04-12-1989 Council Agenda - Laserfiche WebLink

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MINNESOTA DEPARTMENT GAMING DIVISION Mail Station 3315 St. Paul MN 55146 -3315 r. t,. V N 1! E GAMBLING LICENSE RENEWAL APPLICATION For Board Use Only Paid Amt' Check No Date: LICENSE NUMBER: A -49465 -903 / EFF. DATE: 91/04188 / AMOUNT OF FEE: 1. Applicant -Legal Name of Organization ST JOSEPHS PACIE?Y FOR CHARITY INC 2. Street Address 132 9ement Ave E Alt 341 3. City, State. Zip St Paul, NN 55117 4. County Ramsey 5. Business Phone (612 )483 -1203 6. Name of Chief Executive Officer Patricia Pillsbury 7. Business Phone (612 )483 -1203 ' 8. Name of Treasurergr P�ee A rson Who coups for Revenues d.a a?? -4zeri an .71101- -``/L' c `'(r'%Iif/ 9. Business Phone (612 ) 483 -1203 10. Name of Gambling Manager lois 3lombera 11. Bond Number 273618 12. Business Phone (612 )4titstEfel 4.7 .44 13. Name of Establishment Where Gambling Will Take Place Little Canada Bingo Hall little Canada 14. County Ramsey 15. No. of Active Members 27 16. Lessor Name Rovers Warehouse 17. Monthly Rent: . S,6" 'V6'5 -76'2 68 L-i 18. If Bingo will be conducted with this license. please specify days and times of Bingo. £✓ern "„y 3 SSid *C 7 /K- 9.0 a - 9. /S' -l/ ao Days Times Days Times 27 e's sr 0 4'S17ays /dr3e- ifima7 ur,vG Ape • 5a:t ,S�1r- )14 .5;.✓ -A?o•‘1 - JdnN • NIP s - Q,Lw' -r- 1iaJ2Mj o,v A-y -die" fkrr )e - 771d r; - 17-; - ()rt Fr, -Sa ✓ - s f=�6. -721es -,,c d 19. Has license ever been: ;, Revoked Date: ' Suspended Date: ['Denied Date: Hr 20. Have internal controls been submitted previously? 21. Has current lease been filed with the board? 22. Has current sketch been filed with the board? AS Yes ❑ Yes JH Yes ❑ No (If "No, attach copy) l No (If "No, attach copy) D No (If "No, attach copy) GAMBLING SITE AUTHORIZATION By my signature below, local law enforcement officers or agents of the Board are hereby authorized to enter 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 General Gambling Bank Account whenever necessary to fulfill requirements of current gambling rules and law. OATH I hereby declare that: 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. 1 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. 23. Official Legal Name of Organization Sr, JcserpAs Se.. for 69,041, rtif ci ACKNOWLEDGEMENT OF NOTICE BY LOCA�OVERNING BODY I hereby acknowledge receipt of a copy of this app ication. By acknowledging receipt, I dmit having been serve with notice that this application will be reviewed by the Charitable Gambling Control Board and if approved by the Board, will become effectiv Jays from the date of receipt (noted below), unless a resolution of the local governing body is passed which specifically disallows such activity a copy of that resolution is received by the Charitable Gambling Control Board withj.n.�yygys of the below noted date. 24. City /County Name (Local Gove ;jnning Body) C re// O f A11., t{Ie• p �A,nrA. DA • Township: If site is located within a township, please complete items 24 and 25: Signature of Person Receiving Application: 25. Signature of Person Receiving Application Ie Date Receivedithis d to begin ty clerk 3/30/89 d y period) Title: Body: Township Name e •ar,• on D-'veri A•plication.. Local Governing CG- 00022 -01 (5/87) J White Copy -Board Canary- Applicant Pink -Local Governing Body Page 1