Loading...
92-385��� f. _ 92 385 � ' � � � Council File # u Green Sheet # 19240 RESOLUTION C OF SAIN UL, MINNESOTA J � Presented By Referred To Committee: Date RESOLVED: That applications for renewal of various Gambling Manager's Licenses by the following individuals at the addresses stated, be and the same are hereby approved: ID #82232 Scott A. Degel Schwietz's St. Casimir Church 956 Payne Ave. ID #14483 Helmut Kahlert Keenan's Bar Minnesota State Band 620 W. 7th St. ID #38510 Helmut Kahlert Narducci's Minnesota State Band 1045 Hudson Rd. ID #12983 Christopher R. Buschmann Christensen's Royal Guard Jr Drum & 1567 University Ave. Bugle Corps Yeas Navs Absent Requested by Department of: uerin i on "/ acca ee � License & Permit Division es l e tman � une i z son � i BY� O Adopted by Council: Date R � '�' `"' Form A�proved by City Attorney ���',: Adoption Cert'f'ed b Council. Se etary //j%/''Lt�/ ��' Z ,Z I,��. By: jG�li ` By: , V � � �`� � ��� ;.� = Approved by Mayor �'or Submission to Approved by Ma ' r. Date ^ Council By; �?at/��� B : Y �������� �i�� �+ 992 � � ��"�5✓ DEPARTMENT/OFFICE/COUNCIL DATE INITIATED Finan�e�Ll�ense GREEN SHEET N° 19240 CONTACT PERSON&PHONE INITIAL/DATE INITIAL/DATE �DEPARTMENT DIRECTOR �CITY COUNCIL Christine Rozek-298-5056 ASSIGN �CITYATTORNEY �CITYCLERK NUMBER FOR MUST BE ON COUNCIL ACiENDA BY(DATE) qp�TING �BUDGET DIRECTOR �FIN.S MGT.SERVICES DIR. � �O q ORDER MAYOR(OR ASSISTAN� Cit Clerk B a.. � Q �-����_� R TOTAL#OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION REQUESTED: Renewal of various Gambling Manager's Licenses (ID ��82232, �C14483, 4�38510, 4�12983 & 4�':;'; ` ) Notification: Hearin Date: � !? �c�- RECOMMENDATIONS:Approve(A)or Reject(R) PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWINCa QUESTIONS: _PLANNING COMMISSION _CIVIL SERVICE COMMISSION �• �as this person/firm ever wOrked under a contraCt for this department? _CIB COMMITTEE _ YES NO 2. Has this personlfirm 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? SUPPORTS WHICH COUNCIL OBJECTIVE? YES NO Explain all yes answers on seperate sheet and attach to green sheet INITIATIN(i PROBLEM,ISSUE,OPPORTUNITY(Who,What,When,Where,Why): Request for Council approval of the renewal of various Gambling Manager's Licenses as listed. All applications and fees 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. ADVANTACiES IF APPROVED: DISADVANTAGES IF APPROVED: DISADVANTACiES IF NOT APPROVED: Any applicant not given Council approval will be unable to operate lawful gambling in Saint Paul. RECEIV�C� COUnC�! R���?.��" ����e� Mf�t� 0 3 1992 MAR 0 2 �992 TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETED(CIRCLE ONE) YES NO FUNDING SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION:(EXPLAIN) �� NOTE: COMPLETE DIRECTIONS ARE INCLUDED IN THE GREEN SHEET INSTRUCTIONAL MANUAL AVAILABLE IN THE PURCHASING OFF�CE(PHONE NO.298-4225). ROUTING ORDER: Below are correct routings for the five most frequent rypes of documents: CONTRACTS(assumes authorized budget exists) COUNCIL RESOLUTION (Amend Budgets/Accept. Grants) 1. Outside Agency 1. Department Director 2. Department Director 2. Ciry Attorney 3. Ciry Attorney 3. Budget Director 4. Mayor(for c�ntracts 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. Fi�ance Aocounting ADMINISTAATIVE ORDERS(Budget Revision) COUNCI�RESOLUTION (all others, and Ordinances) 1. Activity Manager 1. Department Director 2. Departme�t Accountant 2. City Attorney 3. Department Director 3. Mayor Assistant 4. Budget Director 4. City 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. Ciry Clerk TOTAL NUMBER OF SIGNATURE PAGES Indicate the#of pages on which signatures are required and paperclip or flag each of theae pages. ACTION REQUESTED Describe what the projecUrequest seeks to accomplish in either chronologi- cal order or order of importance,whichever is most appropriate for the issue. Do not write 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 projecVrequest supports by listing 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 projecUrequest 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?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? , 9Z-�5 ,/ DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE o2-/o'L-�� / INTERDEPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by Lic Enf Aud Applicant SGOT/ fT,.1J� C� Home Address � �, G2/YL/1/c�fyl �Fj V�•�•S/� Business Name �'f• �Q'SlrY11 Y'��YCYI Home Phone �,3,3 --�o �8� Business Address ��� �iC{l/�� /4U�, �=5'�D� Type of License(s) �¢�Y1,b�l�1Q //�-Q�Q�'�-' tT- Business Phone �p.��°�.'��� )^�'�1P�.!'�l./ Public Hearing Date � 17 License I.D. � ��c��,�. at 9:00 a.m. in the Council C ambers, 3rd floor City Hall and Courthouse State Tax I.D. 4� g`�� �j��� Date Notice Sent; Dealer � /V�f4' to Applicant Federal Firearms 4� /�J� Public Hearing / � ����'� �� �� DATE INSPECTION REVIEW VERFIED (COMPUTER) COrIlKENTS A roved Not A roved Bldg I & D I ul� Health Divn. � tii� I Fire Dept. � ��� I Police Dept. � ��� 9O2 � License Divn. � �f��ya- � a� City Attorney � �lail9a- I p/� Date Received: Site Plan � �Q" To Council Research � �- �j Zi Lease or Letter N�� Date from Landlord �.s FOR OFFICE USE ONLY � �''°�� LG212 �2-3� BASE L1C#� (Aev. 7/29/91) ' SEa� FEE _ � Minnesota La.wful Gambling CHK Gambling Manager Application DATE INIT ..................................:.:.:::,,......:•.,•:�.:.::::•,::::::.,.:.::::::::.::::.•:..>;:.,,.:::::::.,.::::::.�..:::.�..•::.,..,.,,..•.;:�•: fr:�:�;s:::::::>.::<.:�.A> ............. ...............:.......:...�::r.....,.....,..................................... .,.{..,......:.::,:::::•:::::::.�::::......,:.�:::::::.::;:::.;.::::::::::::,:::::.:. ...... .......:...:,..,.,. ........,.............�:•.:::::..::,.......................,....................,.............r,....f........ w......::..:.: ...... .nM1nn ..... . .......1.. ........ ............................................ .. �.................. ............r ....rxw.... .. ........ ........�......n. ............ ..::..:��::n�.; x::w:::::r::::::::::::n:::.::::::::::::::::.i:{ti+.:. . r..; .. ................. .. ......... J......... 1.... rr..t . .... .....................::::T:::w:.�:::::.�:.�:::::........v v::F.v.....:......n.+.•'l.4::bi::::::::::{r.iiii:v:.r.......r...................:....r:.:+:iiiii::v•t'.'n':r'iii::ii}i:i:iiii.... .;....y...,-r ... . . . . l y::::::::::v:............n.....:::w:::�:::::•::::::n:.......... .. . . ....:::.:.............. ....... ............... ........ ....................... {:��.�•. . ... T' }�............... ................................................n.::::::%•:::::::v::x:::iiii:i:.vw:::•:m:::w.w:r..:.....r....;............... {...v:ti:{•v::x.�::::rv:r i:•i\ti(<L::i(::�iii::•:�ii::i:�i:�ii:•i:•i.hi:::vni'�ii:�.:..:.?:.i:::t:.;::{<;n;;� :.: : . ::,' ::: . ... MOa�s:::::•:<::•:i::':::i::::•:•:•::i::::.iiii:'i:tin::i:ryiii:Y::i:':::::i:i::::•:i:::ii:::vi%vv:ii:•ii�:ti::i:i:i?:i:::i:::::y:i::;}.Y.:i:::i:.;.:::::ti:i::::•:'i::::::tii::i:i:::......................................... .. B O,. ,. Y2CQ .......... ... .. . :�j P:.::.>>:..��PP.:::::;:::::..�:::::::::::::::.:::::;::::::::.::::::::;.:,:.:..:........:. �New Give date tfiat the two-day gambling manager seminar was completed. / / Location of training (p�Y) �Renewal Give date of training received within three years prior to the date of the application fo�newal.�/�/ /�� Location of training � !. �%�"'_� � _ . ::.4G?r).....:..:..:::. ....._..:..:.:....�:.::>:<...:. ,:::.�:::<.:,:;::...,:.:>;»:;<.:..,:....:.�.::« .,::.::<,tz-::;:s:,:;::v ............................_......:.�::::..:...::.,......... .:.:..:•::.::::::•:�. <::."""'k':.'.;;.:�:::-.;�:::.:........�. ::::...:�� W�:::.:..Yh.:�:................ .. ................... .. ........................:v:......v........ .............4.. ........ n....... r.•:::::::•::::::::v::•:.�....� r.. ........:.:.:..w..x.......:......5................... ..... ........... .:.'►:•::.:::::::::::•:::::::::ny{.}:.... vw::::........"'.... Wn..... .' �nC...�u...5.r.. ....................... .. ........ .. ........ . .......:::. :�::::v.�:::+:.:......:. ....,- ......:.......:... ............. ........... . ::i:{ ..... .... . .. .. I'...... . . .. .:::�:i.i':::::.�::::::......n..:-..t..:.........y....v.......:......y......... , .....................................................::v:.�:::::v:::w::n.�:::::....r..:.ri..�......�....... y� :-::y:::;i:.4i::i.:•i:•:'F•:-:ii:�:•:�::. �}i:ii?�:'v::jj:{:;:;i:;::i:::tii�i:{i{t?i:r:if�$'ri:C�::iiiii:i:::�:;ii�:iS+:::t;i:::N:^'::i:v::i:i:iSti�:i'f+i:v�:>.i:<vii:Y::i;M1:;:i::{y�iYi:6:::;+{:t:: �am1�il:n .�fana er;I.n ormqtL .:..:.. ............................. ........ . ....... ...... ................ : .......... :;:<.;::.>::::::>:. ..: . LAST NAME FIRST NAME M�DDLE NAME MAIDEN Date of Birth Soc.Security Number � ( l �- � ( .S�ct.: � � 1� LZ. t� �� .� �z�'-� � �� -�-�t- �-�-� i d ress State ip de aytime hone 11 4 "=► �' `c � i� - .S� i'�= l /h'�tA� .�'s��� � �iz� L�3 °L`���� MEMBERSHIP:Date gambling manager became a member of the organization /�/?G/�`� Sex: M,��,t� Female ......................................:::.�:::::::::::::::::.,,•::,.::::::::::.,•.;;•:.:::::::::::::..,•:.�::.:,•::.....•:::::,..>:.;,>:,•:,::.ff:<:::,,,.�. •M:�:.,v.>;;:•-::.;:?;::;.:, ..................... .......:....:::::...::.....,..................:::.:::.�._._:::...................................... .:::�.:::.��:�;::::::.. ............. .. .....,..............,... . .......,... ,:..,....<.>:.::.;;:•;:•::...........:.........s.....:::.�....... ...,::•::::.;:;•;;:�:>;:.;::•:;: ...... ..:.....r.........,.......:::.............................................................. .....<•:::::::::.::_::::::::.::.......... ......,,.,.. ........... .............................................:........ ,:::::::::.:_::::::::•.::•. ,..................... .....................,.. ........................ ...... .,f:>..::.�::::::...... . ............ ........ ......v............ ...................::::::::::ii:::::ii.Y:::n... m::::::v.�::::::::::..::::::::.w::::::.........; v:.�:::::::::x4::}..ii.W.i:ti� ...r.n.................................v.. .... ................. ...v. :.w:.�.p:......... t.�w::n�n:�:: .............n.. ........ ......... . ................ .t.. ...........::v�::.:�::::.�:.::�::.�:::.. . ......................m::v:::...1. N r.... � . ..r............. .. ... .......... ..v .. . ........ .....................r..................::ni:y:........:.n.........:......... xm:.: , .i....... • ...............J...... ♦ .... . . • • :::.:::.i...... � :ii'}�'i::}'i���iLii'�ij::�::4::�>iii:iiiiiiiiit : . ... . ................ ..... . : . ..�:::.�.�::.�:.r::i.?'�:}i:ii<n�::n::iIX?4 }}}�(x.iY.i.i:ii?iviiiiiiiiii:i:i:;:?;:ii:}`it}i::i%:iii:}4}ii:t�i::i:i:�!tii�:�$'i::?4:i;:ii:. :.:.7iC...........................r :.- . . . ii . . . � .{:i{nii.4iiiii:i'ri._i.�:r::::•iii}y:i?i:JWA:i•i'•ti:8ii::•iii}iiiiii:iiiii::i::i::•i::::.i':?i:ti<ii:!ryi:ti{ry.i'v:{{.iv:ti::r::.i:i::?•i'iii:i:...y.:...::::..:�....:...::::.�... � D antzatio.�;In :ormatzorc:...;....,:.::.... .:::. ..:..... . . ....... . .......: Name of Organization License Number �-� > ' • , � ;vZ�`7 , /• �. ij 1�ia►� i z : �c.�f � Address City/State Zip Code Phone ' r,�ti -,�-�,� (. �C�Z � �� �-( -�3� � c-/ -;,z-,Z. ,�`) i, i c,.��- J /• //%1.,�.1 , S � ....... .... ..........:...- <:x..:.:•:r:..:.:� �v.+<wxt r.x. .v::orr.oT:'?•::trr.s<;v<a;:vr,.v r�:{. ..+�{.{.r:•a,•y,r,:.Ktt4;tryw {;..-. t.. ,...c,.,. ...i x:•r....:.,-r.:�:�:::� .,�F.:. ,...t>...::.�... t. ..;: . .._ � ............:::. .. .;"... ........, . w, ta . .�aM............... . . .. . .. ........... ...::::...- •.z:...:, r-..•::o:?.:;'•.•;::�o:i:::... •.•vr•;:.;•:.. ;•,..F^ r;.ar.`•.:;•'.: N.t...:..r........................;.:�:::.�:�:.:•:::::•:::::::.....................::..............:::•:.�:•:•::•:.�:r..,,:.•.c•..:a...,., .A: •::n:�::>........ ............... ......n.. ................. .....r...............................,-.......:::e�....v...n.v.n........$.r.:v:.....x..n.H.4.. . .{r:J.f•L::...nQ {::::n,v'�lv,F,•y::t::..f:i��'ii� ...i}::•i:•::vv .....::rr+..... .. .:.:: �:..::::.......... 1..............................:............. tf.r.....�......s..,-•;r•:�r�'i�?:i}+"•i:i: � .l.. ..{.{.�v:: .. . . . ................................................................ v.n.....�....... v..�..,r..,.. . . :• ........: ... ........................................................rx::::::::.. ..:.4.....w:rfi:xv::.�.�{.;:••'.i}:'Fv.. .::• :�M";...,'�ry{}:+i•i�in1'r:::i�J:riiii:n:r•;i . . . . ::. � . -' ::::.�::::::::::::.�:::::ivi:�:•:itiS•i:•:4i:•:•i:t:ii:•:4iii:•:•:::•:::::.�^.iin.;}•i:;.:i:•iii$i:;.}•,{{:ii9vs........�:•::•.;;:;•:{.}�..:_:::...:.:....v::., .::'F.::v.{nr - . ........................ .................r...n.....r. {.r.....:{..r... :.rw::::....n.r.v...rn.:::::.n�{:.v:::{:n�:r.:. ...::.:.. �or�c� Informa#sor� . ................:..........:...-.-.-... --A�10,000 fideGty bond in favor of the organization must be obtained fo� the gambGng manager. Name of insurance company(do not use agency name)��'°`N UC./G /ti'i u"��t _ Bond Number l�`�� .x}vsa•{•:'J.M.M}iy.�}vfn},v,{n:.}ti^:Y+,:•};•Y.i::k:i?i'i:�;:•.';{i;}.•.:�.,f,.;]:^:fi.:?,N,..jy9it';'l.Y�(.+{,.,+.;lv�S:}.'i;::^:i}v;•• .. . ..........::..rx:::.:••rx::::::::::::::::x.v::::�::?i.i::it:ri?•::•::•iX•iii'•:;•i:.tu'-:.}•.?}}}.:i{.vyX:�r:.3.::n. ..>.. ..�.:.�:i'n+�. .:.{:v. .i�'f.4::r:}ri •'yttyA,v,. xv�.w :....:....................tr.,-v;ivw.... '..r..r..v.iiYiiiiiii'r,i::.}:.r{iii{.+n••}•vi:.:r.:n.n v�.,.iY-:,?: .:fi.'ii::v? i+f::�.`i}::i:-:.. }}:}:nv.�x:. .�':i•i:::•:::•::�i:•::-i`ititi?•ii.�. ':ry.?ti:4' ....:........ ..........�.........:?:•::•::-i��i:::i}:i�::4i:•i:i•iii:•i:•iY r::::n•::::::._.�.-...n.. �y.r..L.�_{{.. . . . . ..... y.v.:x:... �.?•ri:%>.•:'v'.'r:::tiii{:iJ:;: "" •:.r.. �.�:'�.....nr..�...,^�,••�{...::.:. ......::•.:::x�v••:n�::::n v::::::::: x:::... .w::::.�:•:x::::w::{::.•:•.4.,.n�vY"r":.v}.vxw:7:r:•�••::.::G•,:•;{ry.ri::::::. . !'''".�m:n•. . ..r'i :.y:.w....n.. ..... ....:. ... .... r::''M'•.....'..x..........n...........t: ...h......�/....... .n�}.tC.. .v{?(4n::ii+4r''�:ifi:};?::�:::.'.�........ . ::r•. .............. . . ......_. ..:nY..n�::v:::::::::.....y:::n:'+-" ....r..:.•k..�.. r .� ..\.:. . . . ....""".............n:r•.{•:::.�:v.�::::::::: .... ♦ ^Kn. nr.v.""': x:i}};i:ii:ii{:i:�i:':Sii:}?J}%ti?r i:^:• � . . .. i......... , ni...::: .v,w. x:.x:.:::::nl�'..... ... . ..:::.�1.........n?•:::.::....."""n............v.....:::::n......?:•:n.:�..:::)r{:+.::{v...{?..".v::....... v,,. v. v:i'.}x �:::f•................................:....y::::xr':n:.....................::.:v....y... nr".":i.::+n ...................... ............T....... . . .} .. .'"...}:ht;iifi%i::i:::%<i}+i::?Y..iiTi........ ..:::::v�.:::i':n�....v. �c�cnowt�dr�men� ........:::::::.x....r:::::.::n.:::::< . ..::. .:::,:...... I dedare that • 1 have read this application and all information subm'ttted to the board; • all infortnation is true,axurate and ccmplete; • all other required intormation has been fully disdosed; • I am die only gambGng manager of the organization; • I will famifiarize myself with the laws of NGnnesota goveming lawful gambGng and rules of the board and agree,if I'icensed,to abide by those laws and rules,induding amendments to them; ' • any cfianges in appGcation infoRnation will be submitted to the board and bcal unit of govemment within 10 days of the change; • An affidavit for gambling manager has been completed and attached,and • I understand thatfailure to provide required infortna6on or providing false information may result in the denial or rewcation of the Gcense. / � Signature of 6Gng Mana er r Date > _ �� � � i- �-� � � . � Send the completed application,gambling manager's affidavit.and$100 check made payable to State of Mlnnesota to: Gambling Control Board Rosewood Plaza South,3rd Floor 1711 W.County Road B Rosevllle,MN 55113 . 92-38� ✓ DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE �'"j°2—�� / INTERDEPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by Lic Enf Aud Applicant ����Y1�l.�T N�C-/1lP/�T Home Address �jd �l �12� '�j1yQ; ��/l1rJ Business Name /�/i��'I�SCr/w J'7zL7��ahC/ Home Phone �-�J',�-6/�j� p.�°f�[3? S �,� Business Address �j�0 l�� i J7� �5/v:� Type of License(s) �i'?fry�6`/�� /�Q/1G����— Business Phone �qFj—fo/7`� /`e�1�t�Q'/ Public Hearing Date �-J�)IG�- License I.D. # /���� at 9:00 a.m. in the Council Chambers, 3rd floor City Hall and Courthouse State Tax I.D. �� agi ���� Date Notice Sent; Dealer � /t��/j' to Applicant -� Federal Firearms # ��/� Public Hearing ���r�� �� DATE INSPECTION REVIEW VERFIED (COMPUTER) COI�IlKENTS A roved Not A roved Bldg I & D I ��� Health Dfvn. � u' � Fire Dept. � N�,4 � Police Dept. � l��I�'�— � License Divn. �,�� I9Z i ��L 1 City Attorney ( �I�� I�1Z�I G K.. Date Received: Site Plan �'� To Council Research �- -�'tZ� Lease or Letter Date f rom Landlord �'A' ��12 FOR OFFICE USE ONLY / ' ` �'� BASE LIC# V (Rev. 7/29/91) SEQ# Minnesata Lawful Gambling FEE CHK Gambling Manager Application DATE INIT •:>:;;Q._ ::.'e>.o��:>:A���''���Iic tio�����>�':::'::><>�:�:::<:>;::::<:�>>:<:;:;:::<:>:';:'?::::�:;<:::;::;::�::>:::<::<'�;`:��:�:::::>::::;:�:'::::::��::���:'�::::`:::>:�>:`::':�>:'::::`:>:�:::;:<<>::::>.:>`::�::>:«<�::::::<:»::;::��::>:::;`:;::;::>:::<`:»:::::«�:��:::::":<>::�:::::»:`:r:r<::`:>::<'>::;:::::::::<�:: ..:..�:., :�.IP.::.;:.::.�:.:.:P.:Y?:.::.::.:::.::;..�::.::n.. �New Give date that the two-day gamb�ing manager seminar was oompleted. / / Location of training {ciry) �Renewal Give date oi training received within three years pr'ar to tho date of the application fo�newal.O?/7-8/ 90 Location of training St. Paul Ramada Inn L� � ..«.:,:. ..(G�Y.),. ..«<, :.t:: .,,,s:,t.� �.<:< .. .. . ..:...�..;-:...:.:.::.... .. ..................:::::...... . ,::.::...::::... ............... .......::n:::::�:::::v:-�w::: :.�.�:.::�::v:'.�::•::. ....b.u•rF.v...:.r..r�.:. �ip::e ..Ger,.•�ii4'?:iri4Y.x.¢Y.?�:ti!4:4:CT:�Y.e:e.•erexerv::.we.....�i� .;' .:..:....... :.. I`:i:i::.:::, ........;..............;, ...: .....;....;.i:::::::::::::::::::::.:::n..............n�iii:v:.:::�: .:h.n•::.•:a....v......::... �.rF::::n:•::yt:::•;P;��.'S.;;u;rr,�4vi:flf.:i;:tti:{:�. x:{vn'v'::r;.::ryi.::{:•:::..:::.�:: i:i:{::�;::::;:::�{J;.:i:i:i?:�:::?i::+::r:':�i:•i::�:•:�:::.':ii-:•:'i::!::5�::':!�::�:�:•i::::•.• :i:'� :;�a'. � Q..{Z e t3 z ::>;><.:::.:•.•..:.:,•: amb trt� ;: ri r � ...........;�.;:::.:....,............,.... . <:.::;:,:>::.:v; ... . :<�.:.::::�:..�..::..<:.:.: ..:: . ::. . ...... .. . . . . ... ..:.:....:.:.:::.. �Y::...A:::.,.::. ,......:::,.;:;::::::::::::::::: .. .....::.::,:::: �mc�a�:--:��:�--::-:�:����-:���-�:::::,�::;::.;::�::::..::........ ................,::::::::..,.::.;::.;:.;.<.:�:<.;:.:::::::.�::;::::,:r:.:;::.<:::. ......... .....Fi:::::::::::::::::::?i'•i:::i:•ii:n•..:.s:.'.�:x:.:v::0ii::?ii;.•::}::•iii:•:::i:::•Y ............................. .................... ............:. :..............................:.��:::::::::::r.�::.:v::..�:�:?v::!.::::::::•::::!:::�i:??{+S:ti^:� ......................:..:-................................................... LAST NAME FIRST NAME MIDDLE NAME MAIDEN Date oi Birth Soc.Security Number KAHLERT HEL1dUT PAUL 11-21-33 482-46-9479 Address tale 'p Code DayUme Phane 90 West Plato Blvde Saint Paul, MN 55107 (612� 296-6179 MEMBERSHIP: Date gambiing manager became a member of the organization O1 � 16� 66 �x: Male Female • ,:.y..::.v:r.w:.•:.:v...v.: �..•..:.::::ct?:•:•�:::?:�:�::::2::•:>:•:::•::•::t•:..:>:;•>::�::�:;�:::�::::::.:�:r>:�:a>:a:•;:•:::.>:�::.:;:>:::•>:�::::•>:>:.»•:::::::::::::.::;>::�»>:t:.;:...y;.;... ............r..... :::.�.,•::::::..•::::.::::::•::•:.:.•,...•:•..•.�:..•:.:..:....... . .. ........ .. n..... ..Y...........................r....r.. . . �.t�.�.r .r.�.v�......r j:4i;i't::::::::...... ..............................:.:::i.:nY:.::.�::-.........................::::::::.�:.�:......... ...:.+.?:.. ...S.t............ ... ...... ...{..\.r\.>. .n. ..... .................. ................ ..........� ...... •.:.;.r..•...::::. : ....:..::.......A:.�::::•: I�:•.}•:.::i•:. ....,- ::.•.x.:.:;i:.::.�.��:s::?::iii'ti�:ti!'t':i�:�:•i:•::i;:;:i;:{;i::::::.�::::::%:�•i:i??ii'J:"•i.r.:::::�:•.�..y}:::i;::.�:::•vxv.i:::+'.iii.'•.:'?ir.ii:•ii:};:...t::•i<'i•:•:i•`.•}iii:•i::i:5iti:::..v::v.w:nl.::C''::'':�:' r.frv ::O.�xSG.:inn:•i�i}.'•�ri}!i}Yr};.?}}i•.�.{•i.•w:v:• •r.;}:v:.:int•i.•:ti•:4:Ly}• :. ' . . . ... . . . ::::.�:.::::::::::v::::.:•::::...:x:�::::rY.�my::.l..e i'r'..�...........: M1.f::�iry;r.}rh}ii::.y.�i:Ti:•,'v'i••Y,i.v.}re. ..:h.y•:::w:r. .r�.. ..{ :f.... .n/%�.v:.h.....ti":•:8i"Gi:i• fl..; <.:I :,::w:�. :;<:,:;.. . f ani:zatio.n n o :: atr .�::::::.:::.�::._::.�:::::.::.:.:.�.�::::::::.;�,:::. . .,......... n..,.. .�.:::::::.:::.;. aTr.:.:�::..�:::::.�:.:�::::::::.:... ..,.::.;::,:.< . :.:.... ...._:..:.......:.,.:..:..:.::...:. :..:.:...::. : _ . ..sh:.<::::::v.:<,<::.:: . >.:::::. .�:::.::�::. t i•'...`.i r.:iii.::::Mn�x:.......:v.::i�i::::?:tiv.i:.:........ .... ...... .............................::::x::::•{:nii:{<r,v.:::}.::+..::'.��......+.4?:.i.i:i?i4:{ryhvt.i;{::.};::: {'.':..,.::t�.;..y�}}::ri n....., n + • .. ............................................. ... .n:....:.:::::: ,�;v.}•{.:ti?�::•::.v..:::...:::::^..:.::):..•i•i:i:.;...::::..:::�•. Name of Organization License Number MINNESOTA STATE BAND a-01390-001 Address City/State Zip Code Phone 90 W. Plato Blvd. Saint Paul, �J 55107 � 612) 296-6179 xs<::c�wtay.:y,.>r,..:;•;..,-:.:<...>:•:.x:::<;..:<.;>::::�S:;�i'F:�::r;::r:;.:::>::.::�:>::<•:::tt<:•s:::s:•:•::px•:a:::•:::..,.•rar.+,ws . . •..x„w.;p¢u.cpf ro;qt;{nrrt;.tusrr.•«:rri ta�vn��x�c.a.v.r.x�. ••.t,m�i.axvf•. •.:+:�. .•:r.:.v,..::..::•::..•:.;?iy�;::.:::•:.c:•::::�•:�::::::::::::.�:a:::.�:::;r.;•:.�;�r:•::•:r:•>:.;:�:;::•::::::::•:.�::•::::••::p :... .fi... ..4. .:a' :zo ♦xc''�:t:-r. .i.s.'..�i+ :•:�•,Yi.;+4r, ,..^�,.,n .:±.<,^;.,Y. �✓:k':.'tY.`.r. •:;C:.;.. <'.ct./.:v ,.;f< .at .�f•:;..: �•,r ..>{, 1.�`., ..wfs::.:: r�'. r..• ,t,� , c :':f••,'•.•:.. ,t.r .!, •.•9f k:v�::�• ...r�i��: ...t ...�..•. S• .: ..... ,:r..,..,......... ..... .... ..;. .,x� ..��•. •, ss .. ..::.;.:::::::::... .............•.•: : ::. ...: ..:.........:.. ......,:::�:::::::.;;:.:>::•:•:o-»:;:;.;:•:rr:.�•�,••:•::•:;r:<;::•. .:.t.. ...J•. ..f'•x�ib ..o..�::;'::"�;�b+�....•�•. . � �.:.. . , . .............:.�:..::::•:. .•::.�::•'.:::.:.::::::: ,.:r:: :>..,... ...;•:',e�.. ,'YCt. ..?,�..l.t...:.. +.:?:;.;f� w..,: .�Y-to,:� ::s.:::•.,.,.,h;{.f. .,:.��•.•.. . .n:,•..;3tt�:,!>�. •.;;�:.; ..�i:,. N,., . .4•. ..Ft.•'/.vv. •::lx'iv�%' �, .:;i ,; (,f . . .::.,•.;•.:::.;;::::::........:•>;;:•;:;•::......::�........... „�Z:�. Onc�.. or.m #ion..;.::.::..:�:::.::.::.;:;.;;:.::.;:<.;:.;:.;:::.::.>:.::.;>:.;::.;..r:.v, ...�.,... :...< v:;<.:r;..:.<:<...,:N: ��.� v..... 1:i.•.li'f.�•.n.r r fi:.r:.::?- ' �. 1.��•.}':?yY:is:•. yi::}, .:.r�. �i. _.. . ... ... . .. . . ....................... ... ......::w:.•^:o......... {r:::.:.:.�n ; j....r::i:'r'ti•:er..�.....,.+.�.4r....j .{:}r.:.•�...%M' ,C' .L --A$10,000 fidelity bond in favor oi the organization must be obtained for the gambling manager. Name of insurance company (do not use agency name) Allled Mutual Bond Number �D 79�0536303 ' �:. _ _._ .. . _. .. ..�:,�:;��;�:> ,�:.>:.:-�::. .�>:>...., ,y. > •��� . ::.,:,.,.:x.:.::,:;;:.:•;;,�.,,;t:<:s::?::;>_::t:..;;;>.>.:>:::.:».:<;:>:::;::::%>:>::;::::s>::;::>.:::>:=:1:-kzz:%r�:>.,,.. v x�,.....,..:,;. •.... -•. .. .,. �`•:•:.�::�J,•n:;.�,::r;:,:::.,:x:::.:x�:,::::. .::f•:�:::::..:..... •s.fy,;..;3,,{){,,�.�.8....�;f, ...1:...x�. .,??fi:,:un., . .v.y,.;,,..;.t:a:.?,;.;.,.,;.y:,,�,w.y.,,;,,.,,. .. ... ..n........... ..... ...:..:..::s;;,{;...:,.:.v,..::::�:.::.....:....:.,.•.:::r.:x:.:::.:.:::::::::.;.:•x:. ... s: -.;.;.;;,.k.+ r.. .���y.3Y.• .. ...-.�`�.•�$;:^..., .rY.:. ^.;:8 .. ..... ...,. ..... .... ,......:. ..... ................... f........ ..:..�f . ..,�......;: ..>' •.a : :.;s.,,,.,. r.;s::.•,.;;... ,52;;..;,.;.+�. ,.f, ...f..•:.�: .,c k2..o. . :'t;.S�' . a .,t•. ,:y.,-t .n..;f;:}:,`:;r>:ai�:$r.•:'•r,,.. .}`-�'+�.~'�.'•.3:� -. . . - . • . .,...::::::::.....�.��.:::::::::::::::::,:::::::::::.:..... /� ;:.G.... ..�....rtr.:�..,�••a ..4:: '-.`••f,..,.....:. 7.:... .^� 4i r:.{v.v+:�ii.. .9.:}., Y::!4.,�...+;{Sii'�:i.�.rr.. ..t.t?r.r...:Y•..ti:>•.in+i•}^f00/.•;v,;�.i;Y i.•:•%v �2?+F�n. /� . ..""".....:::n...:n. .r.......:wn;�... '::. v.r•x �. � �{.i.� x�.+✓.Me.r A...r..� v .�a�. v}n:•:•'ii:�.v�r�:..r...;...}:..v +ii�... icn�Lvle.d nte�t�::<::v:::::>;:>:<:»»>;:>:::<;:::<::<:<:<.;::::�::»:;:::;::>:;::>.::::.�..:�.. .��:, , . ..................................if............... .......�.:............::...:.:.::.::.:.....:.......:::.:..,....:::.:>}.,.w,.,..•:•:.•;!<.•.::..,::::Q.�y...r.:.••:a::y::C�:.:.,c?.:.;:1...,...:>., . :r:.qi+f •.n:.n::�t ............... ....... r r Fk s 'i:.::.....,.y,.,,..a.;xr:;�r..? 1 dedare that: F � ..}...� �� ' • I have read this application and all information submitted to the board; � • all information is true, accurate and compfete; • all other required iniormation has been fuly disdosed; �� • I am the only gambling mansger of the organization; • I will familiarize myself with the laws of NGnnesota goveming lawful gambling and rules of the board and agree,if licensed,to abide by those taws and ru{es,induding amendments to them; • any changes in applica6on information will be submitted to the board and bcal unit of govemment within 10 days of the change; • An affidavit tor gambling manager has been oompleted and attached,and • I understand that failure to provide required informa6on or providing talse information may result in Lhe denial or revocation of the license. Signature oi mbling Manager Date u�t� �l" �_ ' � . i- ��sZ . . . Send the completed application,gambling manager's affidavit,and�100 check made payable.to State of.Mlnnesota to: Gambling Control Board Rosewood Ptaza South,3rd Floor � . 1711 W.County Road B : . Rosevllle,MN 55113 . _. �2-3�5 ✓ DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE a/a'9�' / INTERDEPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by Lic Enf Aud Applicant ft�/�`3'!G�'� KQ.�1 IL�f'7 Home Address q'D !.v . `��C��tl �/r� ��%�� Business Name r � ' ST�' ��.(Jili'IQ� Home Phone ��b-lo /'7 � Q/2�GC D�/ Business Address //�'L�� �(�'pn �CL. ,,f�/vd Type of License(s) �Qm6�ing NIQ�c�9P�- Business Phone o2�jj��6`�9 j`t-°/1E1.�r1�-� Public Hearing Date �I i7�qa, License I.D. � ��,�/� at 9:00 a.m. in the Council Chambers, 3rd floor City Hall and Courthouse State Tax I.D. 4� v'L-r'J/a��� Date Notice Sent; Dealer � �//7 to Applicant Federal Firearms � /1�% Public Hearing / � �� C����",� /y�/ .v�� DATE INSPECTION REVIEW VERFIED (COMPUTER) CONIl�IENTS A roved Not A roved Bldg I & D I �la- Health Divn. � �vl� I Fire Dept. � ��� � Police Dept. �"'`� I �I�a�q°�' License 'Divn. f �I�'� � C��L City Attorney � �la� ���� �� Date Received: Site Plan �1J1 Q To Council Research � �.�-I�a- Lease or Letter ��� Date from Landlord � ��12 FOR OFFICE USE ONLY . ` (Rev. 7l29/91) , �-�� BASE LIC# ✓ SEQ# _ Minnesota Lawjul GambIing FEE CHK Gambling Manager Application DATE INIT .,..i.C.a:�,O:>;:: :•;:•>:;::<::.:�:::::::•::::::.: `.;:e;'o:>.:A.;:«.;:.;I ri:>:>:'::>�:<::<:::>;�:'>�:;>:>:<:::::'>::::::>::;::;:'::'�:>::::>::>::>::::::::':>:��:�::::y:::<:::':>:::»::::'::<':>::»:'::>:::��<'>�::::<'::<::<::�:`::;::::;:�;�`:::`<:�::>:::':::::;;:�:;:::;?::;::::>::`::<�:>�:>:<:::�>::��:<::>:':;::':'::>:;::>::`:::::::::>::>::>�::<;;:<:;::::>: :....:.;:.. :Z'�P:.:.:.....�...P..11U:.::.::.::;::.:.:::.:::::.:.::,:.;.;::.:;::<:.::<;:<:.::...... ...::...... ::::::::::::::::.:.,::::::::.�. :.:::.:..:::.. ..... . �New Give date that the two-day gambling manager seminar was completed. / / Location of training (ciry) �` Renewal Give date of training received witt�in three years pr'ior to ttw date of the application fo�newal.�/7'8/ 90 Location of training St. Paul Ramada Inn LJ ;•:v�::•:::�.�:;�::;•>�:-:. .�G�'�.., ,n....:..:.,,..,::.,,.. :.:.::::..:::::..:.::.::::.:::::.::::::.......::::.::.:::.;,.:,::... ,.:..:.:x�:•<::�:c...,.,,;:.,::,..:.��.::.,,....r��:......•.....:.,::.....,-.: . ... . ....... . .. ........ .........:.:::..... •• ,........:...,.:r.,,.....,,...... ..<.........t...[...........:....�.:..;r.,.... .:.............. •�:::;::..,;, . ....::::::::::::�::::::•: ..................�s:•:::::::�:::.::�:>x•>:::::::::::... ' ,.. t. .<:t::::.,.:.:.;...;.�;......vrr....xa:... ,,� .;:::.:::::., :. .......................:. .�::.; ............;....: . . . .:.........._. ...... . ...5....._.:..::}::::.�T::.:::::::i:.�:>:::::t�:.�:::• ;•.;t'::<;:}:;::.:::::»:c•r:r::::>^�::�:�:•::�r:-::;�::�:::::;;q::::;::::Yr:�>::r:co:::r...::•.............. ::v:f.::::::.:.. ...�.............. i�:�:4:�::?�:iii::;: ' � . � �� .. .:�. : + ' :� . ;Lx � . _ Q. .C� e �3� :o :> .:::::::::::::..::::......r• amb trt �� n �-�>� ::::.:::::.::::..:::;.:>;�.:>: ...... ....:...:.:.�:. ..M. �.:::.:<.::;:»�.::<:.:.::.;:;:.:.:. r..rnatr� ..........:.:.... .....:::... ....................::..:::::::.:::.::::.:�::..:,.::::<::;;::;::>::.<>:<<�:>::.�:::,:�:<::..>;<; ,..::::. .:..... ... . . :..::..>::;>;:.....,::.;:;>:::::::::.:;:�:::::::::<:;:.,;:,;>.::..5:::.;..;.:.:. .:...:......,.....:......:. . .�.:::.;:<;::.:::::::::<::»:::::;:::><::::>::;:>::<:;:�:;:>::>::>:.::>.>::<.;::;::<><:::><:»:::::r:::::>;:>, LAST NAME FIRST NAME MIDDLE NAME MAIDEN Date of Birth Soc.Security Number KAHLERT HEL1,dUT PAUL 11-21-33 482-46-9479 Address State p Code ayLme hrne 90 West Plato �lv3e Saint Paul, MN 5�107 (612� 296-6179 MEMBERSHIP:Date gambiing manager became a member of the organization Ol � 16� 66 �x: Male Female :»:.;.:.:::.;::<.... •:>:•.•.:;::»>;:x;:.>;:.:r '•:::::� ��:;z:;'';;;:;::s::;:::".�`.�,::::::�';,%`.':.>:'•:`<:;:�>::>'>::.... ;::.x;:::><>:;v ��::::>::?::>:<;::::::>;:iZ`�,�.:�so.::::::::::.3>::>:>��o::::«:::::>:::Q::':� x czn fx n n tiali�:<<::�:�>::'�<':�:�'�«`::>�'�:>:<��::::«<::::t>`:`'':�::�:>';�>:::>�:�`:::�::::�:���:::�::>;<<�::>:::�;:::<::<:;;.:::'::::::::>::':�:�::'�::�:��`::�:::::`:<::'_:�::::ri:;:::>:<;:.�:<::>:::::::��<>::>:;�:<<>:>:::��: :.:... . ...:........ ...:.:..�. . :..x�t't.... . :......:::.::::.:: .:............. ..... ..:.:::.:�:::.:.�::::,;>::>:;:;�.:;::.: ::.::::.::::::< .............:..�:::.. .�:..,,. ,:.::: . ........ ......... ...: .:..:.:.:.. .:;;>:.>:.::�. . . ........... .:....::,.:..: ..........:<:::<:..::.::::,,.::::,> Name ot Organization License Number MINNESOTA STATE BAND Q-o1390-001 Address Ciry/State Zip Code Phone 90 W. Plato Blvd. Saint Paul, r�J 55107 � 612) 296-6179 �<::«.�.>.:u.;..�.:�.:NS:tn:.:;;::<::.:.,;:«,-;,.�;.:<:.>.:<.:;,:,.:;::.::;:>;�»>:;;:;:.;:.:,,:�:<..:::. . •••{�•:.6r::::::�:x f'�Miii?iiie:an �•:t,+.!!SStt{%!!Y.CSft•iYC%54..:+£.!:w:::it�:!fif/!'!S:!r!.t:•:{+f.�ti� •;::::{•„ �..r.•.�:•::.r........ ..................... : .x::ii. .r.f .........:.::::•;. .:::::.,•:..::::::;:•.�::••:•::�::........ •.•:::::... .;.;. ..........................?a. ..i... :C.¢,x{•;:,+•,i;u.wxco�r.•�y,y.: �;.�.�r . ;.....,.c.,... :......r. :•::..:,.�:::::::::........,.•::::::............. ,...................:::•::::::::..:.:.� ;�::•:•,.....a... . !� ..... ... .. 1.. .a:.CS'R,..::,..?K .... ....... ..::...::.+y.•.:.t :•+,::v;:•::.•.u'��•!n........ ..;...;{. .. :.::: ...:. .....:.... i::.:i:::::::::::'iii:v?i:'•:.:.?•v:•i:ii•i:.i:L.ii:•i:::r.�:::::::.:.�x:::.�•:::.:::..4n;{:.}•.{::�titi: .r....ti..,.,v,...�1.,{.�:.:'?i{.:};••.:::::• .n.v :..t•:.:...�...:?r::::•.c...;;.;��;::.;;•,�.;..•: ,.�:. <.,}:..•::::.b�u>r�„t,<...;y:r,s,. ... ..:.... ........:........,...................................................;.,,.,....,.. ..,.... , t r... r.f ,..7......r. ...,'r..tF...TY �f�frT fs ..;t;;•.::::•.;•.. .{... ..?.'.C.C•.'... ...I.,...o••.�:...+•....C, a::n.•...�... >....:.:�..:,.:::.r.. .t .:.t....:::.•:::•::,.• � • �::.. . . .................................................................,•:..:.:::: ...... • .f1 ..::.. � � . ,;. � . �. ��. . :.:r:•r:::•:>�:..::::•:::::.:.:::::::::::•:::•:;•:n:.;:a:�:��:>:•::•::•:•::•::::::..••..........::. . ......t......-:•..••:)>................. . 3.. k �O�.c�..�. �.QTaJaa.a��l_�•::::::.:�::�:•::•::�:r:•::•::�:�s:•>;:o-:•r:�>:•:;•::•r::.::.......... . t.::.:�..y,.,:.............5.............. ::,��r,::t•.;::::;:,: ...fis....:•r:.•:.+: .. .. ... ��� .... . . . . . . ................. . . .. . .. ..........::::::.::�•::::::•:•::•::s:::::.:•:s:s........:.......: }?�k','•... r ...ir...{. :•.}•}'iv�: px.y r Jy1:'f { ..� . --A$10,000 fideliry bond in favor of the organization must be obtainad for the gambling manager. Ivame of insurance company (do not use agency name) Allled Mu�ual. Bond Number �D 79��5363�3 rv;�::•:.;;.;:;w.:<:,,::•:;:�:::.,.;,::.;<.:•:•::•:,:;:.:;,:,•:..;;:•;;;:;.:�;;:.;;;;:.;::::::..:.:•.:�::,: . _._ _ . . . _. .. .:::::•. ::•::::.,•.,_.,:.;.:::::::.;>�:.;:•..,•.. •.,:..•::• •..•,.. }?ilp.. r.'YA.;... 4h•,Y•x;}w;n•�{.}};�._.}•.}}};'?}....'�'i.'.}n;pvxnvv r.vw.wnw.iM1w.v. ...,-•• v,_�...n......................a........ r.n......................:::.:.::.�::::::w::Y..•......�:..... .....r .r . x...:: i\..... :. .. .... .. .... ...3.+?:.::r:.x v,v,.y l,.y.;::tiv. ;r.v,..l•.v:r::.;"'f•::•:...,F•�::titi•i}:•i?i::{•r:•::;i.:}•i:•.vv:::�..i:::•::::..::::::::..�.�:::::rr:•::::::::::::.�:::•:::.y:.v... ...v: ..3..e..... li.� ...r.v..v:r.:i.v;...s...r....f. :rn��:F?.�:. .. v.... .:.v:�:�:.... :.... ::.............: ........... ..............xS:n�......ri{;_.,-:...............ie..{:�!/� .tv:%•::r3i;;•;;.,..;v:.. _...x r•�-w^fi:i::J,`f.;C:p;.:+:?•ti.}:t;•.?;Sr�:^;.....�.v .;.i:s.rvv�.•:q'�..'•• -.4•::.;M.,.,.;rr:•.^.C::v,.�4::;r}.f.}. .r/..n. .irv...:wvnr'�:'i:i7+C . .::.:........................... r::r<•:::�:��';"'....y..,.. ....::•:::?•.::�.......:..r...:�.........w.:...: ..:,.v .:k•:: . {.... . : . _, _ ..........:::::::................ ....:........ .......::�-:>:•:::.:c.:.::�::.::;,,.,,.,.,.....;,:.;.::., .>..r.f..t........f:+...........::..;Y. ...sL,tf. . ..t�.. ��•�" >.'•�s'��.�'••:: ::.<>. ;..>:::.,-:::...... . .. : ..:•n•::.:�::........:.:::::•.�::.;>::•>:•::�:�....... ........ .:•. .,5.:•. ,.f.,..,x•:r.:::.,.:: ..r:c•.,.::•:,•. .:'''r•'%;•,r..�.;:'::.`.{r.;;v.c Ac�cnt�ivle.d �ner��:.:.;:.;;:.;:.::>:::;>:<:;>::::>::>::><:;:;:.;�:::::.<:..:..::::;:.;::;:.;::.::.::::.:<r....::..:..:.. .. . .....,.<....:...:..,....... ...<>.<.:..;: .. ,.. :;::»::{::.:v�:.:.::. . ..._..... ....._... _4 ... _. .......................:..:.:...:.,,.:.:............:.�..... ....,..:...:..<.::.::>.:.:.:,..:..:.k,.:<.,..::>.:.,.�:., ..:� ..f....,, �,,. I dadare diat: • I have read this application and a)I information submitted to the board; - • all information is trve, accurate and comp{ete; • all other required information has been fully disdosed; • I am the only gambting manager ot the organization; • I will familiarize myself with tt�e laws of NGnnesota goveming lawful gambling an�rules of the board and agree,if licensed,to abide by those laws and rv4es,induding amendments to them; • any changes in application iniormation will be submitted to the board and bcal unit of govemment within 10 days of the change; • An affidavit for gambling manager has been completed and attached,and • I understand that failure lo provide required information or providing false information may r�sult in Lhe denial or revocation of the license. Signature of ambling Manage� I Date ��,�� -� � . /- 2�. s z . . Send the completed application,gambling manager's affidavit, and$100 check made payable.to State of_hilnnesota to: Gambling Control Board Rosewood Ptaza South,3rd Floor � . , 1711 W.County Road B . : Rosevllle,MN 551'13 . . ' � �-" 3g5 ✓ DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE — / INTERDEPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by Lic Enf Aud Applicant �1 h1�7?J /Teh (�11NQnyJ Home Address �'���j^ ��''^�, �"j�//�' D I� h� �hC[Wl !1� Business Name � h S Home Phone �p38- �T�,� Business Address /5"(,���r1l11Qi''3i�r'T✓P���Type of License(s) �gaM6�/l29 /YLQ.r1CLAPf— Business Phone �3� ����j ]^e yjP�cL` Public Hearing Date .3,17�q� License I.D. � 1�f�� at 9:00 a.m. in the Council Chambers, 3rd floor City Hall and Courthouse State Tax I.D. �� /���}' Date Notice Sent; Dealer $ ��� to Applicant ,,l Federal Firearms 4� N//�} Public Hearing ���' ✓ �1� DATE INSPECTION REVIEW VERFIED (COMPUTER) COrIl�IENTS A roved Not A roved Bldg I & D ! ��� Health Divn. � ��q� I Fire Dept. � �IQ I Police Dept. ��a3'q�- � � ��a��yz a �, License Divn. f ��,19a � o,� City Attorney � 3�a��ya.- � o,�. Date Received: Site Plan Il>i�} To Council Research 3 �- �j L Lease or Letter ate f rom Landlord �1 f-� - . LG212 ��.��� FOR OFFICE USE ONLY � (Rev. 7/29/91) BA.SE UC�t SE�� - �iruiesota Lawfui Gamblirtg FE� Gambling Maaager Application oA� INIT .,a<z:::,:;.::;�:,»;::;::>::;>::::>:>::;>s>:<�:«�:>:>�:::::;::::::<:;�:«::;::::<:>::s>�:>;>:-s:::>::,.::;:.:,.: ,;:f;=;;,��>;>,;.:.;,::::.;:,:;. ...................:::...:.::::::::::.:: .........,....... ......... ...... : ...::.:.;,:,;:.::•<�:•:. ,.. �,•:::::,. .<.. ..,..;:•;:,,,.:::«;�•;:<;>,.:N.;:..�r,.,;�.:.:;,,:,;:;,:::•<:•:<::::;>:<><>.:�.... ::....:.,,:>:,:>:=>::»r,;:;:>:•>;>,:;::.>: . •.;' ' .::. . . w::4i'::.::i:i'Siviii:Jiiiiiii:vi'¢i:i:::?y�.}>•.�;::.ii::L•i:::�v.�.v.•v•••.•• /� w.4:v:::::^ii'f.�?:�n�r::•::x:::::::::::n�::::ii•e•:iiiiY'i%rfir. {.�rf•nv:r::::.r.�w�:�:•�n:w::::::::::.:�:«f.:n�.:x://.•.iNttii:�i'.G3:'N.'�.Ni.�:ii:i:iii'?ti�::i:::ii''F.�iiJ i: : ' :y .:: .. �/ /'/ /�.:i:?:::X.:i._:e..................::.......:r..:..:..........:r.r.{:n:v::•: ... f............................:...................5........ O�.i:•..::::ni'.i'iii•ii{:i}iyiii:;ii?:i::iii:b.iiii::::ii::;:i'r:;';.;};•j+yiii:i{ri:;:';$$:r??iyi4.�.-:::::;}:}i�v:......:.::.....:...:�::v::::::v.v:...;.:......... �����0�:���`�Ix�..._..':"xvi�.i ......tn;.;y.:.:::4i'•�' . . ......:... . .. .....l, / ..J �New Give date that the two-day gambling manager seminar was completed. / / Location of�aining (pA') �Renewai Give date of training reoeived within three years prior to the date of the application fo�t�newal. 7 /Z�3/ y� L.ocaDon of traininq ��•1'wv� ��'•'l�; I j,r,�'',u�iC y"�,�„^ U Q_-- , a ) _: :..,..,.......,......................�...?Y... _....................:........... . . .....,. ....,,...f.:....;.;.,,•<•.::::o�::�•:.,,,: 3.....:.fi.'rfi::� . � ...........�:•:�:::.......... t :::<:..,,.a:.:• :v iw.....;,.., ;.:....:}.:..... :{:.:::•.�. ,:.: :........::::.y:.::�: ............,....:..•:::::.��� � ..::..::::: ..........y.,� ..;......, .. ♦ . .+��' :...::....:.....:.....rn., . .:.:.::.....,... .i:::::.::.... ............. ..xr�.;xti.}v:;}r;.;i;:�.jjii:;:•}'F,.•i:i'i�}:}::{iiiii:::i:i;}ii:�y{.:.r::r.v{r:;,Ti i•:4:+�r�.':S{r• s y�wr T ..�,,� fr f E o .✓{S'•..,2?••,':�.:���: '� �`•iv+;:;;:::; ' ���� :��;:;cyy;:;;;c;i.r{.'�,•.;;; >i 9`",dyff � � t li „� ;•:...y+,,..,•..::�,f(.,�t�.'-;vS.,•% �'.?'4:::;::r;>.�• �T-GLI����� ill.{��.: �;::L: �T.� .. { :.,..:::..-..,.:�..,..rxr,;,;:.u.;.:>:::...:::••..t..::::::::.: •a�.;:� . ..... ....... ..................................v ........:................... ,......•:.::•:.: ,:.`.�:.;,,, ' .......... :................{iw::f......: ....F....:i:... ....:?}i:n�::•::..t LAST NAME FIRST NAME MIDDLE NAME MAIDEN Date of&rth Soc.Sewrity Number QVS�h MG�;n (;i��►5i�,1�,r �'��r�' �0 Gg'67 ul�q-CZ'G'S73 8�S A-r��,� ��- ��: ���� �r N� �Si� 7 c 6�a 638—y��'6 MEMBERSHIP:Date gamdinp manager became a member of the cxganization I /Zb/�b Sex: M e Female •.•:a:cr.�:n:,:.,.r.r.ox•nxu.:•,•. x•.x:»:::c;a.:,,»•::.::•a;,;.•;..;w;;.;,..;..f,.:..,;..:arrr.=:•:.>:tr3..•.w:cvn•• •o:r•r.>»::.:.;:•::;•::,,.,.,:::�,x:r..:- xaa:., •:;.>:.r�,., ...a:.,.;: ...,.>•:�, ., �% 2.::•::-:::..,...::R:::7fi»c�S"••:?F::::�:::•::::••.�:::.�:::•.�•:.�.....�:...;....:.:,•:•::>•.,:..,-;.;,..::•::•.t�::::..................,...,.:...,;:.z,..7..'#:a:;??Y�'✓.•.'t:t...�....�c*' ^.:�'i:.:.:.., •'•t�?::.:i- Jd .,,.?.::.:::::... �:::�.... .: . .,. �:: �.::,,.. ,...... ;......, ........ . ,....:. - ..:��•=-:•�::��.::r<:a.:: .::: ............... .. ........... ...x:..;;;,,;,•.,.,.•.:r:.:....:,:.�..:.. r:�•:•:::::>::xa;:•;::•:;:•;;:�;:;�::::•...::•.............•:3s�::::•:ra••S.•:•«�,:•.:'::� �. ............. .::�. .......... :......:•::::.r..:::::>:.:.t•:.::.::r.�/.:::rv::::+a::.::<.::•::;:n::��:::::::.�...:::::::::•:v::..•.::::..:....�•:::::::::•>::•:...;�,..;r:..;r���r. ..�i:k.::d:�:::�i':; .:;.w:r.::o::?:<.>.�:xro.::r.•:::::a:.>:.:.:;;v�. •:�tox:•::::•:•:E.f::�::+;�::...�., vRt. :.:.'�':•?.�:+..�:3: ...5....•.s:}.. •:;i,...}],•�r••:•:::•:::::•: •:•.4::vv. . ..5.��"��>:iN::{:i{':•`•:;�:.. ..{.. .>I CI�Qlf:'•�>;�>�:»::••.�:::::.�:.�::::::•.�:::.�::•::::::•:::-:::'+•'RZ.>:::`•��;•:::.:�::::. �;:� .Li�lLZlI�iOI�.... '..OlT?L .<zs.:...:.,..,�.s.,.,,:>�.:>,>.,...,>s::�.:.c:;:r<::::�z:'<;;:::::::>�;:<::z; . .....,,...,.......:.:..::<.:•::.::..:,.:..,.:......,......:.,:.........:....:........,>;,:.,.... . ..... _.... _ _. . . Name of Organization � License Number �. -t -L'��� �J� ��V,�'? �.��' ,(:�v` � G� s �'D�l�f;� Address - City/State Zp Code Phone �7S�i rf��,^�.�,f � . �f,P��i,;��� 55r i.� �6 i 2� ���=CZyB� 4.�i.!vt•::!:;i>:� N' �c "''' :.::.:....:.�::::::.::.:.;:..::::::.::.>::.::.. .�:::z>. .��� :,f.,:Y::�:.::.::...:x.�<u�,; .!�.t }}{ }�C:x:.iYi'.ii:i:: j} +I/+!�^ •Y•R•�: :.Y1.w.¢Yri:<•i:::.•r:.tIXw:r. .Yi{P �+�'.�}::Q.4:: xrX...pi9::S�.:.::Y•'r ����:�C"-�-�4`i+ . %4Y�}'4r 1.;..y..n �':.. • ;•t�•,v ';i.;N:..•,-••,-n•t. w.� ,,�+ ��, 5� .�. � '�tn... ....�n::: v::: ...... ...::•.•...rr..� ..... v:::::t .. ... ............ nt•::/.Nt V:x:. .:% : ;:.. ..,............ •a�::::::.::.:, ./,.:�,,.t•�•.::..x,.•.:�:.,:;.t:::.r;:•::•:.......�.:..o..::x.•:::•:::::•::•::•:x:.,.:..:+:;;::.::�:k:•::�n:�:........,w......y�%::::?:5,•;+:ii•r.�a�•r.:..»u r.xYY4r>.. �.'�•:>::3:•Sx� 'f.�9 .�R�..^.v,rq••,v,i•::t-0^:-0'1+:�.ii:viii,v,•;•iii:{{.i:•i:{.;{.,v,ry}x;.},v,•i::i.,v,•:•i^::•:+fi::::l.:•:O:•:!.?i.v•.�;.},v,•i?:t�N..4:.'i;.i.;r��.;ryy:�:�4� n:l..�{ '};�v:{;q:;:rC�.;ryy .v r.m... c . :.;;•?,:.:.:�t�::•.<.�•�.�;;.,,_ ...�s?�.;:�;;;i:; . ::. /� �> � :. :.:i=.i::•.`•:{•:?>.:.::•iri?:::...::.:.:�i•ii::::i:i•i:•}:ii•}}Y.4:v}i? fi . T .....;..1 v.•.•:•:::n r r �0�. �?:M��M�O�...,/.....:..............................:::: :v:... 'f�f:}h:ti;:ti4'{'i1,.>;i:n{v.L;:?::?,lA.,',N�Cii{i4�,:M.;.M,+,',h,'.?ii ::.�4:..rn• ...:G.�. :.:3::} ......................................... . ... ...... ...........................:................................ --A$10,000 fidelity bond in favor of the organization must be obffiined for the gambGng manager. Name of insurance company(do not use agency name) U�^.�� FK. !��( CGSJaI{t� g�d Number ���Z� Q i}. 'v }0'•v,v,.:}:{k:Ji:?{•'n:•:v'.\+iri:^iay;;.;:{ry:4i:Mi::�}.}..i:.}:{:�:i..i�•iii:3%.v}},v,.Y^i:•#ii4x.tiii{.;.}..}%�}.v�v v.�\i:r�i{x••.:.xy;.};.,w. �+ v v}}l••yv}v -.2{mv, w,yy;�- ��• ..'�r.ik�i'i.Pi'�h'�}.{..v x..�,.�}+,�... .:8::••::.13k�•:. -.i:. ..�:x'a�}iv ::�+.>i...JYr.r.Y+i..r:n�•�� . t:i��♦ ...r .•. .......::�x•.... r................. �k • v, �.ti.•:? ...5. ''i .�•ris::-+}:•i•.4fi:.;...::::��.:v::nvv. v ...v......n v�:•i'ii:.i:•:::{�•i:ii:.i::.ii:.iJii:-i:.:'�...nv ....n.•:::::�r:::::::.:.v:v i:.: .:: •n+.i•i<•.S:-i'•:•:{?.i::r.:.:;�:.5: 4..:i: f.:..y:..::::::v. .i.?v ::..,�.�._�.,..v..;,..t-- :.,;/;....;:..:?,3,•,.::. ,::::•.�`.�:•o::'::::•:.. ..::::::::::::::.�:..;�f;....,{....;..;.;........... ...3,.,., :,t..:�n.•::.ff .,.;..r.}'n.. ...tr::.•...+n:%:?'.;;t`:; .:;:(:;;..t.. ..;t'w,. .;f...:•:. :t:.,.•.:;::r.ay.;c;:;•:;.;•.y;.{,....,'�.,'•�;:•:.v ..r., t...,+',.., :;t}r,. • ..s. .;�•.. ,;:;k•;.;....f..�.•::���'•r:�i:+;t:r:x;t:: .::n'0k:..r., .,f,.., .•.'S:C•...>:t. ...y �.;':'.•;:� ...+:tc+'•:�`.•. �ri:Y ..+. '�r`�:�.•:4:�:::::h,.. .,.3,.::..•:•:::•:•:..��C.'S: ,..,?>..•::::.r.,';rr::m:^' r`�i.+r.....�. �:�::a'::wAE::��n.. "%;'':::•:,.,...,, �:f;;�. •�`%�' �•:. �i�Yrriow�e rnen�:<r�.::.:.:.:...........::>:.:.,.... �� ..::.>.<:.:>.<:,:«;::;�::..,.:.:.......�:::..;<>::.:<::::.<:.:<...::<.;.,.::�.�;.3:::.�.,�:�,�:.�;:: ��>..,..� :.�.<::>;�.. _ ........ .. i dea�a,er • I have read this appGcation and all intormation submitted to the board; • all information is true.acwrate and ccmplete; • all other required information has been fully d�sdosed; • I am the only gambfing manager of the organization; • I wiA famil'iarize myself with the laws of Ninnesota goveming lawfuf gambGng and rules of the board and agree,if ficensed,to � abide by those Iaws and rules,induding amendments to them; • any dianges in appC�cation information will be submitted to the board and bcal unit of govemment within 10 days of the change; • M atfidavit for gambGng manager has been completed and attac*�ed,and • I understand that failure t�provide required infortnation or providing false information may resuft in the denial or rewcation of the lioense. Signa re of Gambling Manager � Data . ��i��/ /-$' 9Z Send the completed apptication,gambling manager's aHidavit,and�100 chedc made payable to State of Mlnnesota to: Gambling Control Board - Rosewood Plaza South,3rd Floor 1711 W.County Road B Rosovlllo,MN 55113 -