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MINNESOTA LAWFUL GAMBLING LG22O Application for Exempt Permit lt/17 Page 1 of 2 An exempt permit may be issued to a nonprofit organization that:. conducts lawful gambling on five or fewer days, and. dwardS less than $50,000 in prizes during a calendar year. If total raffle prize value for the calendar year will be $1,500 or less, contact the Licensing Specialist assigned to your county by calling 651-539-1900. Application Fee (non-refundable) Applications are processed in the order received. If the application is postmarked or received 30 days or more before the event, the application fee is $1OO; otherwise the fee is $150. Due to the high volume of exempt applications, payment of additional fees prior to 30 days before your event will not expedite service, nor are telephone requests for expedited service accepted. ORGANIZATION IN FORMATION Organization Previous Gambling Name:Catholic United Financial - St. Jude of the Lake Council Permit Number x-93077 Minnesota Tax ID Federal Employer ID Number (FEIN), if any:Number, if any:4487032 4L-Ot82070 Mailing Address: c/o Catholic United Financial, 3499 Lexington Ave. N City Arden Hills State: MN Zip: 55L26 County 1 Ramsey Name of Chief Executive Officer (CEO); Boni Westberg CEO Dayti me phone: (612) 418-6206 CEo Emait; bonjim@hotmail.com (permit will be emailed to this emall address unless otherwise indlcated below) Emait permit to (if other than the cEo): Pa u I Lindema nn, Complia nce Ma nager (plindema n n@catholicunited. org ) NONPROFIT STATUS Type of Nonprofit Organization (check one): t/Fraternal E Religious E veterans E other Nonprofit organization Attach a copy of one of the following showing proof of nonprofit status: (DO NOT attach a sales tax exempt status or federal employer ID number, as they are not proof of nonprofit status.) A current calendar year Ceftificate of Good Standing Don't have a copy? Obtain this certificate from: MN Secretary of State, Business Services Division Secretary of State website, phone numbers: 60 Empire Drive, Suite 100 www.sos.state.mn.us r' St. Paul, MN 55103 651-296-2803, or toll free l-877-55L-6767 IRS income tax exemption (5O1(c)) letter in your organization's name Don't have a copy? To obtain a copy of your federal income tax exempt letter, have an organization officer contact the IRS toll free at L-877-829-5500. IRS - Affiliate of national, statewide, or international parent nonprofit organization (chafter) If your organization falls under a parent organization, attach copies of both of the following: 1. IRS letter showing your parent organization is a nonprofit 501(c) organization with a group ruling; and 2. the charter or letter from your parent organization recognizing your organization as a subordinate. GAM BLING PREMISES INFORMATION Name of premises where the gambling event will be conducted Catholic United Financial - Home Office(for raffles, list the site where the drawing will take place): Physical Address (do not use P.O. box): 3499 Lexinqton Ave. N Check one r'City : Arden Hills zip : 55126 County : Ramsey ! rownshiR:zip:County: Date(s) of activity (for raffles, indicate the date of the drawing)March LO,2022 Check each type of gambling activity that your organization will conduct: Bingo Paddlewheels Pull-Tabs Tipboards r'Raffle Gambling equipment for bingo paper, bingo boards, raffle boards, paddlewheels, pull-tabs, and tipboards must be obtained from a distributor licensed by the Minnesota Gambling Control Board. EXCEPTION: Bingo hard cards and bingo ball selection devices may be borrowed from another organization authorized to conduct bingo. To find a licensed distributor, go to www.mn.gov/gcb and click on Distributors under the List of Licensees tab, or call 651-539-1900.