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1VJint�e.sota La�+vful Gambling <br />�.�22fl App1 ication for Exem pt Perm �t <br />An �xempt permi# may be issued to a nonprofit organizat�on #hat: <br />- conducts lawful gambling on five or fiewer days, and <br />- av�ards �ess than $50,U00 in prizes �urir�g a ca�endar year. <br />�A��z�►�r�o� ������na�-�o� <br />Page '� of 2 2I'� 0 <br />Ap�licat�on #ee for eacfi even# <br />!f a lica#io� ostmarke or received: <br />iess than 30 days rnore #han 30 days <br />be#ore the event before the event <br />�1 fl0 $�0 <br />cn�� # s <br />Orqaniza#ion name Previous gambling perrni# numbe� <br />Renewing Hope Re�ources dba ����ing For Life <br />Type of nonprofit organization. Check one. <br />� Fra#ernaf � Reiigic�us � Ve#erans �X Other non�rofit organizatior� <br />Mailing address City S#ate Zip Code Co�nty <br />301513th l4ve S iVl�nne�tpo�is AAN 554�7 Hennepin <br />Name of chief executive officer (CEO} <br />To� Good�ich <br />Dayt�me phone number <br />f 1 ��-98�-�i4�f f <br />Emaf! address <br />gaady�Cstp@av�.com <br />At#ac� a�o�y af ��y,�, of the #oltowin� for �raof Q# r�o�p�ofi# sta#us. �heck vr��. <br />Do not a�#ach a saies tax exempt status or federal iD empiayer numbers as they are r�ot pr�f of nonprof� status. <br />Nonprofit Articles of lncorporation t?R a cu�ent C�rt'�fiicate of Good Standing. <br />Do�'t have a copy� Tt�is certifica#e mus# be obtained each year from: <br />Secre#ary of S#aie, Business Services Div., � 80 State fl�#'ice 8uitding, St. Paul, M�t 55'15� Phone: 651-296-2803 <br />X iRS income tax exempt�on j501 �cj� letter in your organiiation`s name. <br />Don'# have a copy? Ta obtain a copy of your federal income #ax exempt Istter, have an organ�zativn o�c�r <br />con#act #he IRS a# 877-829-55n0. <br />IRS - A#�iiate of national, statew�de, or internationa� parent nonproft organiza#io� (cha�ter� <br />lf you� organization falls und�r a#�afen# r�r�anizativn, attac� copies of both of #he following: <br />a. IRS ietter showing you� paren# organ�zat�on is a nonprof�t 501(c� o�ganization w�th a group ruling, and <br />b. #i�e charter or letter from �lour parer�t o�ganiza#ion recog�iz�ng your organiza#ion as a subordina#e. <br />❑!RS • proofi previously subm�#�ed to Gamb�in Con#ro1 Board <br />9 <br />!f you previousiy subrnit#ed proofi o# nonp�ofit status fiorr� ihe 1RS, no attachment is requireci. <br />G�1�UIBLI�VG Pf��AAlSES 1�Y�ORMAT�UN <br />Name of prem�ses vvhere gamb�ing a�iivity will b� conduc,�ed (€or raffles, list #he site wt�e�-e the drawing w�li take place) <br />North Heights L,�theran Church <br />Address (do not use PQ box� Ci#y <br />1700 W Hwy 9� Arde� Nii�s <br />Date�s) �� activi#y �for ra�l�s, indica#e #he date o# the drawing) <br />�ay � �, 2�� 0 <br />�ip Code Cour�#y <br />551 � 2 Ramsey <br />�c #he box or boxes #hat indicate the type of gam�ling ac#�vity yc�t�r organization wi11 cor�duct: <br />� 8ingo* � Raffles � Paddlewhee�s* � F'u11-Ta�s# [� Tipboards* <br />* Gambling equipment for pull•tabs, bingo paper, tipboarris, and <br />paddlewheets r�ust be obtained from � distributor licensed by the <br />Gatnbling Co�trot Board. EXCEP'TiQN: Bingo hard cards ar�d bingo <br />nurriber se�ection devices may be �rrowed from another organi2at�on <br />authorized to canduct bingo, <br />�"o find a licensed �istributor, go to vvww.gcb.state,mn.us and clic#c or� Ust <br />of ucensed Dis�ributors, or ca11551-539-40��. <br />/�Iso complete <br />Page 2 of this form. <br />Pr�n� �or�n <br />Reset fo�rrt <br />