89-553 WHITE - C�TV CLERK CDUnCII �� . J�
PINK - FINANCE G I TY O A I NT PA U L J
CANARV - DEPARTMENT
BLUE - MAVOR File NO•
Counc l esolution , ��
l �
Presented By -
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That application (I I #6 415) for a State Class B Gambling
Cicense by the Minn so Wildlife Heritage Foundation Inc.
at Mounds Park Loun , I067 Hudson Road, be and the same
is hereby approved� .
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
Lo� �_ In Fav r
Goswitz
Rethnan
Scheibel 0 _ Agains BY
Sonnen
Wilson
� 3 O Form Ap oved by City torney
Adopted by Council: Date . i,q
, � �S(
Certified Pass y c'1 Sec t By
gy,
A ro by Mavor: at __'� j Approved by Mayor for Submission to Council
By BY
Ptf�ll� AP? - 1 ��
8'4-553
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oan�C'r�ASOM - ow��o�croA �,uvoA�on�i�rrn
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Fi na:ce +&, t. .: _ Z -5056 or�A .1 .«rv��,�, —_ _ _
Application for a State C1ass Ga bling License. `
Notifi.cation Date: 3-16-8g Hearing .Date: 3-30-89
�'nows:cMv�ove(�)«�.�.a ta>) couMCr. cH�oar: ,
. . . .PLAPMIO OOAMAIBSION � CIVIL SERVICE COAMISSION DATE M DAlE aR -� � ANKY9f � . � - Plqt1E ND.. � .
� ZONWO OOMM48810N � 18D 92B-BCFpOI.BOARD . . �. . � . � .
. . ST�PF . . . _ dY1RT�1 COI�MuR88tOPl � IS --ADDL MFO..AOOED� _WR�ADD'L N�F�'� � __f�i�. . .
� D18TRILT OqNICIL - � � *� : � . . . � - � - . .
� �'"SUPIOR78 WHICH COUNqL OBJ�TIVE7 . .. � . . � .. .. . .. . . . .
MIN1r18 PAOYLE�r l�llE.OP�OR11N�r(YYlW.WhN.Whe11.Wllof6.Wl1Y�: .
Hugh C. Price, on behalf of.the i esota Wildlife. Neritage Foundation, Inc. ,
requests City Council approval h's application for a State Class B Ca�tbling
: License at' Nbunds Park Lounge, 6 Nudson Road: Proceeds from the puli�ab
. sales r�ill be used fo_r conserva o educa�ion. _ .
; ,.�►noK c�.r�srn.�r.,aiew�..,a�>: _ . : ` .
All fees and applications have b en submit�d. The organization is aware
that .5l�.of the proceeds from pu lt b sa1es :rnust be used to benefit. the„ '
ci�ize`�s of St. Pau�. . . :
x�e0u�o�t M�r.wn.n.syd Yo wnom►: � • , _ . . . . .
If Council approva1 i5 given, th VJi dlife. H�ritage Foundation, Inc. will
be 1icensed to sell pulltabs and r ipboards at the Mounds Fark� Lounge.
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. Cou, cr� Research Center
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. 8q -553
DiVISIUN OF LICENSE AND P�:RMIT A.ilMIti ST TION DATE 7' � V� / � � � �
INT�,RDF.PARThfFNTAL REVZEW t:HECKLIST Appn o essed/Received b
Lic Enf Aud
Applicant '' u c,�r,c.e. Home Address `T �a`� �h hGm ��
Rusiness Name � V1�5(�{'ft W��q �Q„ ✓-�e-fiome Phone �dinc�. �Sy3S
�ounda-}ioN �v�c� f�
Business Address ,v Type of License(s) �C oZ5— /�I�3" ,a�lS T�ON �-
Business Phone �}pp/� �-�c�C� �p(,(1 .�j,� �Q,� ��Grn�O���
p� Li CQ hSe� �
Public Hearing Uate (� a � License I.D. 4� (p'j �l�
at 9:00 a.m. in the Counci Cha bers, G
3rd floor City Hall and Courthouse State Tax I.D. 41 a -IJ7�
3�1�0 '0�1 ���0 3 Dealer � fV ��'
llate Nutice Sent; � Q
to Applicant �
I�'ederal I'i.rearms �� ��A'
Public Hc�..iring
DATE IrSL CT N
RE`JLEW VERFIED (C ER) CUMMENTS
� roved N t roved
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Bldg I & D �
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Health Divn. '
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Fire Dept. : � �
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' Sen� Z/�6��
Police Dept. j
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License Divn. ! � �qCc7rn��ma.,'14 �e r��G�-i i,l ��''` � i
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City Attorney �
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Date Received:
Site Plan �7�f�"
To Council P.esearch
Lease or Letter Date
from Landlord �V�i4
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• • C y of Saint Paul
Depanment of ina ce and Management Services � -553
Lice sa nd Permit Division
City Hall
St. Pa I, Mi nesota 55102-298-5056
APPLI A ON FOR LICENSE
CASH CHECK CLASS NO. N w Renew
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Date ^� 19�
Code No. Title of license �'
.
From � 19�To � 19�
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, �� rl � 1(.'S"�' !� ApplleanUComPany Nams �
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10Q Mail to Address � Phone No.
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Mansper/Ownsr•}ISme L`.-, — ,_.,,
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100 AlansqeHGw�er•Home ACdnsa Phon�No.
109e Applieatbn FN �
Received the Sum of � tpp_._ � ! ,�/f � `� ' '-1,�
v� /^ � r�(� � ; � y `1�
ManaqsNOwner•City,State 6 Zip Cods
100 To al 100
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L.' /,,�„�
Lleens�Inapector • � - 8y; �� S�ynawn o1�ppkant
� Bond•
Compsny Name Policy No. � . � 6cpiration Date
Insurance•
Company Name Policy No. Expiration Date
Minnesota State Identtficatlon No Social Security No.
Vehicle Inio�mation:
S�NaI Number aN Numba
Other
THIS IS A REC IP FOR APPLICATION
THIS IS NOT A LICENSE TO OPERATE.Yow application for lic sa ill either be yranted or re�ected sub�ect to the provisions of the zo�ing
ordinane�and completion ot ths inspections by th�H�alth, Fi �Z inq and/or Licenss Insp�ctors.
$15.00 CHARGE FOR AL RETURNED CHECKS
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' � 8�1 �553
- - i;it� of Saint Paul
Department of Fin nc and .Zanagement Services
Division of Lice se and Permit Registration
INFORMATION REQUIRED WITH APPLICATION FO P RN:IT TO CONDL'CT PULLTAB/TIPBOARD SALES I;1
SAINT PAUL (Class B Gambling License in Li uor Establishments - New Application)
1. Full and complete name of organizat on which is applying for Iicense
/�'�/�G K-C S G�� C.1/<^ i �e �/ P '� �bt�'Gt�r �'? .f�k L�
2. Does your organization meet the def ition of a "large" organization as outlined in
the November, 1988 revision of Sect' n 09.21 of the Legislative Code? �U
Attach to this application pertinent fi ancial and/or organizational information to
support your answer to this questio . OTE: Only 5 large organizations will be allow-
ed to open pulltab operations under he revised city ordinance. If more than 5 organi-
zations apply, qualified applicants il be selected randomly by the City Council.
3. Address where games will be held 6 7 v��'Y! .�`t. o�� '�a��G'�
N ber Street City Zip
4. Name of manager signing this applica io who will conduct, operate and manage
Gambling Games v (? G �G � Date of Birth �— `s—�j�
(a) Length of time manager has been em er of applicant organization � y�J1-,�_
�9
5. Address of Manager �' ;�� � %1 �1��� � a� � � �7�}� %�
Number Street City Zip
6. Daq, dates, and hours this applicati 's tor .S�y - Sa.�" � --/l�yy�
7. Is the applicant or organization org iz d under the laws of the State of MN? �"�'__�__�
8. Date of incozporation iJv� 3 � '
9. Date when registered with the State o M nnesota J+���/ Z j, r 9 �s�
10. How long has organization been in exi te ce? ��" ��'��
11. How iong has organizatioa been in exi te ce in St. Pau1? l;�� 4:- �f -`�/ �:-/���� ,
12. WEiat is the puzpose of the organizati n? Gv�7�5 crvc��i'cn� ��vG=z � c�i
13. Officers of applicant organization:
Name P � �• C�`iF'i S/� Name ��f'f" /�O/
3sG N• w�.6��d. s:�.f� 3 ��,�. � ��r�-d� �,r't ��
Address 5f dh �'s�io2 Address SJ`� /�a�u� /�!lV S'Syo/
Title ��"�f , DOB �:���' �/ Title s'�C-.. DOB /Z -2 —36
Name U` �j C. �'l��- Name �la���� ✓.- /��Y. �v
�
Address ��tZ vy� s�ii d� � Address 7?�?� �f�t�%� �;�+ C�c'��u��,
.
Title �� DOB �S�� Title ����-� DOB /�"' S'��
• . . 8� 553
_ iw. Give names of officers, or any othe pe sons who paid for services to the
organization.
r
Name � C'� �i G-e Name
Address ��t z aavr�td� Of Ea��� 1� Address
Title ��� ��� �/f'�p Title
(Attach separat s eet for additional names.)
15. Attached hereto is a list of names a d ddresses of all members of the organization.
16. In whose custody will organization`s re ords be kept?
y�z•�- Dc��r�s�.�.. P�•
N� �v �, �j �L �. Address Edics�►,�, '�'iN S"sS�3S'
17. List all persons with the authority o ign checks for dispersal of gambling proceeds:
Name v '�j L, / �- 2 Name
�� ?-�-f .D��,hv.�, ,U�-.
Address �d.`h �. s�7n.j SS 4� Address
Member of Member of
DOB �—S� 3 C- Organization? DOB Organization?
Name l�c,�7 ��" G�?%f � G�, P � Name
2r� N �v�Gd-s�.�, 5�.' �> �a
Address 5� ��i / � Address
Member of Member of
DOB ?i —2 7—�`� Organization? DOB Organization?
18. Have you read and do you thoroughly u de stand the provisions of all laws, ordinances,
and regulations governing the operati n f Charitable Gambling games?
19. Will your organization`s pulltab oper ti n be operated/ma.naged solely by members of
your organization? yes �� no �Uil( hi✓L Sorn� (,�'Z
b�,�.-�S�da. G�tkp.��,
20. Has your organization signed, or does it intend to sign, a consulting agreement or a
managerial agreement with any person r ompany to assist your organization with the
pulltab sales and/or recording keepin ? yes no �
If answer is yes, give the name and a dr ss of the person and/or company contracted.
Name Address
Name Address
If answer is yes, how will such a con 1 nt be paid? (percentage, flat fee, gambling
funds, general funds, etc.) Attach a co of said contract to this application.
21. Operator of premises where games will e eld:
Name �, � �'G '� ��( �'
Business Address /�o✓�o� �o ✓ai- /o�i vcF J
Home Address G' � S? � �Z � ^ v� G � �
' � 8q - 553
_ 22. a) Does your organization pay or in en to pay accounting fees out oi gambling funds'
yes � no
b) If you do pay accountiag fees, t w om will such fees be paid?
Name �L /c.icL r-�•� G Address �27 �hS��'6�! /p� �, N�-`-'/T��
DOB � "' �� —s� Member of rg nization? �_C�
c) How are the accounting fees cha ge out? (flat fee, hourly, etc.)
ha�� l'�
d) What do you anticipate will be u average monthly deduction for accounting fees?
�/�o.� �
23. Amount of rent paid by applicant org ni ation for rent of the hall:
�G°'C'��fJ�
24. The proceeds of the games will be di bu sed after deducting prize layout costs and
operating expenses for the following pu poses and uses:
Cf-�-r � c=/-vc�.f cnz � 'v ��i' y
25. Has the premises where the games are to be held been certified for occupancy by the
City of Saiat Paul?
26. Has your organization filed •federal 0 990-T? � If answer is yes, please attach
a copy with this application. If an e is no, e plain why:
?,ny changes desired by the applicant assoc'at on may be made only with the consent of the
City Council.
�1 �`��(/.Fe �%7� e- ��
Organization e � �
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:
Date vl � � � BY= G' � �^ �
% a��rl ha ,o game
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Org�nizatio P�es.fdent'or
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