92-384 �������, , ':Council File #` ������ "
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� Green Sheet � 19239
RESOLUTIO
CITY OF SAINT PAUL, INNESOTA
c - �
Presented By
Referred To Committee: Date
RESOLVED: That applications for renewal of various State Class B Gambling
Premise Permits by the following organizations at the addresses
stated, be and the same are hereby approved:
ID #B-00269-003 St. Casimir Church Schwietz's
956 Payne Ave.
ID #B-01390-003 Minnesota State Band Keenan's Bar
620 W. 7th St.
ID #B-01390-002 Minnesota State Band Narducci's
1045 Hudson Rd.
ID #B-03146-001 Royal Guard Jr. Drum Christensen's
& Bugle Corps 1567 University Ave.
Yeas Navs Absent Requested by Department of:
uerzn i
on �
acca ee � License & Permit Division
es i
e tman �
un e i
i son /" BY�
U
Adopted by Council: Date Form Approved by City Attorney
Adoption Cert' ' d b Council ec etary ��1�/� + � f�
_ gy; f"7i'"�/(�i�/�/%� � %� G� Z -Z� "lZ
� �
By:
` � � �"��" A roved b Ma or for Submission to
Approved by May Date ���' �" `� ' �' Conncil y Y
�
By: �/'�����/% B
Y=
�:��'��� I��'i� =� `r�2
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9Z.- 3g�f�
DEPARTMENT/OFFICE/COUNCIL DATE INITIATED N� 19 2 3 9
Finance/License GREEN SHEET ,
CONTACT PERSON 8 PHONE INITIAL/DATE INITIAUDATE
�DEPARTMENT DIRECTOR �CITY COUNCIL
Christine Rozek-298-5056 Agg�GN �CITYATfORNEY �CITYCLERK
MUST BE ON COUNCIL AQENDA BY(DATE) NUMBER FOR ❑BUDGET DIRECTOR �FIN.&MOT.SERVICES DIR.
ROUTING
C1C Clerk B I � 1 0 ORDER �MAYOR(OR ASSISTAN� ���R
TOTAL#OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION REQUESTED:
Renewal of various State Class B Gambling Premise Permits (ID 4�'B-00269-003, ��B-01390-003,
4�B-01390-002, ��B-03146-001 " ') .
Notification: Hearin Date: 1�
RECOMMENDATIONS:Approve(A)or Re]ect(R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWIN(i QUESTIONS:
_PLANNING COMMISSION _ CIVIL SERVICE COMMISSION 1• Has this person/firm ever worked unde►a contract for this department?
_CIB COMMITfEE _ YES NO
_STAFF _ 2• Has this personHirm ever been a city employee?
YES NO
_ DISTRICT COURT _ 3. Does this person/firm possess e skill not normall
y possessed by any current city employee?
SUPPORTS WHICH COUNCIL OB,IECTIVE? YES NO
Explain ail yes answers on separate sheet end attach to green sheet
INITIATINO PROBLEM,ISSUE,OPPORTUNITY(Who,What,When,Where,Why):
Request for Council approval of the renewal of various State Class B 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
ADVANTAGES IF APPROVED:
DISADVANTAGES IF APPROVED:
RECEIVED
MAR 0 3 1992
CITY CLERK
DISADVANTAGES IF NOT APPROVED:
Any applicant not given Council approval will be unable to operate lawful gambling in
Saint Paul.
Council R��e�r�h G�;���r
MAR 0 2 19�?_
TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETEO(CIRCLE ONE) YES NO
FUNDIN(i SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:(EXPLAIN) �' .I
W
. .
NOTE: COMPLETE DIRECTIONS ARE INCLUDE� 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 rypes of documents:
CONTRACTS(assumes suthorized budget exists) COUNCIL RESOLUTION (Amend Budgets/Accept. Qrants)
1. Outside Agency 1. Department Director
2. Department Director 2. Ciry 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. Activity Manager 1. Department Director
2. Department Accountant 2. Ciry Attorney
3. Department Director 3. Mayor Assistant
4. Budget Director 4. Ciry Council
5. City Clerk
6. Chief Accountant, Finance and Management Se�vices
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
sach ot these paysa.
ACTION REQUESTED
Describe what the project/request seeks to accomplish in either chronologi-
cal order or order of importance,whichever is mqst appropriate for the
issue. Do not write complete sentences. Begin each item in your list with
a verb.
RECOMMENDATIONS
Compiete if the fssue in question has been presented before any body, public
or private.
SUPPORTS WHICH COUNCIL OBJECTIVE?
Indicate which Council obJective(s)your projecUrequest supports by listing
the key word(s)(HOUSING, RECREATION, NEIGHBORHOODS, ECONOMIC DEVELOPMENT,
BUDCiET, SEWER SEPARATION). (SEE COMPLETE IIST IN INSTRUCTIONAL MANUAL.)
PERSONAL SERVICE CONTAACTS:
This information will be used to determine the citys liabiliry for workers compensation claims,taxes and proper civfl 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 annuai 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 projecVrequest produce if it is passed(e.g.,traffic delays, noise,
tax increases or assessments)?To Whom?When?For how long?
DISADVANTAGES IF NOT APPROVED
What will be the negative consequences if the promised action is not
approved? Inabflity 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?
�Z-38� ✓
DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE o`�-�a'�o2 /
INTERDEPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by
Li En
/� - , �.�� � / ��r.Thn �-�f�� �n�G'
Applicant ��� C�QS//�?!i- �_.JU-CI�-!'l Home Address G�-3!� E�, C:�Qi'1C1/?lUh'1 /7U2. .��/D.(�
�
Business Name % • �$`� /- �J�/�J�l. Home Phone '��l,L-Q���
S [� • _1� -
Business Address ,5' � /����/O/ Type of License(s) ��T� ��4-�'� �Q'�rl�/�
��� � `�
Business Phone 7?���J"�f� `��Ph'1/S`�s Ti�I'`/►?�`� ' I^�'f��GfJ4/
Public Hearing Date ,�- I? License I.D. � ,�- 0 D� '�j - �43
at 9:00 a.m. in the Council hambers,
3rd floor City Hall and Courthouse State Tax I.D. �� ��'6 7 d''��
Date Notice Sent; Dealer � ���1'
to Applicant
Federal Firearms �� �/f�'
Public Hearing C�6L� / � �
f�
DATE INSPECTION
REVIEW VERFIED (COMPUTER) CON��ENTS
A roved Not A roved
Bldg I & D I
�
Health Divn. �
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Fire Dept. �
til� �
Police Dept. �"'�I �"���IG�
License Divn. �/� 9a i bK 7� /D �.e..�'
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City Attorney f
`��°2(�yLf L� /�.
Date Received:
Site Plan 1 �a$'�j Z
To Council Research � � q�
Lease or Letter Date
f rom Landlord � �oZ� G�
� �2-3�y ✓
� FOR BOARD USE ONLY
LG214 BASE#
-Orza9,� PP#
FEE
Minttesota I.amful Gambling CHECK
Premises Permit Application - Part 1 of 2 �NITIALS
DATE
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� � _ _ -Class of premises permit ;
Renewal {ehxk one) �
�.Orpanization base i'�cense number U[.^ � � A(5400) Pull-tabs,tipboards,paddlewheels,ratfles,bingo �
. Premises permit number OU ZLG/-bC� �B(5250) Pull-tabs,tipboards,Paddlewheels,raffles �
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� New ❑ C(5200) &ngo only ;
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Name ot an on /'�
GJ ��� r//'r //(_� \ L%(.c.f' ���
Business Address of Organization-Street or P.O Box(Do noi�u�e address ot your gamb4ng manager) �
.1 � IT t,/[1-!'�-�
Ciry ^ State Z�p Code nty Daytime phone number
J l /''�- � • /'./ .�.��C� � ��dl f'Gr �C'1�) 6�
Name of chiei execudve officer(cannot be your gambGng mar�a�} tle _ Daytime phone number
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. BingO OCCasions
If applying for a class A or C permit. fill in days and beginning& ending hours of bingo occasions: j
No more than seven bingo occasions may be conducted by your o�ganization per week. � (
� Day '' Begiruung/Ending Hours Day B�ng/Er�ding Hours Day Beginning/Ending Hours �
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` ameN o�sta4l�s ent where gamblin,�will be cond Veet Ad (do not use a po t office x number) _.
_ - � � _ i � -�
� Is the premises located witivn aty Gmits? Yes Ci No tf no,is t�wnship �organized � unorganized p unincoryorated �
' City and Cou ere gambGn ises is located OR Towrntsip and County where gambGng premises is bcated if outside of city fimits
�,:<. _ �i'�t,f C I -
� - Name and address of fegal owner of pre ses C+ry � Sta Trp Code
RI CkRR,Q---SL'� .(�J �/3' /��Gf /7 �/!. C C C=' /� J S l� �
-Does your organization own the buldng where the gamdinp wil be axducted? p YES NO _ i
H no.attach the foqowing: � '
' . ._ • a eopy of the lease(form LG20��terms for at least one year. ;
_ � • a copy of a sketch of the Ooor ptan with dimensions,showing what portion is being leased. , j
, .,. A lease and sketct�are not requied for Class D app6catio�s. 1
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- : Minnesota Latt�ful Gambling �Z-3$� V
Premise Permit Application - Part 2 of 2
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GambItn4 Bank Account .}' :::>::::<:«:»>::>:
Bank Name Bank Account Number
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Gambling Site Authorization •1 am the chief executive officer of the organization;
I hereby consent that bcal law eniorcement 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 saiety,or agents oi the commissioners, .�„„���tamiliarize myself with the laws of Minnesota
- may enter the premises to enforce 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 futtill •any changes in application information will be submitted
'� ' requiremenls of current gambling rules and law, to the board and{ocal unR of govemment wfthin 10 days
== :. Osth of the change;and
I declare that: •I understand that failure to provide required iniormation
- •1 have read this application and all iniormatbn submitted or providing talse or misleading iniormation may result in
to the board is true,accurate and complete; the denial or revocation oi the license.
�= '_; f-- •all other required iniormation has been fully disclosed;
� -� Signature of chi executive off' er Date
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�;. Z ;_:� 4. A co y of the I.,�.al unft of aovernmerd's re�l�nion aa
��' 1. The city'must sign this application if the gambling prem- ��vina this ao�l'�cation must��±?a�he�1 t�this a��lication.
2 �� - ises is bcated within city limits. 5. H this appl'ication is denied by the local unR of government,
± 2. The county••AND township•'must sign this appl'ication if �should not be submitted to the Gambling Control Board.
`� the gambling premises is Ixated within a township.
3. The bcal unit government(c'rry or county)must pass a Township: By signature below.the township acknowledges
� resolution specitically approving or denying this application. that the organization is applying for a premises permit within
� _ township limits.
;=;°_:- - - -_ .
Clt • or Count " Townshi •'
�City or Counry Name �� Township Name .
�:.; Jz k ;;-.' �
�`f` � S' nature ot on receivin lication
�s, ,���-_ Signa e of p on receiving a�b'oA �fl P� �aPP
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: �'��Trtle �.yy�,��m �„ abe Received Tide I Oate Received
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t�s`-�..- �a�-
� ��..
�� � � -:� Refer to the instruetions ior required aCachments.
.,�' _
Mail to: Gambllnp Cont►ol Board
r"� _ - Rosewood Plaza South,3rd Floor
�:% 1714 W.Counry Road B
_��°: Rosevllle,MN 55113 LG214(Part 2) .
(R.v7r2a91)
. 9Z-3g� ✓
DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE r�-�o`�'�02-/
INTERDEPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by
Lic n Aud -
� -� s-�.-1� � <��„ <.���l��d ,�5.�
Applicant �(I'?✓?�Sc� C(nd Home Address cJ(� �, f��� ;� UQ� S�%Q�
Business Name mlhn`PSO�A/ �A7£' �CJtti'l� Home Phone a.�'�-� (�� ?g
�' Pe`14�-t S j_ �/� Q
Business Address �02� G�, �J / ��✓j�2, Type of License(s) cS�7� (�lC(SS ,U L'T�21Ylfj�/11G)
/ 1/
Business Phone o2 R,� - /r�/?`j _��' 'j-�ryl(,S'�J `�e�'`/'Y1��- �'`�-`'i1�IiJQ l
Public Hearing Date �-I I']� 1� License I.D. � � - �/�`'JQ-�p.3
at 9:00 a.m. in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. 4l �Z�/ �5���
Date Notice Sent; Dealer � ��
to Applicant
Federal Firearms �� /v�f¢
Public Hearing
C?�9�� ,��-
DATE INSPECTION
REVIEW VERFIED (COMPUTER) CONII�ENTS
A roved Not A roved
Bldg I & D I
���
Health Divn. I
N�� I
Fire Dept. �
�j�. I
Police Dept. o��I �-���IS�
License Divn. ��1 (��I �5�° �y�.����'"��-"`'",`J
City Attorney I
�'a�1�1� �
Date Received:
Site Plan J �3j �� a
To Council Research �- q Z/
Lease or Letter D te
f rom Landlord � I 3 I ��
� , ,
qZ.-38� ✓
FOR BOARD USE ONLY
LG214 BASE#
n�,�
PP#
. FEE
Minnesota Lcuvful Gambling CHECK
Premises Permit Application - Part 1 of 2 �NITIALS -
. DATE
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� Class of premises permit
Renewal B-013�0 (check one)
� Organization base license number � 'A($400) Pull-tabs,tipboards,paddlewheels,raffles,bingo
Premises permit number B�13�-��3 X� g($250)�Pull-tabs,tipboards;paddlewheels,raffles
� New ❑ C($200) Bingo only
❑ D($150) Raffles only .
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Name of Or anizati n
MINNESCf�A S�ATE BAND
Business Address of Organi2ation-Sveet or P.O Box(Do not use the address of your gambling manager)
90 W. Piato Blvde Saint Paul, MN
Saint Paul �te Zip Code County Da ime phone number
55107 Ramsey � �� 296-�179
Name of chief executive officer(cannot be your gambling manager) Tide Daytime phone number
('rORDON 0. BACKLITND Band President �612� 229-5001
Bingo Occasions
If applying for a class A or C permit, fill in days and beginning & ending hours of bingo occasions:
No more than seveii bingo occasions may be conducted by your organization per week.
Day Begiruiing/Ending Nours Day Beginning/Ending Hours Day Begiruiing/Ending Hours
to to to
� to to
� If bingo will not b�conducted,check here �
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Name of establishment w re gamblin w�ll be conducted Sveet Address( not use a post o#ice box number)
KEFNANS BAR 620 1�. '�th Street, Saint Paul, a� 55102
Is the premises located within city limits? �Yes O No If no,is township �organized � unorganized p unincorporated
Ciry and County where gamb!ing premises is located OR Township and Counry where gambling premises is located if outside of ciry Gmits
I Saint Paul, Ramsey County NIN 55102
Name and address of legal owner of premises City State Zip Code
William� W: Keenan, Jre President, ISEENANS, 620 W. 7th Street, Saint Paul, Mrt 55�02
Does your organization.own tf�e buildng where the gambling will be conducted? p YES 7� NO
' If no,attach the lolbwing:
' a copy of die lease(form LG202)with terms for at least one year.
' a copy of a sketch of the floor plan with dimensions,showing what portion is being{eased.
A lease and sketch are not required(or Class D applications.
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ACVR Warehouse, 106.'Fillmore St, St. Paul, Mn 55107 & 90 W. P1ato Blvd. 55io7
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, , Premise Permit Ap lication - Part 2 of 2 �Z���� �
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H1wAY FEDERAL r,R�DIT UNION 27737
Bank Address City State Zip Code
111 Empire Drive Saint Paul, �r 55103
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Gordon 0. Backlund, 90 W. Plato Blvd., Saint Paul, MN 55107 Band President
Helmut P. Kahlert, 90 Y�. Plato Blvcl., Saint Paul, r�r�55io7 Gambling Manager
,ohn Pemble, 90 �. Plato Blvd., Saint Paul, MN 55107� Band Member
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Gambling Site Authorization •I am the chief executive ofiicer of the organization;
I hereby consent that local law eniorcement ofi(icers,the •I assume full responsibility for the tair and lawful opera-
board or agents ot the board, or the commissioner of tion of all activ�ties to be conducted;
revenue or public safety, or agents oi the commissioners, .I will iamiliarize myself with the laws of Minnesota
may enter the premises to eniorce ihe law. governing law(ui 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 inciuding amendments to them;
gambling account whenever necessary to fuffill •any changes in application iniormation will be submitted
requiremenis of current gambling rules and law. io the board and local unit of government within 10 days
Oath of the change; and
I declare that: ' •I understand that failure io provide required iniarmaiion
•I have read this application and all iniormation submitted or providing false or misleading intormation may result in
io the board is irue, accurate and complete; the denial or revocation of ihe license.
•all other required information has been fully disclosed;
Signature oi chief executive ofiicer Daie
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1. The cfty•must sign this application if the gambling prem- 4• A copv of the local unit oi aovernment's resolution ao-
ises is locaied within city limits. �rovina this a�olication must be attached io this a�olication
5. li ihis application is denied by the local unit of government,
2. The county"AND township" must sign this application 'rf �should not be submitted to the Gambling Control Board.
the gambling premises is locaied within a township. ,
3. The loca) unR government(city or county) musi pass a Township: By signature below,the iownship acknowledges
resolution specifically approving or denying this appl'�cation. that the organization is applying for a premises permit wiihin
township limits.
Cit ` or Count �' Townshl '*
City or County Name ' , Township Name • �
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Signa e of pe on receiving applicaGon Signature of person receiving application
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Tit(��r_ ', 0, _ I .Date Received Tide Date Received
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Refer to the instructions (or required attachments. � - � , ,, , :_-_ � ; r � �
Mail to: Gambling Control Board
Rosewood Plaza Soulh,3rd Floor
1711 W.Counry Road B
Roeevllle,MN 551�3 LG214(Part 2)
(Rev72451)
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DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE ,�1�-9�2- /
INTERDEPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by
� �,/ / Lic nf Au
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Applicant /f/�innE,'Sp7AJS�"7� �C.Jand Home Address C.L yQ� � �
Business Name nne�a-�CV �-�.�Z ,�ind Home Phone aq.b-6�79
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Business Address /Q!� SOi� (1:J�5lcd6Type of License(s) �j� (�/Q.�S' �,� L9"4YY1lJ!/
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Public Hearing Date �,t7 I �j �' License I.D. � ��� Q,(3 �� - Qd�
at 9:00 a.m. in the Council Chambers, r
3rd floor City Hall and Courthouse State Tax I.D. �� �f/a���
Date Notice Sent; Dealer � Nlj�
to Applicant ' "�
Federal Firearms 4E /v`/}
Public Hearing L���r� l ��'
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DATE INSPECTION
REVIEW VERFIED (COMPUTER) COrIlKENTS
A roved Not A roved
Bldg I & D I
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Health Divn. �
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Site Plan 1�3�'�a-
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Lease or Letter Date
from Landlord ! '3r q3�
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/� FOR BOARD USE ONLY
LG214 '' ` BASE#
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FEE
Minnesota Lau�ful GambTing ._ CHECK
Premises Permit Application - Part 1 of 2 �NITIALS
. DATE .
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Class of premises permit
� Renewal ' B-01390 (dieck one)
Organization base license number � °A($400) Pull-tabs;tipboards,paddlewfieels,raffles,bingo
B-01390--002
Premises permit number . � B($250),Pull-tabs,tipboards,paddlewheels,raffles
� NeW ❑ C($200) Bingo only
❑ D($150) Raffles only
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Name of Organization
MITTI�TESOTA STATE T3AND
Business Address of Organization-Street or P.O Box(Do not use the address of your gambling manager)
90 We Plato Blvd.
City State Zi ode County D e phone number
Saint Paul, MN ��107 Ramsey ����296-6179
Name of chief executive oHicer(cannot be your gambling manager) Tide Da time hone number
GORDON 0. BACKLUND Band President �6�.2� 2�9-5001
Bingo Occasions
If applying for a class A or C permit, 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 Be�nning/Ending Hours Day Beginning/Ending Hours Day Beginning/Ending Hours
to to to
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tn If bingo will not be conductcd,chcck hcre �
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Name of establishment w re gamblin will be conducted ee Address(do not use a post ofiice box number)
NARDUCCIS, 104�HudsonaRoad, Saint Paul, MN 55��0�
Is the premises located witt�in city limits? �Yes 0 No If no,is township �organized 0 unorganized p unincorporated
Ciry and County where gambling premises is located OR Township and County where gambling premises is located if outside of city limits
I Saint Paul, Ramsey County MN 55106
NPERRY NARDUCCelgal owner of premises 104���Hudson Road, Sain�atePaul� �r 55106 Z'P CO�
Does your organization own ihe buildng where the gambling will be conducted? p YES NO
' If no,attach the folbwing:
' a copy o(the lease(form LG202)with terms for at least one year.
' a copy of a sketch of the floor plan with dimensions,showing what portion is being leased.
A lease and sketch are not required for Class D appCcations.
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AVCR Warehouse, 106 Fillmore St., St. Paul� �r 55107 & �o w. P1ato St. Paul, MN 55107
Minnesota Lai.uful GambIing � /
' � � Premise Pernut Application - Part 2 of 2 �� �� v
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Bank Name ea7?37 unt Number
HIWAY FEDERAL CREDIT UNION 2
Bank Address City tate ip Code .
111 Empire Drmve Saint Paul, �t 55103
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ame ddress i e
Gordon 0. Backlund, 90 �'. Plato Blvd., Saint Faul, T1�1 55107 Band President
Helmut P. Kahlert, 90 Yf.. Plato Rlvd. , Saint ?�1, MN�55107 Gambling Manager
John Pemble, 90 9�f. Plato Blvd., Saint Paul, MN 55107 Band Member • �
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Gambling Site Authorization •) am the chiei executive ofiicer oi the organization;
I hereby consent that local law enforcement otficers,the •I assume full responsibility for the i2ir and lawtul ope;a-
board or agents oi the board, or the commissioner of tion of all activities 10 be conducted;
revenue or public saiey, or agents oi the commissioners, .I vrill familiarize myseli with the laws of Minnesoia
may enter the premises to eniorce the law, governing lawful gambling and rules oi the board and
Bank Records Infonmation agree, ii licensed,to 2bide by those�laws and rules, •
The board is authorized to inspect ihe bank records oi the including amendments to them;
gambling account whenever necessary to iuKill •any changes in application iniormation will be submitted
requiremenis of current gambling rules and law, to ihe board and local unit oi government wrhin 10 d�ys
Oath . . of the change;and
I declare ih2t: •) understand that tailure to provide required iniormation
•I have read this application and all iniormation submitted or providing ialse or misleading iniormation may result in
io the board is true, accutate and complete; the denial or revocation oi the license.
•all other required iniormation has been iully disdosed;
Signaiure of chiei execu ' e oflicer Daie
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1. The city'must sign ihis application ii the gambling prem-. 4' A CODV of ihe local��r,�r o�qovernment's resolution 2�-
ises is locaied within city limits. Q�vina this a�oli -a+��� m„st h,p �r��hed to this a��lication.
2. The county'•AND iownship•'must sign this application it 5. If this appl'�cation is denied by the local unit of government,
the gambling premises is located within a township. ; - �should noi be submitted to the_Gambling Control Board.
3. The local unit government(city or county)must pass a Township: By signature below.the township acknowledges
resolution speciiically approving or denying this appl'�cation. ihat the organization is appfying for a premises permii within
. ., township limits.
Cit ' or Count " � � Townshl "
City or County Nam��� � Township yame
Signa r of rson receiving application Signature of person receiving appl'ic.ation
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Tide � ..e�-�.� Date Received Tide I �Date Received
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Retet�to the instr'uctions fot equired attactiments: •- - • , . . . ' � • ; •.• , . ..
Mail to: . Gambqng Control Board- - -
Rosewood Plaza South,3rd Floor , . �
'1711 W.Counry Road B
Rwevllle,MN 55113 LG274(Pari 2j
(Fiw7/2D91)
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DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE �0�,3' o'Z /
INTERDEPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by
�aya�l C�-unro��'r. �Y�c.rn � Ci���eeh �� i� ��.,�
Applicant , (�pr , Home Address I^ , $'.5"j/,(�
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Business Name Home Phone �o3S"'f��,6
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Business Address � uQj�% ��, Type of License(s)
Business Phone �38���f��_ �Qmblchq�r�rn�s��rr�i� '' �h��(
Public Hearing Date ,3 17 License I.D. �� A- 03��,6- �4�
at 9:00 a.m. in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. 4� /J�/�'
Date Notice Sent; Dealer � /Jl�}
to Applicant ���
Federal Firearms ��
Public Hearing /
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DATE INSPECTION
REVIEW VERFIED (COMPUTER) CONIMENTS
A roved Not A roved
Bldg I & D �
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City Attorney �
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Date Received:
Site Plan � j
To Council Research � �1�--
Lease or Letter Date
from Landlord � b � a
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Organization base license number .7 b � A($400) Pull-tabs,tipboards,paddiewheels,ratfles,bingo
Premises permit number �� � B($250) Pull-tabs,tipboarda,paddlewheels,raffles
� New :_:;_: , - -�= - .:_;.. . _.,_ ❑ �(5200) &ngo only ,. , . :_,. �� �_
❑ D($150) Raffles only
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1� Gl GJti�d �7� �Nm u✓►t.� a� (,G 5
Business'Address oi Organization-Street or P.O x(Do not use the address of your gambling manager)
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City State Zp Code Counry Daytime phone numbe�
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Name of chief executive officer(cannot be your gambling manager) Title Daytime phone number
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Bingo Occasions
If app�ying for a class A or C permit, f�ll in days and beginning& ending hours of bingo occasions:
No more than seven bingo occasions may be conducted by your organization per week. ;
Day Beginning/Ending Hours Day Beginning/Ending Hours Day Beginning/Ending Hours
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tn If bingo�vill not be conducted.chack here �
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Gam������ �g�S te Autho t oa •1 am the chief executive o�cer of the organization;
I hereby consent that local law enforcement officers,the •I assume tull responsibility tor the tair 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 of the commissioners, .�will familiarize myseN with the laws of Minnesota
may enter the premises to enforce the law. governing lawful gambling and rules of the board and
Bank Records Informatioa 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 account whenever necessary to tutfill •any changes in application information will be submitted
requirements of current gambling rules and law. to the board and bcal unit of government wfthin 10 days
Osth of the change;and
I declare that: •1 understand that iailure to provide required information
•I have read this application and all informatbn submitted or providing ielse or misleading iniormation may result in
to the boar� is true, acr,ur�te and wmpleta; the denial or revocation ot the license.
•all other required iniormation has been fully disclosed;
Signatur of ief execut�ve officer, Date
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4. A coov oi the local unit of aovernmenYs resolutbn ao-
� 1 The cdy'must sign th�s appl�catpn rf the gambling prem • • ^� ;
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'�,� �2. The county AND towri's}up must sign this appficafion�,.�� aPP�O � ,:
` n sfioWd not be subm�tied to tFie' 4 ►n� r�oi Bo -� •
the gambling premises is bcated within a township ._.: t ,� t; ,,,,�;, , � �, .' -�' , �..�,;,� �, �,s;�
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�` . ��'3 The local unit governmerit(city or county)must pass a : . . �'"" - • ~ ' �`� �'� � �� �;
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resolution specitically approving or denying this applicat�on that the or an�zation is I in for a rem�ses rmtt wilhu�
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