Laserfiche WebLink
3/11 <br /> Minnesota Lawful Gambling Page 1 of 2 <br /> LG240B Application to Conduct Excluded Bingo No fee <br /> ORGANIZATION INFORMATION <br /> Organization name Previous gambling permit number <br /> Centerville Elementary PTA XB-36441 <br /> Minnesota tax ID number, if any Federai employer ID number, if any <br /> Type of nonprofit oraanization. Check (�1 one. <br /> _� i <br /> ' Fraternal _�. Religious _� Veterans ✓ Other nonprofit organization <br /> Mailing address City State Zip Code County <br /> 1721 Westview Ave. Centerville MN 55038 Anoka <br /> ATTACH A COPY OF NE OF THE FOLLOWING FOR PROOF OF NONPRAFIT STATUS <br /> * Do not attach a sales tax exempt status or federal ID employer number as they are not 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 /> Secretary of State, Business Services Div., 180 State Office Building, St. Paul, MN 55155 Phone: 651-296-2803 <br /> � Internal Revenue Service - 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 <br /> contact the IRS at 877-829-5500. <br /> �� Internal Revenue Service -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. 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 /> EXCLUDED BINGO ACTIVITY <br /> 1.� No �Yes Has your organization held a bingo event in the current calendar year? <br /> If yes, list the dates when bingo was conducted 2/25/2011 <br /> 2. The proposed bingo event for which we are applying will be: <br /> �� one of four or fewer bingo events held this year. Dates 11/4/201Y 3/2/2012 <br /> OR <br /> � conducted up to 12 consecutive days in connection with a: <br /> �county fair. Dates <br /> civic celebration. Dates <br /> Minnesota state fair. Dates <br /> 3. Person in charge of bingo event Shannon Swanson Daytime phone 651-407-0202 <br /> 4. Name of premises where bingo will be conducted Centerville Elementary School <br /> 5. Premises street address 1721 Westview Ave. <br /> 6. City Centerville If township, name of township County Anoka <br /> Bingo hard cards and bingo number selection devices may be borrowed from another organization <br /> authorized to conduct bingo. Otherwise, bingo hard cards, bingo p aper, and bingo number selection <br /> devices must be purchased from a distributor licensed by the Gambling Control Board. To find a licensed <br /> distributor, go to www.gcb.state.mn.us and click on List of Licensed Distributors. Or call 651-639-4000. <br /> Be sure to complete page 2 <br /> 10 <br />