::.:�:.a6�•:•.,. ...... ::� . '�' - �'. ::�.}v:?Ok::{?r�.�..... •:C..:�::�::........ v .... � ! " .. 6•::. Av��71..�r.....:•:-:::.::::�::::��v:••{.}•:•:.}yti:j�;ii:,.>r.. _ ;� ,�.�i.,�ddxess vf sto.;..� e;:s ace�f; amblin ;�. enLyd :i�:�>YCry�:'i';�C...?. � ....:. 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Gambling Site Authorization ...................:.:::,::.:::::.::::::.;;:,;t:.;:.;,:<..;:..«:.::::�:»::>.::.>::�<�>:;::::>}::::::::::::�:<>::<;<><>:::;;<::>� - i hereby consent that bcal law entorcement officers,the ��am the chief executive officer of the organization; board or agents of the board,or the commissioner of �assume full responsibility for the fair and lawful opera- revenue or public satety,or agents of the commissioners, tion of all activities to be conducted; _ may enter the premises to enforce the law. •I will tamiliarize myself with the laws of Minnesota "�` � � Bank Records Iaformation governing lawful gambling and rules of the board and The board is authorized to inspect the bank records of the agree, 'rf licensed,to abide by those laws and rules, _ - gambling account whenever necessary to tulfill including amendments to them; -= tequirements oi current gambling rules and law. •any changes in application information will be submitted �:=_ Oath to the board and bcal unit of govemment within 10 days '� -� I dedare that: of the change;and � -: _.•I have read this application and all iniormation submitted '�understand that failure to provide required iniormation � = to the board is true, accurate and complete; or providing false or misleading information may result in _ -all other required information has been fully disclosed; the denial or revocation of the license. � • Signature of ief executive officer § :i�; �' Date � �" =- r� i�� r�( O/ 2 //9 Z �; , .... ::�:..:.�:.....,.:::::, - ,..:.:�.r.:: .........A.:.�.::.:.:�.�;.....v:.:�. .:..:.::.::..::<:»�:<:.:.::;:.>:<.::.:.::;.:.::::.:.�..:..,, .�-:-: �:...��.... .... :.:....:....:...x...>::<:::::::>.:::::�:�::::::�:.:.::..:...... _ ..... .........::._::. .,: ..,.::.. .....:.. , ... ,...,..:::.:..>:>.::::. 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The local unit government(city or county)must pass a �resolution specifically approving or denying this application. Townshlp: By signature below,the township acknowledges ` . that the organization is applying for a premises permit within ° '��` township limits. ��: � Clt * or Count •* . �. ��:� , Townshi •* �� :��,�� rty a County Name Township Name � - `P�c�e.. �:�;- � -` '��'� p pe n reoeivinp appGcation � r, � Si`nature oi _ �� Siynature of perton receivin9 application 'Y�,�^.,, � ' Thle `'� �.� � �/Yti..L�t�'►� I ate Received Title Date Received "�. J�( � °� �1z- � Aeier to the instructions for required atiachments. - .�;_r, �•��: Mail to:.:`` Gambtln�Control Board . > Roaswood PIaL South�3rd Floor . ��' 1711 W.Counry Road B - � . Rosevl0a,MN 55113 LG214(Part 2) F,�,z,� �;; . > `.. • . _.. (R.r7r�tl ..-'�i'i . . q2-3�3 ✓ DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE �~��L / INTERDEPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by �Ro a.l C-`�l �Y; �rticn�t� C�'a�il ee�i ��►�°ws� Applicant rOh S • Home Address /`J�G� /�(,[/L�/- �, j�'J/,6 o r. ►u'"�� Business Name ��plOV h�5', Home Phone �o.,3�r�� Business Address f�al� �, c�QS� �g'jp� Type of License(s) �'"�."T� (�lLl.�'S � Business Phone ��8- ��',b Q!'!9�!l K �he/Yl tS�PJ�PI''�'►')t! 'I'`Pn�--°��/ Public Hearing Date I"J �/�. License I.D. 4� �-�31�,6�� at 9:00 a.m. in the Counci C ambers, - / 3rd floor City Hall and Courthouse State Tax I.D. 4� /v��} Date Notice Sent; Dealer � /(1/ /9' to Applicant • 1 Federal Firearms �� Nl� Public Hearing �?��'�� j DATE INSPECTION REVIEW VERFIED (COMPUTER) COrIlKENTS A roved Not A roved Bldg I & D � �� Health Divn. � �fr�- � Fire Dept. � �� I Police Dept. I I�a3 tiaJ ��a4 tiz �� License Divn. f ��ia l 75�v ��-.-� �� City Attorney � a�a�lya- � o�. Date Received: Site Plan �j/(t� �l� 3 ' T• C�uncil Research � �- Lease or Letter ate f rom Landlord � ��(� q� . Z ��3�3 ✓ FOR BOARD USE ONLY LG214 BASE# v�� PP# FEE Minrtesota Law,fui Gambling CHECK Premises Permit Application - Part 1 of 2 INITIALS DATE .:.,:::::::::::::::::..:.:,,:: ,.�.:.,:.r,r��:::::,: ::.::.:::�.::.�.:-:.;:-;;�.�:..:,.:::.::<:::::::::.�.::.;:<.;:.;::::.;:.:.;::.;:.>�:.� ,..r......::.;:>:.;>:::,::..•,::.:�:..::..„.:..:;..::<.:::.:::.::::.::::.::..::.:.:::.::::>�.:;.;:.;r;.;:;<.:,.::;.:;:,<,.::;<.;:;.>:.;:.;;>:,:.:;;:, ,.,.....:.,,.. :::::.::.:.:..........:.:.:::::::..::. ..:..... .......:..:... .,.....:::::::.::::.,;.:::::,: >::;:>:<::>:.�� :;.:e:��''` ._:.ca�::.:>:or��':'':<:;:'>:.:i.:;<;;<:;��<��:�:;`:��::'�<�::::»:':>::::�:>:�::::��:>;�>::<>:::::'�:::�>:::<:�:::::::::;::.>::>;<'::::>::»»''::`>:::>::::�:::��:::;::;�::<:::;::::::;::<<:::�:�'<::<::�`>�:::`«:;�:;':::::::;:<>:��;;<�::;::�<:�.'��:>::<;::<;<::'»`<;<:`:<<:��_>:;:<:::::<::<::<: ................:::: :.:: .;.....:�::.:::::::. :<:::.: . .:_- :.:: ;.: ; o A ' ,1�. t� .........:.:...:.::::.................:......... > � Class of premises permit Renewal (check one) Organization base Iicense number �-�3�yG � A($400) Pull-tabs,tipboards,paddlewheels,raffles,bingo Premises peRnit number ��.`� � 6($250) Pull-tabs,tipboards,paddlewheels,raffles � New ❑ C($200) Bingo only ❑ �(5150) Raffles only :::�.;:.,::•,;:.,,,,.,•:.,.,.•:,�::,::.,:,:::.,.:.,.,:,:::::«�;.;:;;;.::;.:<;.;,,.:::,;...:::f;.r.�....:::.:..::.::.::<:<;:�;•:;;:,.; <,.:r;,..,:;.::;•;v. .<.,,,,:...:..•::.,::..,.:,:::::.::r:,:::...•::...:::::::,•,�::,..::,::::::.....,,::r:..,,..,.,.:•..,,:.::.:•.�,:.:.,•:,.�:..:.:.,•... ......................... ........ : .::..:..:....::� :....:;;;..,.....,..................................................:.�::................:..........:.:................:.. .,,.::.. . ..........,:••:.: ,:.;�....,,,.;::,:..,.::..:..:,,.;�.:<.::::::::::::::.:..�::::::::::.:•:._::.::.;:.;:-::.>:;:.::.�::::::.::�:;:::•;;:•;::•:•::,. �.,,:... ,. :•:•:::: .j� �::;:r:�::>:,,;.>.>:«..»::s;<:�>,::;>:::�s::»>::>::::>s:;�»:<:::=»:«:z<::<:::>:«:>::>::>::s:;:::::::::;::>,:::»:<:;:>: . . .::.... . .... ...:�.:�::::::"'.::::t::;:::;a�:.:...:.:::::::•>:;.:.:tt:::;.:...........x:::•::;�:: �7 /�7�� 2:�i:%:::�:::5:;:o::i::::';�< :...t.t. �Q � . �i.�L`Y/L:��::i:t';::i:i;;.:=i:;i:;;:;:x:;';:;`.i:;:iii;�;:ri:;i::;;:`_:�;::i:;;:::i;[�'`:i:::ii;:;:<;:::::r;:�i:i;5::?"<4i`3:f:�::::;:;•`:;f`S:ii��::'•`:'t�:�:i'..'•':::.'•.'��':=::%:3%:;#i:::;:;:;:;�::;tk:•`:��:::i.:S:�:..•�:::........... �' QTE1�L tIOTi� Ot'tfL .............<.::...:.{.:�::::::: ;::::�;.9.::::.,::::::.:::::::::::.:....:.::..� ..:............,;...............::::.,<:.:::................. ..........................................:...............................................................................::................,......:..:.....:..,,....,..:,,:..:..,......:.,...:..:.:......... �Name of Organization OCetle � �iud��rd Tte k�ON �� «w� o t� d 8uQ �t CO►DS usi ss ddress of Organization-Street or P.O Box(Do not use the addres of your gamb ng manager) S v�. � c� c,(,..e.t..; City State Zip Code County Daytime phone number / ^/ S// - OO/ ��wc,s (�►��)G3S—Y Name of chief executive officer(cannot be your gambling manager) Tide Daytime phone number K� �� l� K. K�� .�� P�PS%al�►.t. -� c�,z� �9SSx33 Bingo Occasions If applying for a class A or C permit, flll in days and beginr�ng &Pnding hours of bingo occasions: No more than seven bingo occasions may be conducted by your o�ganization per week. Day Beginntng/Ending Hours Day Beginning/Ending Hours Day Beginning/Ending Hours 'r"u� '1-00 to L/-!� �/�'� to to to to to to If biago�vill aot be coaducted.check here � .t.:�...x {� .. �h. .... .r ...i ,..}, . . .4'O.i::[:.,..:\}i•.}•:::::.}v:y:�•:� y' . .. .. .. - . ... {�..'.�.i:::a'r..'.:.:•v::.:nn:.: . .. .�. •:.....i'. .......+. . .... . .. . ... .. ...............:..;..,i.:,:s>�:<:n::rv.y:::aii.ii'}'�::v:;._.;;..:: . �:+ :. . ' =it:.f:•..:::.:.:'s�o-:::�:-:::::>'x•::;::3;�::-::::'::':�;.';;�a•`.•.✓.+.c:'�,•:..<,.... fi+.e:�?i.^;.r'':�•:•:•:�:��:i:` ::±Gamb <::�remises:::�isformation:.:.;;:.:.::.::.;::.::.:.:;:.::>:.:.:;::.:�:.::...;:.;:.<:�;.:.::;:<:>::>::>::<:::<:<::.::::.::.�:::::::::.:.::.:...:::.<.:.::::::..::.�.,.::::::::.�.:::::.:...��:.:u:::.:r::<..�.:::: :..;..:.:. . ::. ;:. _ __ _,;,..;.:::::...............�::::::.::..:.:.�.:::::::::. ..... . .... . . ::.::.::::..:. . .... . . ..:; Name o establishment where gambling will conducted treet AddressJ(do.not�use a�post�office�box�number) �� P ba(�.. Pa M k �k �l �3,?s/ � ,ees e s t. Pe� / �1�/' s S/O 6 Is the premises located within city limits? �$f Yes O No If no,is township �organized � unorganized p unincorporated City and County where gambling premises is located OR Township and County where gambling premises is bcated if outside of city limits st. Pa.�../- Ro�s.�y I Name and address of legal own r of premises City State Zip Code R►�{b.� . Ma�. � ; �ois S;6/ ff*•�y. G i/y dd/e �1�/ ss//8' Does your organization o n the builcGng where the gambling will be conducted? � YES NO If no,attach the folbwing: • a copy of the lease(form LG202)with terms for at least one year. ' a copy of a aketch of the floor plan with dimensions,showing what portion is being leased. 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Gam g S te Autbo oa •I am the chief executive officer of the organization; I hereby consent that local law e�orcement officers,the •I assume full responsibility for the fair and lawful opera- board o�agents of the board,or the commissioner of tion of all activities to be conduded; _ . revenue or public safety,or agents of the commissioners, .�will familiarize myseli with the laws oi Minnesota _ may enter the premises to enforce the law. governing lawful gambling and rules of the board and Bank Records Information agree,if licensed,to abide by those laws and rules, The board is authorized to insped the bank records of the including amendments to them; gambling axourrt whenever nec:essary to fulfill •any changes in application information will be submitted requirements of current gambling rules and law. to the board and bcal unit of govemmeM within 10 days Oath of the change;and I declare that: •1 understand that failure to provide required information •I have read this application and all iniormation submitted or providing false or misleading infortnation may result in to the board is true,axurate and complete; the denial or revocation of the license. •all other re uired information has bsen fully disclased; c ecutive off' Date � �' g ... . .............. .......................:. ..::..:::::..::::.. ..... .:......::::....�:::.�:::::::: �:.:.::..::.::::.:....:::..::::.....:...:.:.:.:.:::�. :.m:::::�. ...;:.::::....:::.µ::,.,:..::.:::.::.:::.:... ::.:::.: :....::::::::...::::i::::.v::..:: :: ..:::::...::.:ry.�:::....::.::::::::.:.:.:,.::..::........... ..}.�w.::::.:. .::�.}'..::.�.:.�...{.:r.�.:.{..........�.. x�.. ..�.� ..�.. ....... .n.......... ... ............ .wi....\............:• ... ...::.......................::�i'-iiiiiiii:Siiiiiiiiiiiiii,�� :::::x::.�.:.......4.......... vi:)8{�'• :•Tr.. ::l'ii:t�iiY<4� ...... ...:v::••r.•Y::�:vx::::::.�....n'�'i.~..........M.}n>..:y: :w:::::..i•... .. ..r............................:::::..�:::rrr....}. v .. }:::::::::. �(} .......i::.Y... .nv. ................v............v.. .}.. :.... ................ .:n. ::::::::::::::::•::•.........vv..:.......::.""'"'............:.v::••.5�� .r..'^X vTr.i�iJyt;:ti•�} .,-_}.. : :: ......... ..... ............ .....................�: .. .. . :..,.........;..... :.:•.v::.:.:..•::x::..:::::::::::•::.v:n...� i�'ti�ki•:+•.v�32 p ¢ .,.., ..,...y,.:;..... . r •::s:,: :`•:`:•`•�;:••`•�''•�<'>:�:Y::;�•^.::s;:;::.:,-.•:.�•::.`�, ��:>:<"��K�.`q''�:>.��.N-.'�:;.<.'::.. •:•;\•:;;i:•�:•i}i:?;:}4:ih:j_:jY:}::�:�:.;.;..r:J,'••:;'l•>�':i:•: ..vi•• i.:^.�v\•.�.}f��}�.?6::•::•.. � ..�.;$:v:y.. .::}r�.•I:i�i:+i::ii�ih: . ..}......::.:.....ry. •:4.r '.}}.,`-i,S :>;: . .;«: mmen�::�lckn � . . .. .. .�: �/Q '�., ..:.�,,,r�.:::.:�:<:><::><::.., • .Ci <.;<>. _: .. :•::::,........;:<.::r;.<:,:,;::;:;::::,<:;<i::z>:::,ris�.>:,.:::...;:::;:'.��:::.,?�:::::.,•: ::«...•:::.,.:.....::,..: �....:..:............w.....:,....,_.:.:::._:•:::.:�:::�::::::::::•:::.:�:::::::::::::::::::::::.�:..�✓..�•::�:.�::..�.�:::::�::.;::.:•�:::.;.�..;...... .. ....... k...... 1. The city'must sign this appl'ication'rf the gambling prem- � 4• A coov of the la^?I�nit oi aovernment's re�l��!ion ao- ises is located within city limits. orovi this ao�lication must be attached to this�b�ication. � — �-"'— '" �- st sign this application if 5. If this appl'ication is denied by the local unit of government, t � hin a township. �should not be submitted to the Gambling Control Board. ; �`"`L, l`� r county)must pass a Township: By signature bebw,the township adcnowledges r /I `; enyi n g t h i s a p p l i c a t i o n. that the organization is applying tor a premises permit within �r township limits. i < < /.�-�w Townshi " � - Township Name Signa f person reoeiving a li tion , Signature of person reoeiving application T' e I Date Tide I Date Received _ -9-9'� Refer to the instrucxions for required attachments. f��lD"902 , Mail to: Gambllnp 6ontrol Board �A� Ros�wood Plasa South,3rd Floor y�,��in� �� 1711 W.Counry Road B _ Rosevllkr,MN 55113 LG214(. . _ (r��r��) � . q� - 3�� ✓ DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE p��//�02 / INTERDEPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by ,, �ic Enf Aud / l�'�f 1 E6��zC-'T� .�5'/!9 Applicant;�j�S`edSae�crne�rf�Io/ri�E.��fHome Address Ge�-r.�.�d�?'ansen IGafn6� �q�". � /� J Business Namepj 'e'll� Pt2h1P{�T ►y't��Home Phone �� J -J�o�� .� e�� a -- Business Address ,g�'/l�ype of License(s) �-�`� �Q.,�S' � Business Phone ��-7�j�,�. �m6//ng ��m��/'i'V)�'�= Y`e i?�U�L� Public Hearing Date � ? c�.• License I.D. � � - � D ��-li'�3 at 9:00 a.m. in the Council C am ers, 3rd floor City Hall and Courthouse State Tax I.D. �� o�.��? Date Notice Sent; Dealer � �(f l�' to Applicant Federal Firearms # /U`/� Public Hearing ��C�y" / / '`=� l; 1/ DATE INSPECTION REVIEW VERFIED (COMPUTER) CONIl�4ENTS A roved Not A roved Bldg I & D ! �� Health Divn. � ��. i Fire Dept. . J� � NJ � Police Dept. �'� ( °�I �a� �a' License Divn. � 1 � i �5,,,� ��,c..c. C1�. II City Attorney �I�+� f O� I � Date Received: Site Plan �-)(e �g� To Council Research � o� '�j y Lease or Letter ate from Landlord � (o %�. � q2- 383 � FOR BOARD USE ONLY LG214 ' � BASE# �`z�"n,� PP# FEE Minnesota Lawfui Gambiing CHECK . Premises Permit Application - Part 1 of 2 �NITIALS DATE � :.:,...,.:,,:.;:;::.;::.>;:.:.;;;:.>;:.:::.;r.:.. :.:,...,:.r::.;;>�.:.:::.;:.v�,.;:.:::.:..:::.,:;;:.:;<;.>:r.;::.::: :::3Y:i:-0:^::'itin:'.�:�r�.}•:..y.a.:.},:.�:Yf+ti:•,v,•i'•i}ii:ti4:4':irrv{{:r::}i:rir..;.y}y.M1y.x:4::}:}:%ti4�}_.}} .}}}}}::.i:ti4. ::xt:f.+�:..�,r,;..n}i'r.•:5:•.. 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Business Address ot Organization-Street or P.O Box(Do not use the address of your gambling manager) E U • , . - . ity _ State Zip Code . Counry . Daytime phone number . .. ._ _ _ ,_ u/ S � _ �.,� _ L . . Name of chiet executive officer(cannot be your gambGng manager) Tide� Daytime phone number _ � - , . . /J . . .,. , , ; �,¢ rVd�f_.. �/�rr�la . : _ �"�t_s��1r.vZ` (L.dJ�� - 7'/�/. : . . " Bingo Occasions ° :� . - '. , . . � If applying for a class A or C permit. flll in days and begiiuzing&ending hours of bingo occasions: No more than seven bingo occasions may be conducted by your o�;ganization per week. . Day Be�nning/Ending Hours Day . Beginning/Ending Hours ' ' Day" Begtnning/Ending Hours �ES , /.• cn to�.�,i - _. . � . _ ; . . . . to ' � _.. , _ ; . _..: ... . ,_ -- - . . . _ - • -- - _. _ � . : ._ , _ � _ . . ` ' � �;_ '_ `� "� ' ' ,�; � to L' '�- - If bingo'�vill not be coaduct�d,chec]�here, ' ; s . . ' r � .,� . - � ... � J � '� - �'�°'�.p�,p'�"' 'rc�,u<,uy..`ix' y"'�K•a"m•;,R�""'Y'f�crYcQ°f'�,vt'g�" � � �� t..'� ,S�j� �` ;� � .;jiq?>'�'�r•`.`f,`"y � = 'slII1�)�Ii��TC Q�$'�� .:.� a'.��"` . � �. . ,...:.::>::.,..,.. �` ......m�e�..� ... . .:......�.. :...6><�:, � ._.�<... .�..<.��:.��:< >.�`.�V� �,�::<:..: {� �`��Y$ - � ame o esta is ment re gam ing v�nt con ; : „ ��Veet � ess(do not use a post o ice box num r) S , �` -- 'T�F�9/`��'',�i9'l/°�'-�`}_�,�.i��„' •:pr-/5�� i✓•'�'Alr�.- �Sf`�i9L/�Ji�";..5.�/l7 �. � ��Is the premises Iocated witFun crty Gmtts� ; �'Yes` �No ii no,is tovmsh�p`;�cxganized 0 unorpanized O unincorporated `' . � � � - City and County where�ambling premises is located OR TownshiP and Couny where gambfirg premises is located if outside of ctty GmRs . �'..� �:�� r-�� _} �. . s`, �t-t"� I _ ss f r: .� ,1� '' ` F,'3 s.� x S��' �9�i� �,u Ar�sr ��' �`" s ' ' _ � 1 Name and address of 1e9a1 owner oi prem�s �, Cib "; > State ;= T.ip Code „ ~ �s� ., :as> - - -: -��:. -ta�_ �( r�r .. . .: _-a -•a�:r; -� - -. ».�.�.�., 1 „ „, � Y` � �_lo.sEr�h :::�F,e�DU%�!�-,:__ S7��/I'l.�,tii�'d St•i�.9�l•..��:'/rl�y=.,; �.. ,S,s/a d ��'" , .r . �� ' � Does yo orpanization own the buildng where the�,�amblMy w�l be oo ucted? p YES . �' NO -_ ti..� y��r� � ,r ' ,ti If no,auach tfie toilowinp :�. :.,: ;�` .:, , `_: _:�' � �" ' ,�� Y � ' r• �� ; - ' a copy of the lease(form LG202)with terms for at least one jrear _ -- .� ...,- �':,;.'.� - .. ;" i� "' r'�' , u�'�' a copy`of a sketch of the tloor plan�with dmensiona.showinp what porbon is bein�leased. � ; Is'; -,�: �- � _ ,... , :, ,., . . _ ,. 4_;, - ..-:' A lease and sketch are not required for Clasa D appGca�ons _ _ , . .. . _ . - , :: � _, _ . . ._. , :. > , . _: _ � : ��a�.� �. - . ::: .: :..... ..... :...•• ,. :..... :•:. - . ..n.. :....Ui. . .� � .r -..- . y.^ . 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' governing lawful gambling and rules of the board and =,', _ -� Bank Records Information agree, if licensed,to abide by those laws and rules, ' � _ �j The board is authorized to insped the bank records of the . including amendments to them; �. -.: " �. gambling account whenever necessary to futfill _ ` � � •any changes in application intormation will be submitted _ �_ � requiremeMs of current gambling rules and law. to the board and local unit of government wRhin 10 days _:. : . _='_Oath\ , �_ , _ _ . , ..: _.� _ . ` _^_ ._ , - - � - •.- _. - of the change;and ; _ . . .. �� I declare that: ' •I understand that failure to provide required intormation� ` " " - � •I have read this application and all informat�on submitted or providing talse or misleading information msy resuft in = - - to the board is true,accurate and complete;. _. the denial or revocation of the license.�-� ` � . •all other required information has besn fully disdosed; a - S' nature of chief executive officer Date - � _ � � �q qa� .... , , - +•;\•,v,•,y:?:::s.:u:r•f.:^rh•{,v.:.i..}..:. „.- �, .::.v:.•:.v::::�xv::.vrx•.•:•r:x•::•.:.•.v nl•x .v... ..r•n•.v. :• r•. �:+r:• •.�•n•.v•p»tt.�vv •.vrnv...,..:•:r•r :t•.'s'::.•. �.,v.:}•.v.v,.;.x.}:.r....••S:•::: ...:ti.... -�- -� ...........,.........k...........r.. .x.t.....+x..•'k:0'X.:•`.}>:,t,.. .. 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' ��tli�e gambling premises is bcated within a iownship , � -. - - ,� � ��,�� - `� . ; _ : j �3 L;The local unR govemment(crty or county)must pass a '. � 4" �"� `' '� " � ; �. , . _ .Township:_By s nature tiebw,the township acknowled es � : �- ,resolution specrf'ically approvmg or denying�this appltcationx.¢_;that the orgarnzation is applying for a prem�ses permit w'rthin '� �T � � . �'..��T.e r .. r+ - � . f . . f � . ~ , . . �.. �...�. � .M �`��`£ ' �`F < township limds : `. ` ' Y -� -�.F �`f'�ir`� .,''�' "� _:f t �h t. ,i ✓-- z'� � ��,;j� -� �,4 r'. " ,� • '1- x h � . �,k. .-: .�,. '��.... .a-- �' -. � '�� '��` �" ' t .�G� ��'^r.��'.'� .�^ .jrt�. , . . , ; ' ' --. . , . .�..� i r �.e�", ' �: � r , � ��,Cit ' : or �Count •' ` = - Townshl '• . �� =� ,;� �,. ; , � ;�Gty or County Name 7 �- x � Y � �- Townsh►p Name . , < r _ '�' ? , � � •Y r y - �� y-' y a�z,.r " ? yic}" r x � �. �.� �s:�. . � ,Y � -, iV u ..� � � .. .- . - .• �.. ry � � ., . � , R � - Signa +re f son recervinp appGcabon v �- S�gnature of person rece�wn9 applicatwn r �° $,` V '.. -J� .� 41 F - �Y' "y � - f � � ..K�G _.J�-�: . t - � ��Ta . � - �,Tide �l.�,Y;��,�,t:,� „��'� .. �,Date : �� Title, >,,.��:3 ,�y° : .,. � Date Reoeived -i- -� .:: "�` ��'r�i3"� ��s''r •w7'�r'� I-�w. .y. i� .s - ��,o y _� .�z.. .�si+„�� ..." "A�'��-.c r^.[ r^'.r_, � �++ -r e �!'t. t,i:' w"R �, '� 1 .. . .v I �^� E' ✓ ` . :> � t i . : i..,.t-` � � � • • � _ 7S � �.;r_._ �, � �. � .,F .,, . r' . _ � y f�-.r �r� Fist the instruc�ona for�fp�u� suacFiments;��-��'^�. :'q : + `"� � .� � ? '1r��"`-',i:�� '•��`•' �` �.�„� �'• "te •�`1 � o.. r '`` s ..�y, YT' Y�.� ; r� �,t a�, -"Yn � .. ty"hn�: �-��r .. �� .� `�-.4 �' ; 2:�� .4P: •_� �.• .' '�- ,:. . .... , .. .: ,. , 7x. . . ..�.. .. �. ;.�.., .. , - . ,. . Mail to : Gamblln�Control Board "= - `• - -- • ' � ' . .. �.. .- - � .�:'. <..� � �.": � Rosswood Plaa South,3rd Floor ` , , -' 1711 W.County Rosd B � ` . Rosevllls�hAN 55113 � LG214(PaA 2) . ;� - . (wv�r��) , -. ;; . : _ . r - _ .