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MINNESOTA LAWFUL GAMBLING 8/14 <br />LG220 Application for Exempt Permit <br />Page 1 of 2 <br />An exempt permit may be issued to a nonprofit organization that: Application fee (nonrefundable) <br />conducts lawful gambling on five or fewer days, and If the application is postmarked or received <br />awards less than $50,000 in prizes during a calendar year. 30 days or more before the event, the application <br />If total prize value for the year will be $1,500 or less, contact the Licensing fee is $50; otherwise the fee is $100. <br />Specialist assigned to your county. <br />Organization Information <br />Organization Name: Previous Gambling Permit Number: <br />Catholic United Financial - St. Jude of the Lake Council X-93077-14-002 <br />Minnesota Tax ID Number, if any: Federal Employer ID Number (FEIN), if any: <br />4487032 41-0182070 <br />Type of Nonprofit Organization (check one): <br />IZIFraternal Religious Veterans Other Nonprofit Organization <br />Mailing Address:City: State and Zip: County: <br />Catholic United Fin., 3499 Lexington Av. N. Arden Hills MN 55126 Ramsey <br />Name of Chief Executive Officer (CEO): Daytime Phone: Email: <br />Bonnie Westberg <br />Nonprofit Status <br />Attach a copy of ONE of the following for proof of nonprofit status: <br />Nonprofit Articles of Incorporation OR a current Certificate of Good Standing. <br />Don't have a copy? This certificate must be obtained each year from: <br />Minnesota Secretary of State <br />Business Services Division <br />60 Empire Drive, Suite 100 <br />St. Paul, MN 55103 <br />Phone: 651-296-2803 <br />IRS income tax exemption (501(c)) letter in your organization's name. <br />Don't have a copy? To obtain a copy of your federal income tax exempt letter, have an organization officer contact <br />the IRS at 877-829-5500. <br />IRS - Affiliate of national, statewide, or international parent nonprofit organization (charter). <br />If your organization falls under a parent organization, attach copies of both of the following: <br />a. an IRS letter showing your parent organization is a nonprofit 501(c) organization with a group ruling, and <br />b. the charter or letter from your parent organization recognizing your organization as a subordinate. <br />Gambling Premises Information <br />Name of premises where the gambling event will be conducted (for raffles, list the site where the drawing will take place): <br />Catholic United Financial (Home Office) <br />Address (do not use PO box):City or Township: Zip Code: County: <br />3499 Lexington Ave. N. Arden Hills 55126 Ramsey <br />Date(s) of activity (for raffles, indicate the date of the drawing): <br />March 19 2015 <br />Check each type of gambling activity that your organization will conduct: <br />Bingo* =Paddlewheels* =Pull-Tabs* =Tipboards* <br />Raffle (total value of raffle prizes awarded for the year: $49,484.00 <br />Gambling equipment for bingo paper, paddlewheels, pull-tabs, and tipboards must be obtained from a distributor <br />licensed by the Minnesota Gambling Control Board. EXCEPTION: Bingo hard cards and bingo number selection devices may <br />be borrowed from another organization authorized to conduct bingo. <br />To find a licensed distributor, go to www.mn.gov/gcb and click on Distributors under the LIST OF LICENSEES, <br />or call 651-539-1900.