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MINNESOTA LAWFUL GAMBLING 5/15 <br />LG220 Application for Exempt Permit Page 1 of 2 <br />An exempt permit may be issued to a nonprofit Application Fee (non-refundable) <br />organization that: Applications are processed in the order received. If the application <br />conducts lawful gambling on five or fewer days, and is postmarked or received 30 days or more before the event, the <br />awards less than $50,000 in prizes during a calendar application fee is $100; otherwise the fee is $150. <br />year. <br />If total raffle prize value for the calendar year will be Due to the high volume of exempt applications, payment of <br />1,500 or less, contact the Licensing Specialist assigned to additional fees prior to 30 days before your event will not expedite <br />your county by calling 651-539-1900. service, nor are telephone requests for expedited service accepted. <br />ORGANIZATION INFORMATION <br />Organization Previous Gambling <br />Name:Catholic United Financial - St. Jude of the Lake Council_ Permit Number: _X-93077-15-003 <br />Minnesota Tax ID Federal Employer ID <br />Number, if any: 4487032 Number(FEIN), if any: 41-0182070 <br />Mailing <br />Address: c/o Catholic United Financial, 3499 Lexington Ave. N. <br />City: Arden Hills State: MN _Zip; 55126 County: Ramsey <br />Name of Chief Executive Officer (CEO): Bonnie Westberg <br />Daytime Phone: (612) 418-6206 Email: bonjim@hotmail.com <br />NONPROFIT STATUS <br />Type of Nonprofit Organization (check one): <br />a Fraternal Religious Veterans Other Nonprofit Organization <br />Attach a copy of one of the following showing proof of nonprofit status: <br />DO NOT attach a sales tax exempt status or federal employer ID number, as they are not proof of nonprofit status.) <br />A current calendar year Certificate of Good Standing <br />Don't have a copy? Obtain this certificate from: <br />MN Secretary of State, Business Services Division Secretary of State website, phone numbers: <br />60 Empire Drive, Suite 100 www.sos.state.mn.us <br />St. Paul, MN 55103 651-296-2803, or toll free 1-877-551-6767 <br />F17 I 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 the <br />IRS toll free at 1-877-829-5500. <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 />1. IRS letter showing your parent organization is a nonprofit 501(c) organization with a group ruling, and <br />2. 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 <br />for raffles, list the site where the drawing will take place): _ Catholic United Financial (Home Office) <br />Address (do not use P.O. box): 3499 Lexington Ave. N. <br />City or <br />Township: Arden Hills Zip: 55126_County: Ramsey <br />Date(s) of activity (for raffles, <br />indicate the date of the drawing): March 10, 2016 <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 calendar year: $45,000.00 <br />Gambling equipment for bingo paper, paddlewheels, pull-tabs, and tipboards must be obtained from a distributor licensed by <br />the Minnesota Gambling Control Board. EXCEPTION: Bingo hard cards and bingo number selection devices may be borrowed <br />from another organization authorized to conduct bingo. To find a licensed distributor, go to www.mn.gov/gcb and click on <br />Distributors under LIST OF LICENSEES, or call 651-539-1900.