HomeMy WebLinkAboutResolution 2010-056 bingo application for st. christopher'sMARANA RESOLUTION N0.2010-56
RELATING TO BINGO LICENSES; RECOMMENDATION TO THE STATE
DEPARTMENT OF REVENUE .REGARDING A CLASS B BINGO LICENSE
APPLICATION SUBMITTED BY ST. CHRISTOPHER'S CATHOLIC CHURCH
LOCATED AT 12101 MOORE ROAD
WHEREAS pursuant to A.R.S. § 5-404, the Town Council of the Town of
Marana is empowered to consider and approve or disapprove requests for a Department
of Revenue Bingo License; and
WHEREAS the Town Council has determined that it is in the best interests of the
Town and its citizens that approval be granted for a Class B Bingo License to St.
Christopher's Catholic Church to be used at 12101 Moore Road for the purpose of
providing bingo games as a recreational activity.
NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND' COUNCIL
OF THE TOWN OF MARANA, ARIZONA, that the application submitted by St.
Christopher's Catholic Church located at 12101 Moore Road for a Class B Bingo License
is hereby approved and a recommendation for approval shall be sent to the Department of
Revenue.
PASSED AND ADOPTED BY THE MAYOR AND COUNCIL OF THE TOWN
OF MARANA, ARIZONA, this 15th day of June, 2010.
~~~
Mayor d Honea
ATTEST:
yn C ronson, Town Clerk
APPROVED AS TO FORM:
O
Arizona Department of Revenue Bingo Section
Phoenix: (602) 716-7801
ENDORSEMENT BY LOCAL GOVERNING BODY
For Official Use Only
To be completed by the local governing body and returned to the Bingo Section pursuant to ARS §5-404.A.
^ New Application ^ Change of Location LICENSE # DATE
0 G ((o Z O O
FROM (NAME OF LOCAL GOVERNING BODY) ADDRESS -NUMBER AND STREET, PO BOX
Tow OF M.4RAN I SS W. G~v~c GENr~ ~IQIVE
TELEPHONE NUMBER WITH AREA CODE CITY STATE ZIP CODE
52c- 3~a- !9q ~tARANA ~~ 85b53
1. This is to certify that on I ~, 61 ~ ,5 12,0 , ( ,0 i, a hearing was conducted pursuant to Arizona Revised Statute, Title 5,
Chapter 4, on the:
Application for a bingo license by the following applicant
^ Application for a bingo license location transfer
~ ~/ r~
2. Name of applicant: LI~L'jj°'/
3. Location/address where games will be conducted; _ ~..
4. Days and times of games:
Monday: ^ AM ^ PM Friday: ^ AM ^ PM
Tuesday: ^ AM ^ PM Saturday: ^ AM ^ PM
Wednesday: ~GiD ^ AM ~ PM Sunday: ^ AM ^ PM
Thursday: ^ AM ^ PM
5. Background investigations:
^ have ~ have not been conducted~~,,ion all individuals listed in the Bingo License Application.
6. Recommendation: The application be LI Approved ^ Disapproved
7. Specific reasons for disapproval are hereby listed pursuant to ARS §5-404.1:
NOTE: This endorsement must be signed by a delegated authority of the local governing body.
~~U ~ C . ~ re-»Ss-r)
IG ATURE DATE TITLE
ail complet ,signed form to: Arizona Department of Revenue
Bingo Section
1600 West Monroe, Room 520
Phoenix, AZ 85007
ADOR 71-1002f (4/06)
Arizona Department of Revenue Bingo Section
6 Phoenix: (602) 716-7$01
APPLICATION FOR INGO LICENSE
Complete all information on this farm. If you do not complete all information, your application will be returned. All information
is subject to verification. If you need more space, attach additional sheets.
Falsification of information contained in this application constitutes a Class 6 felony.
All bingo licenses expire one year from the date of issue. To continue conducting bingo games, you must renew your
license prior to the expiration date.
For Department of Revenue Use Only
REVIEWER'S NAME (please print} DATE
® Approved ^ Disapproved
License Classification: ''Q Class A ^ Class B O Class C
LICENSE NUMBER.. TERM OF LICENSE:
Frorn:_ To:
Type or print in black ink.
1 APPLICANT'S NAME 2 TELEPHONE NUMBER WITH AREA CODE
St. Christo her's Roman Catholic Church 520 682-3035
3a ADMINISTRATIVE OFFICE LOCATION 4a MAILING ADDRESS
12101 Moore Road
3b CITY STATE ZIP CODE 4b CITY STATE ZIP CODE
Marana AZ 85653 Marana AZ 85653
5 Class B and Class C license applicants only: If applying as a qualified organization, indicate the type of organization:
Check one box:
^ Charitable ^ Social ®Religious ^ Veterans
^ Fraternal ^ Volunteer Fire Department ^ HomeownersAssociation ^ NonprofitAmbulance Service
6 Glass B and Class C license applicants only: If applying as a qualified organization, give the name and address of your one
parent or auxiliary:
PARENT. AUXILIARY
I
6a Diocese of Tucson 6b
ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO. ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO. ~
111 S. Church Avenue ~
CITY STATE Z!P CODE CITY STATE ZIP CODE
Tucson AZ 85701
7 Class B and Class C license applicants only; If ap lying s a qualified organization, indicate the date your organization was
established in Arizona: ~M, a i r, a i n a ~ f ~~
ADOR T~-~oiot iaiosl Continued on page 2 ~
ARIZONA DEPARTMENT OF REVENUE APPLICATION FOR BINGO LICENSE
8 Class B and Class C license applicants only: If aoolvina as a aualified oraanization, list current officers:
NAME NAME
8a Father Abran Tadeo 8b Bella Altamirano
TITLE TITLE
Pastor/President Secreta
ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO. ADDRESS -NUMBER AND STREET, RURAL RT.; APT. NO.
12101 Moore Road 12101 Moore Road
CITY STATE ZIP CODE CITY STATE ZIP CODE
Marano AZ 85653 Marana AZ 85653
NAME NAME
8c David Stevenson 8d Fr. Albert I. Schifano
TITLE TITLE
Treasurer Vice President
ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO. ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
12101 Moore Road 12101 Moore Road
CITY STATE ZIP CODE CETY STATE ZIP CODE
Marana AZ 85653 Marana AZ 85653
9 Class B and Class C license applicants only: Bingo checking account information:
Checking Account Number:
Bank Name and Branch:
10 Class Band Class C license applicants only: Bingo interest-bearing account information:
Account Number:
Bank Name and Branch:
11 Class B and Class C license applicants only: List all officers and/or supervisors authorized to sign checks from the
accounts listed above. If apolvina as a aualified oraanization, all supervisors must be members of the applicant:
NAME NAME
11a Father Abran Tadeo 11b Janet McLa
TITLE TITLE
Pastor/President Mana er
ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO. ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
12101 Moore Road 11272 W. Rudd Drive
CITY STATE ZIP CODE CITY STATE ZIP CODE
Marano AZ 85653 Marano AZ 85653
12 List the name(s) of the one or two persons who will serve as managers. If applying as a qualified organization, these persons
must be members of the applicant. Each person must submit an affidavit.
NAME NAME
12a Janet McLa 12b
TITLE TITLE
Mona er
ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO. ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
11272 W. Rudd Drive
CITY STATE ZIP CODE CITY STATE ZIP CODE
Marano AZ 85653
13 List the name of the one person designated as proceeds coordinator. If applying as a qualified organization, this person must be
an officer or director and a member of the aoolicant. Each aerson must submit an affidavit.
NAME ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
Father Abran Tadeo 12101 Moore Road
TITLE CITY STATE ZIP CODE
Pastor/Presdient Marano AZ 85653
ADOR 71-1010 (4106) Page 2 of 5
ARIZONA DEPARTMENT OF REVENUE APPLICATION FOR BINGO LICENSE
14 List the name(s) of the person(s) who will serve as supervisor. If applying as a qualified organization, each person must be a
member of the applicant. Each person must submit an affidavit.
NAME NAME
14a Theresa Ramirez 14b Philli Treinen
TITLE TITLE
Member, Parish Council Member Parish Council
ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO. ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
12574 N. Barbadense 6612 N. Dimitri Lane
CITY STATE ZIP CODE CITY STATE ZIP CODE
Marana Az 85653 Tucson AZ 85743
NAME NAME
14c Lar Duke 14d Richard Sin ervault
TITLE TITLE
Member, Parish Council Parish Council Member
ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO. ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
6855 N. Saltbrush 9515 N. Twinklin Shadows Lane
CITY STATE Z1P CODE CITY STATE ZIP CODE
Marana AZ 85653 Tucson AZ 85743
15 List the name(s) of the person(s) who will serve as assistants. If applying as a qualified organization, each person must be a
member or new member of the applicant. Except for "Class A" licensees. each person must submit an affidavit.
NAME NAME
15a Rose Treinen 15b Belia Altamirano
NAME NAME
15c Pe Fi ueroa 15d Veronica Jacinto
NAME NAME
15e Mar aret Duke 15f Thomas Travers
NAME NAME
15 Elmer Clem McLa 15h Lawrence Luter
16 Street address of the physical location where bingo will be played:
12101 Moore Road, Marana, Az 85653
17 Indicate the time on each respective day that bingo will be played:
Monday: ^ AM ^ PM Friday: ^ AM ^ PM
Tuesday: ^ AM ^ PM Saturday: ^ AM ^ PM
Wednesday: 7:00 ^ AM ®PM Sunday: ^ AM ^ PM
Thursday: ^ AM ^ PM
18 List dates of proposed game cancellation if any:
11/24/10 12/22/10 12/29/10 4/17/11 11/23/11 12/28/11
19 Indicate the type of premises where bingo will be played. Check one box (line 19 continues on page 4}:
a ®Neither rent nor mortgage will be paid from bingo funds.
b ^ Rented or leased. Attach rental affidavit and copy of rentat agreement.
LANDLORD'S NAME ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
TELEPHONE NUMBER WITH AREA CODE CITY STATE ZIP CODE
c ^ Owned solely by the organization. Attach copy of mortgage, deed of trust, purchase agreement, escrow agreement, etc..
HOLDER OF MORTGAGE ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
TELEPHONE NUMBER WITH AREA CODE CITY STATE ZIP CODE
ADOR 7i-~o~os (a/os) Page 3 of 5
ARIZONA DEPARTMENT OF REVENUE APPLICATION FOR BINGO LICENSE
19d ^ Owned jointly with other organization. Attach co of mortgage, deed of trust, purchase agreement, escrow agreement;
etc..
HOLDER OF MORTGAGE
1 ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
TELEPHONE NUMBER WITH AREA CODE CITY STATE ZIP CODE
CO-OWNER HOLDER:
2 ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
TELEPHONE NUMBER WITH AREA CODE CITY STATE ZIP CODE
CO-OWNER HOLDER:
3 ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
TELEPHONE NUMBER WITH AREA CODE CITY STATE ZIP CODE
20 List bingo licensees who are or will be conducting bingo in the same premises as you and those licensees located within 1,000
feet of vour premises.
NAME
20a None NAME
20b
ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO. ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
CITY STATE ZIP CODE CITY STATE ZIP CODE
21 Expected bingo expenses (line 2? continues on page 5):
a Mortgage: $_ _..0.00 ______ per month
PAYABLE TO
No Mort a e on Church or Pro ert ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
TELEPHONE NUMBER WITH AREA CODE CITY STATE ZIP CODE
b Rent: $ ________.__0.00 per ^ month ^ hour ^ occasion
PAYABLE TO ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
TELEPHONE NUMBER WETH AREA CODE CITY STATE ZIP CODE
c Janitorial Services: $ 0.00 per ^ month ^ hour ^ occasion
PAYABLE TO
Parish Custodian to erform services ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
TELEPHONE NUMBER WITH AREA CODE CITY STATE ZIP CODE
d Accounting Services: ~ 0.00 oer ^ month ^ hour ^ occasion
PAYABLE TO ADDRESS - NUMBER AND STREET, RURAL RT., APT. NO.
TELEPHONE NUMBER WITH AREA CODE CITY STATE ZIP CODE
e Security Services: ~ 0.00 oer ^ month ^ hour ^ occasion
PAYABLE TO
Parishioners will serve as securit ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
TELEPHONE NUMBER WITH AREA CODE CITY STATE ZIP CODE
ADOR 71-1010f (4/06} Page 4 of 5
ARIZONA DEPARTMENT OF REVENUE
21 Expected Bingo Expenses, continued...
Bingo Supplies: $ !_:~ per
APPLICATION FOR BINGO LICENSE
PAYABLE TO
r'lXiy~c.- ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
T LEPHONE NUMBER WIT ARE ODE CITY STATE ZIP CODE
g Maximum prize payout per occasion: $.
Attach game schedule that lists individual prize amounts.
PAID TO ADDRESS - NUMBER AND STREET, RURAL RT., APT. NO.
TELEPHONE NUMBER WITH AREA CODE CITY STATE ZIP CODE
h Utilities Expenses:
ELEC RIC (payable to} ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
AC OUNT NUMBER ONTHLY AMOUNT CITY STATE ZIP CODE
GA~(payabie to) ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
ACCOUNT NUMBER : MONTHLY AMOUNT CITY STATE ZIP CODE
WATER (payable to) ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
A OUNT NUMBER MONTHLY AMOUNT CITY STATE ZIP CODE
TR SH REMOVAL (payable ta} ADDRESS -NUMBER AND STREET, RURAL RT., APT. NO.
A COUNT NUMBER MONTHLY AMOUNT CITY STATE ZIP CODE
- _ $
22 Briefly state the specific projected use of net proceeds from games of bingo:
To pay bills and mortgage and finance a Parish pre-school.
Under penalty of perjury, upon oath, I, ~~ , !!'~~jPl~vi ~ ~ C~G>'k' c.> ,declare that I am duly authorized to sign
and file this application. I hereby swear or confirm that I have read the foregoing application and know the contents thereof, and
that al 'formation vided has been fully, accurately. and truthfully completed to the best of my knowledge.
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FIA 'S S GNATURE DATE TITLE
ADOR 71-1010f (4106) Page 5 of 5