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rr <br />MINNESOTA I.AWFUL GAMBUNG LLltT <br />Page 1 of 2LG22O Application for Exempt Permit <br />An exempt permit may be issued to a nonprofit <br />organization that:. conducts lawful gambling on five or fewer days, and. dwords less than $50,000 in prizes during a calendar <br />year. <br />If total raffle prize value for the calendar year will be <br />$1,500 or less, contact the Licensing Specialist assigned to <br />your county by calling 651-539-1900. <br />Application Fee (non-refundable) <br />Applications are processed in the order received. If the application <br />is postmarked or received 30 days or more before the event, the <br />application fee is $1OO; otherwise the fee is $15O. <br />Due to the high volume of exempt applications, payment of <br />additional fees prior to 30 days before your event will not expedite <br />seruice, nor are telephone requests for expedited service accepted. <br />ORGANIZATION I N FOR]IIATION <br />Organization Previous Gambling <br />Name:Ducks Unlimited North Suburban Chapter 239 Permit Number:x-03315-20-014 <br />Minnesota Tax ID Federal Employer ID <br />Number (FEIN), if anyNumber, if any: <br />Mailing Address: <br />: 36-3766069 <br />1320 Amble Rd. <br />City : Arden Hills State: MN Zip: 55112 County ; Ramsey <br />Name of Chief Executive Officer (CEO):Peter Belsito <br />CEO Daytime Pho ns;651-242-3889 cEo Emait: peter.g.belsito@gmail.com <br />(permit will be emailed to this email address unless otherwise indicated below) <br />Email permit to (if other than the CEO): <br />NONPROFIT STATUS <br />Type of Nonprofit Organization (check one): <br />t] Fratemat E Relisious t_] veterans Other Nonprofit Organization{ <br />Attach a copy of one of the following slrowing 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 Ceftificate 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 65L-296-2803, or toll free t-877-55L-6767 <br />IRS income tax cxemption (sof(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 L-877-829-5500. <br />IRS - Afflliate of nationa!, statewide, or internaUonal parent nonprollt organizaUon (chafter) <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 />{ <br />GA]TI BLI NG PREITIISES I N FOR]IIATION <br />Name of premises where the gambling event will be conducted <br />Welsch's Big Ten Supper Club(for raffles, list the site where the drawing will take place): <br />Physical Address (do not use P.O, box):4703 N Hwv 10. Arden Hills. MN 55112 <br />Check one: <br />City : Arden Hills zip: 55112 County: <br />County: <br />Ramsev <br />n Township:zip <br />Date(s) of activity (for raffles, indicate the date of the drawing):7 1o zt <br />Check each type of gambling activity that your organization will conduct: <br />Bingo t] Paddlewheels E Putl-rabs Tipboards Raffie <br />Gambllng aqulpmcnt for bingo paper, bingo boards, raffle boards, paddlewheels. pulFtabs, and tipboards must be obtalned <br />from a diskibutor lic€nsed by the Mlnnesota Gambling Control Board, EXCEmON: Bingo hard cards and bingo ball sel€ction <br />devlces may b€ borrowed from another organization audrorized to conduct blngo, To find a licensed distributor, go b <br />wwv.fin.goylgcb and click on Dritdbrrtro,l' under the Lrsl of U6n3.rr tab, or call 651-539-1900. <br />{ <br />{