88-2041 WHITE - CI7V CLERK
PINK - FINANC�E G I TY O F SA I NT PA ZT L Council /� � !'
CANARV -�OEPARTMENT �(% (7J�/
BLUE - MAVOR File NO• - " O•
Coun il Resolution 3�'�
�._,
Presented By
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That application (ID #25002) for a Class B Gambling License
by the Hayden Hei�hts Booster Club at the Kick-Off Bar,
1347 Burns Avenue, be and the same is hereby approved/
�e� with the following stipulation:
This organization must be in compliance with all
sections of legislative code 404.21 & 22.
Specifically: 1) Gambling manager's compensation
shall not exceed $50.00 per week.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays �,
Dimond
t.ong � In Favor
Goswitz
�h�� o Against BY
�s�n�
-��
� �� � Form Appr ed by Cit A ey
Adopted by Council: Date '
Certified Pa s y Council Se ta BY �Z � �
gy,
Approved 'Nlav ate — `IdN — � 1�� Approved by Mayor for Submission to Council
B � BY
P�.IStiEB J�,�'`� �. �: �989
TOR ~ f = OM�llIRY1T� O4ieQ0� • �—VR � '
� ' Mr. J. Carchedi � ` . ���� ��� tro.�Q� '�J `� _
� o�xrr►c�rr�nECron _ w�ron�or+�sr�urry
Christine Rozek �� _ �8�*��+ ��«�
. ^�P"°"�� Rounrra �� �Counci 1 Research
-y
f i 11C & t..: . 298-5056 ; °�'. � cm An� —
Rpplicativn' for a Class B Gambling License. - +
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Notification Date: Hearing Date: 12-22-88
Tto�cMvrow(�a Fal•a(R)) couac�nES�►ecH R�POnr:
. . . PLAl1llfi COI�116&ON CML SERVICE COA�IIBBION � � DA7E IN DATE OVr ANN.1'ST � . - PlIOIE NO. . ...
. . . . .. .. . . . . . _ . � j �
� ZOtlMp OOMiMBSqUI � 13D 826 9CNOOL BQMD � . . .� � . .
. . . . - . � . � . . � � .. .
. .. STKf- �. �. . � , fkillRTEH OOMMB810N ; -�LElE AS�S � -AOD'L�N�IFO.ADDED'� �_R1R I100�NIFfS�` �R� A�GYf AO[1ED� �. ..
� DI$iPoCT COIN�qL � � .. . � � �
. *O�LANA710N: . . . . . . . . . �
� : !tlP.P0117'8 WHK�1 C01JlKAL 0lJECTNE4 � � . . � � � � . . - � . � . .. � j ..
. . . . � . � � . �.. . . . . . . . . � . � . . . . .. .. r
�. . . . � . . . . . .. � . � . . . � . - .. �. . . . -. . � � . . � . .
-�� . ' . �.� '..' '.. . -,. . . � � . - . . ._ - _� �� �.- . ... . � . �� . . � � . . :� � � � � � ,� � t" .
M�tIR3�0/IIOM.lY.�IE.tlT�ORItNMTY(WIfO.VNtat.YYIIltI.VM�srSi VMAY):. �
Kathryn.Band�rant ;on beh�lf of Hayden Heights Booster Club requests �
Council ;approval of her ;a�plication for a C1ass B Gamblir�� License . �
� . at the K�ck-Off, 1347 Bur.ns Avenue. Gambling proceeds are used `for '
youth activities in the 'Hayden Heights area. �
' 1
; ,iuRn�rd►�ww�.�.A.wo.�.n..wm►: . �
4
All fees and applications have been submitted. Notices have b�en sent.
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COlqtO�(Mllrf.`YMw4 aM T"e,Wfnm):. _ ,. _ • - ' �
If Council approval is given, Hayden Heights will op�t���p��reh Center ;
booth at the Kick-Off. ;-� r: � , f
. u L 1 � i���. t
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. _ ' ;
K�,�:, w� . cc�s '
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STIPULATION: Gamlil�ng manager st make only $50.00 per nth. The gambling
, ' " � manager was over id $404.00 ]ast year. Ar a»gements have been
_ made for repaymen .
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. . � . . . . . . . . . . .. . . . . f
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. _ _ .. . . . . . . . . . . ., . . (.
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Hayden Heights was operating at the Westsider. The W�stsider, because of �
.
gambling violations, cannot have .charitable gambling until October, I989. '
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DIVISION OF LICENSE AND P�RMIT ADMINISTRATION llATE � �� OV / �� ����
_ � .
INTE;RDF.PARTMFNTAL R�,VIEW GHECKLIST A.ppn Processed/Received by
� Lic Enf Aud
Applicant '�t,t,��Q,�l }�4�'1'�-5 '�ODS�-((�� Home Address
t
Rusiness Name F-��� �T � Home Phone
Business Address �� y1 �t,�i►1S �� Type of License(s) C�4S�S � �14m b��r+G�
1
Business Phone L1 �,y✓►S'�
Public Hearing Date �� �� � License I.D. �{ � ��Z
at 9:00 a.m. in the Council Ch u�bers, ���
3rd floor City Hall and Courthouse State Tax I.D. 4t
llate Notice Sent; Dealer �f � jl4'
to Applicant �� � �
Pederal Firearms 4� � L�
Public He�.iring
DATE II�SPECTIUN
REVLEW VERFIED (COMPUTFR) CUMMENTS
A roved Not A roved
�
Bldg I & D �
1��A'
Health Divn. '
�,��. ,
� �
Fire Dept. ��� (
I �
I �
Police Dept.
IOIf��� oK�
�
License Divn. '
,����� o ��
City �ttorney �
������ ���
Date Received:
Site Plan �Z��� ,(�
J/ To Council P.esearch �� � � I�U
Lease or Letter q G j�([ Date
from Landlord l� t °u
. . � . . : . h�,C,,_�4,'t�;. . . .. _ '�� ��^'r :t :a�r,-�.« �,;, .. . �. ' , .�:�`.- a . . . . . .
r .y.. :�
CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
� N . ��/'�
.-• . . _ . . . I /Lj-/
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. ' Charitable Gambling Co�trol Board FOR BOARD USE ONLY
, Room N-475 Griggs-Midway Buiiding uce�,s.N�mbs. —
1821 University Avenue '
St. Paul, Minnesota 55104-3383 PAID
. (612) 642-0555 AMT
• CHECK#
DATE
GAMBLING LICENSE APPLICATION
INSTRUCTIONS:
A. Type or print in ink.
B. Take completed application to local governing body,obtain signature and date on all copies,and leave 1 copy.Applicant keeps 1
copy and sends original to the above address with a check.
C. Incomplete applications may be returned. -
D. Enclose license fee with application.
Type of Application:
OClass A — Fee S 100.00(Bingo,Raffles,Paddlewheels,Tipboards,Pull-tabs)
�Class B — Fee S 50.00(Raffles,Paddlewheels,Tipboards,Pull-tabs) Makscheckspayableto:
❑Class C — Fee S 50.00(Bingo only) MlnnsaotaCharitableGamblingControlBoud
❑Class D — Fee S 25.00(Raffles only)
Check one: ❑1 A. Organization has never been licensed.
�(1 B. New site —Give base license number. � � ���l�"'k�
n..:x...,
❑1 C. Renewal of existing license — Give complete license number. 0 - � - L�
O 1 D. Change in class of an existing license—Give complete license number. 0 - � - 0
F�Yes ONo 2. Has organization ever received a Lawful Gambling Exemption Permit from the Board? If yes,give complete
permitnumber %'�'-f��.1�/3�ac%/
��Yes❑No 3. Have Internal Controls been submitted previously on a form provided by the Board?If no,please attach copy.
4. Applicant(Official,legal name of organizat'on) 5. Business Address of Organization
�.�v F 1 r;�;���s '� _ ::lerCl�� � :- �t,�S �l�fl' i�`;�e �
6. City,State,Zip � 7. �ounty 8. Business Phone Number
� i ��1t�.L �'(M� �1�1 l�l,t yri)L�� ( /-/� 1 ??�/- �:��;�/
9. Type of organization: ❑Fraternal ❑Veterans ❑Religious Other nonprofit"
'If organization is an"other nonprofit"organization,answer questions 10 hrough 12.If not,go to question 13."Other nonprofiY'organizations
must document its tax-exempt status.
❑Yes ONo 10. Is organization incor orated as a nonprofit organization?If yes,give number assigned to Artictes or page and
book number: Attach copy of certi�cate.
❑Yes�No 1 1. Are articles filed with the Secretary of State?
#jjYes No 12. Is organization exempt from Minnesota or Federal income tax If yes,please attach lette�from IRS or Department of
Revenue declaring exemption�-� � %/j� ;=k'.i� � � '7U��rh��
❑YesQNo 13. Has license ever been denied,suspended or revoked?If yes,check all that a ly:
❑Denied ❑Suspended ❑Revoked Give date: -
14. Number of active members 15. Number of years i�existence Note: Attach evide�ce of
three years exlstence.
�J�r_� 3�-� o�'✓ `� ,� i��.� 1,�1 �r._
16. Name of Chief Executive Officer(Cannot be. 17. Name of treasurer or person who accounts for other revenues
Gambling Manager) of tF�.@ organization(Cannot be Gambling Manager)
:11 � � i1(1.% 1 Z ' r)'F/ I�� r/i,�;F
Title Title
.....�
�,;r��P-4t i l.f r�'iT,;�C!i�t.'�tf�
Business Phone Number Business Phone Number
( .J''�� ( ) �i�' " �G''!%.ri
18. Name of establishment where gambling will be 19. Street address(not P.O.Box Number)
conducted �c ,, �� -
f'`1� k Ltt"j' �f�j= � �f rl! �.����('�,l� /i'•,�:.�
20. City,State,Zip 21. County(where gambling premises is located►
;�� %�+c�' %t��l;� �;,Sjl% I';'u :-��s�-I
�
CG-0001-03(S/88) White Copy-Board Canary-Applicant Pink-Local Governing Body
Page 1 of 2
"I� � �� ` � � � ��-��/
'Gambling License Application
Type�af Application: �Class A ,6�1 Class B ❑Class C ❑Class D
�ElYes ONo 22. Is gambling premises located within city Iimits7
�Ye�s�No 23. Are all gambling activities conducted at the p�emises listed in#18 of this applicationT If not,complete a separate
application for each premises(except rafflesl as a separate lice�se is required for each premises.
❑Yes O No 24. Does organization own the gambling premises?If no,attach copy vf the lease with terms of at least one year,and
� attach a sketch of the premises indicating what partion is being leased. A lease and sketch are not required for
Class D applications.
25. Amount of Rent Per 26. Do you plan on conducting bingo with this IicenseT If yes,give days and times of bingo occasions.
Month or Bin o Occasion Day Time Day Time Day Time
S � .
����:�U�
�(t]Yes ONo 27. Has the S 10,000 fidelity bond required by Minnesota Statutes 349.20 been obtained?
28. Insurance Company Name(not agency name► 29. Bond Number
��; `'r/^ 1 ! 1/ 3G �� S' / �:��.>-'-��1�';J��/��
30. Lessor Name 31. Address 32. City,State,Zip
L -�1�/� ; i_;r.,:vT�
33. Gambling'Manager Name 34. Address 35. City,State,Zip
:-`� �� �!. j�� i��.q, � ..f �'� iC-' %S �- �i�i i�f' /'f'C� ,Cj`�.� j�,'� ".
36. Gambling anager Business Phone 37. Date gambling manager became
( .��=, ��,��_._.`i,�;J, �,��_ �7�,,� member of organization: Month � Year r��
❑Yes �No 38. Has the license termination form been completed?Attach copy.
❑Yes ONo 39. Has the compensation schedule been approved by the organization?Attach copy.
40. List the day and time of the regular meeting of the organization. Day �S i ��+�S 'Y��✓<1 -�°r`:t{�� Time �%u�,��t�
41. Bank Name 42. Bank Address 43. Bank Account Number
Tc;�..L�.v �� r"�.��<< j i� �iuc� !�i s" �..r ;i'i%'f���( �'.�(� Iti`,�aluxt����u �/l j k a�
GAMBLING SITE AUTHORIZATION
By my signature below,local law enforcement officers or agents of the Board are hereby authorized to en#er upon the site at any
time gambling is being conducted to observe the gambling and to enforce the law for any unauthorized game or practice.
BANK RECORDS AUTHORIZATION
By my signature below, the Board is hereby authorized to inspect the bank records of the gambling bank account whenever
necessary to fulfill requirements of current gambling rules and law.
1 hereby declare that: OATH
1. I have read this application and all information submitted to the Board;
2. All information submitted is true,accurate and complete;
3. All other required information has been fully disclosed;
4. I am the chief executive officer of the organization;
5. I assume full responsibility for the fair and lawful operation of all activities to be conducted;
6. I will familiarize myself with the laws of the State of Minnesota respecting gambling and rules of the Board and agree, if
licensed,to abide by those laws and rules, including amendments thereto;
7. Membershi list of the or anization will be available within seven da s'after it is re uested b the board.
44. Official,Legal Name of O,�ganization 45. Signature(must`be signed by Chief Executive Officer)
�rt �r�f,��-� 1�!��i�IN s �anskv l'�c�S x -1":. :� _.._ -
Title of Signer � Date _
/-�/(�C'_�-+e�.c.c.� � t 1 1 `�
ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY
I hereby acknowledge receipt of a copy of this application.By acknowledging receipt,l admit having been served with notice that
this application will be reviewed by the Cha�itable Gambling Control Board and if approved by the board,will become effective
60 days from the date of receipt (noted below) unless a resolution of the local goveming body is passed which specifically
disallows such aciivity and a copy of that resolution is received by the Charitable Gambling Control Board within 60 days of the
below noted date.
46. Name of City or County(Local Governing Body) If site is located within a township,item 47 must be completed,in
`�, addition to the county signature. If township is not organized,
� :� � ' _ county must sign.
Signature of pecson receiving application 47. Name of Tow�ship
X �• . r`
Title Date received (60 day period Signature of person receiving application
begins from this date) '
, • � . X
48. Name of person delivering application to Local Governing Body Title
CG-0001-03 18/881 White Copy-Board Canary-Applicant Pink-local Governing Body
Page 2 of 2
F . City of Saint Paul ��''G�QY1
� . � Department of Finance and Management Services
� License and Permit Division n�/'�a--
; 203 City Hafi CJ L/v •
� St. Paul, Minnesota 55102•298-5056
� APPLiCATION FOR LICENSE
CASH �CHECK CIASS NO. New Renew
tao � aa - � ��(
; Date � ��i 19�""/
' Code No. Title of License From f t � ! 19'd To � � � �/�
1 �g•� i
� '�'z' -� �' �' %' � �J�• �G
��I .� �. t�� ���y- �; — �c ,:� ,-�,(, �.,t�� b,� 1
I i: � ,� ��;,r r�_° ;�, f��'����_'�`" �Ci��k/'
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� �rn� � +`t_� !:-.�.r ,.) .f �-•,`1J 3^�-I, �(� AppllcanUCompany Name 1 �)U "
, � �
i LJ t0o �.�n�� �'� '�� Cl`� '1
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100 Business Name
I
� ,� i � �i'i b�� ��; � .� u z�
�
i Business Address�__` Phone No.
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� �� � I � t�C',�;� � � , `' ;;.� �v//`/
f 100 Mail to Address Phone No.
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; ,00 kc '�.O i��l 3 � J� �u�,Jc.c ��n n �'
fManapeNOwner•Nar�r e � --
� �oo � ��`J _'
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oi0 ?� �+�V �'u� �
100 AlanagerlGwner•Home Address Pho�e No.
�' 4098 Application Fee 2: 5a q �
Aeceived the Sum of I 100 j j •�CI t,t I � /�I 6/ � �� '�f
�,: ��!� S� ManagedOwner•Clty,Slate 8 Zip Code
�; 100 Total 100
i
ff L(cense Inspector �� By; � �� Signature o(AppliCant
I
f �
� : Bond•
Company Name Policy No. Expintion Date
Insurance:
Company Name Policy No. Expiratlon Oate
Minnesota State Identificatlon No. C � c�l��I Social Security No.
i
' Vehicle Information:
�
� Sarial Numbsr Plate Number
Other.
' THIS IS A RECEIPT FOR APPLICATION
� THIS IS NOT A LICENSE TO OPERATE.Your application for license will either be granted or rejected subject to the provisions of fhe zoning
; ordlnance and completian of the inspections by the Health, Fire,Zoning andlor license Inspectors.
�
i
$15.00 CNARGE FOR ALL RETURNED CHECKS
`C;�.4e,r�G� �`�'� �
. , Cicy oc Sain[ Paul /�
� ,, �_, � , Depar[ment o[ E'inance and Management Services C%' v° 4�Q�
( , � , Dfvisian of License and Yermic Regiscracion
INFORMATiON REQUIRED WITH APPLICATION �OR PERMIT T•O CONDLlCT CHARITe�BL.^�.. G?u�fBLiVG G?u`!�' I�1
saiNT PAUL
1. Full and complete name of orRanizacion which is applying for 1�cense
�� �e�► /.-����� � � �s�✓' � Ccc�
,
2. Address where games will be held ���L 7 �L-1 /�IllS � � �f�/'c.�t- '�`�1
Number Screec ity Zip
3. Name cf manager signing this application Who will coaduct, aperate and manage
Gambling Games 9 Dace of Birth ����r�' 7�
(a) Length of time manager has been member ot appl{caac organ�zacion L
4. Address of Manager �(77C' ���/ � � �r/��4 � �l� �l9
vumber Screec Cic� Zi2
5. Day, dates, and hours chis applicacion is co� KE�� C-Q�--a6(_Q
6. Is the applicant or organization organized under t`�e lavs o= c�e State oz �1? �
. e o incor�
8. Date when registered with the State of Minnesoca y-a�► � 7g
9. Hov long has organization beea in esistence? �(� �jS•
10. How long has organization bee:� in existeace ia St. Pau�? _�L'�?���U'�� Jv���•
11. Whac is the purpose of the organization? �Q��.�� C('_�d7�1�Y�4
12. Officers of applicant organizatfon .
Name �l`�4Y1 LQ� Vame �Li'�' +t�J��G Cl n
Address r�-Q[�O /« � f�UC �i7 �Tp ��ty' Address 1�7� �' i4r1/��T�Qyi
Title �rt'P5%C�F-cc�" DOB ���-��D TitZe PC/'ef„�i �aB S�`Sf
Name �i�Yi Q' l�-4 C� Yame A.VtGU-/ ��-1't. i lJT --
Address �Q � eCL� � 'r/ address �1�C1�L(.9P � 'Sl P��,l�
Title ��.�'- �/'CS•QP.It� DOB '��-y7 �icla plY�t�py DOB
13. Give names ot officers, or any oczer ?ersons :rao ?ai3 ::ar se^r:ces co �ae o:3ar.:�ac'_�;..
`ame � �C2e)ZQ ���.��� Vame
Address �'��� �=, �+GCe-�%�Y`K� addrass
T i t l e �iQ�i��l rB'/� ��' �'y 7� --='-e
(��ccach separaca snz�- -..- ac�:::ar.a: -�=a�.
� � � � � � ���a�
. ,�4. ' �ccached hereco :s a Iis� or names and addresses oi all �emoers oc �:�e .r5d.^.:23_:�- .
t
15. In ahase cuscody vill organization's records be kepc?
, Name C���,t. �11�f,d�fJl,tx'�"" �,ddress �7.s �v`'/ �ct� �� STQ��
16. Persons vhc vi11 be conduccing, aasistinR in conduccing, or operacing che �ames:
Name -,U�I'�Lc/ ��(,� Wt�r�� Date of Birch
addresa /�i�,�.t�r� �7��/4tt. � �/���
'�ame oi Spousa �/��(!e/ Dac• of Birth
Daces vhen such ptrson will conducc� assisc� or oparace
.�
�Uc� � �C�r�, S�f�� ��c-��
Yame �CL{�Ul ���f�c3�%S�� Date oE Bizth ,�'•,,s= ��
address
Name of Spouse �-enry �•�;"rl/,vc fi �? ��S'lrjn��,.ov���{�Dite of Birth
�
Daces vhen such person �.ri1? con�ucc, ass:sc , or operate
1/��fv� � Fr`�
—,
17. Have you read aad do ?au c'�oraughly unde=sciad che provisioas of alI lavs , ordinances,
and regulacier.s �o�re_^...ag c�a ope:ac_on a c Cha:�tab_e Ga�b li� games? ��,. .��e,��
� �
18. actached herec� az c:�e fa:r `ur..ished bv ch� C.cy o: Sc. Paul is a Financial �epa�t
vhic!� ':emi=es aL= rece=�cs, es�eases, a�d d:sbu:semeacs oc cne aoplicanc organizacion
as vei� as a:: o:gan:za:=�ns vna zave :ece?��ed ?unds �or c:�e prece�+:::g ca�_ndar �ear
whica `�as beez s:;::ad, r:a�ared, and va:=._ed 9Y �Prfy /NQG�L� . ��fT'
• Va e
�.�T� �v�.�6��c� Clc� , �h.pC���
�c�reas
vha is che ��/� cc che applicanc O:ganizac=or..
Vame ar Of:=:.e
19. Operator of premi=es vhere �ames Ji�: �e ;�e?d:
Name L,QTry �QLCrfG -L�(/�Z�UFI`-
H�csiness �ddress I�'�7 , LL l��.P �''� � ! f/�'t'�
Home Address
Z0. �ounc oE renc oaid by aopL_�anc Or3ani=acioa rar reac ec che hall; specf:y amounc
pafd per 4-hour seaR.an �U�i �-� ,�(i'Y�'LC�GYl2, � ��• � �r�/-P�..�C.�"
. ' ' : � � � �+���:��`��
� '' .21: The proceeds oi cne games wiil be disbursed after deduccing prize layouc coscs and
operacing expenses for the collowing purposes and uses:
c �
. � �vr/-re4 rr � ;cc�" ��F'�ua
-�r� -
22. Has the pre�ises where the games are co be held been certified for occupancy by che
City o£ Sainc Paul? �!T�UJ
23. Has your orgar.itation riled cederaL fora 990—T? Ir answer is yes, please at�ach
a copy vic:� thfs applicacion. I? answzr is no , expLain vhy:
Y�rU
Any changes desired �� tne d7DI=Ca:1C �ssociacfon ma� be xade only wich the conse.^.t o* c�,e
City Council.
��
0 ' an:aacion
Date ��' �— � By: �,.
�Ian er ' c arge oi ga�e
v � � � � zt ^ � — � .. — -; �
CJ 3 :D �G � � " J :7 '9 7 r-
R T f9 fT ;j 1 :Q R "{ r+. � :3
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TO BE COMPLETID BY
ORGANIZATION PRESIDENT AND GAMBLING MANAGER
I understand and will uphold Saint Paul Ordinance 409, Sections 409.21
and 409.22 relating to pulltabs and tipboards in bars.
Further, I understand that my jarbar must meet city standards; that lOZ
of the net profit from pulltab sales must be returned to the City-Wide
Youth Athletic Fund on a monthly basis; that monthly financial state-
ments must be filed with the city; and that alI proceeds from pulltab
sales must be used for youth athletics.
1
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Signature M r
t
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Signature - Organization President
��Y la,L/ � '�., �""..''U
Organi'ation Nam
I v��'
Gambling Loca
J � - d �" �
Date
Please retain the attached ordinance for pour records.