2015-05-27 CC Packet - Laserfiche WebLink

Home Browse Search

MINNESOTA LAWFUL GAMBLING 8/14 LG220 Application for Exempt Permit Page 1 of 2 An exempt permit may be issued to a nonprofit organization that: Application fee (nonrefundable) • conducts lawful gambling on five or fewer days, and If the application is postmarked or received . awards less than$50,000 in prizes during a calendar year. 30 days or more before the event,the application If total prize value for the year will be$1,500 or less, contact the Licensing fee is$50; otherwise the fee is$100. Specialist assigned to your county. Organization Information Organization Name: Previous Gambling Permit Number: Church of St. Genevieve X-98008 Minnesota Tax ID Number, if any: Federal Employer ID Number(FEIN), if any: 4361808 41-1417861 Type of Nonprofit Organization (check one): Fraternal a Religious Veterans Other Nonprofit Organization Mailing Address: City: State and Zip: County: 7087 Goiffon Rd Centerville MN 55038 Anoka Name of Chief Executive Officer(CEO): Daytime Phone: Email: Fr. Grea Esly 651-429-7937 i f ns Nonprofit Status Attach a copy of ONE of the following for proof of nonprofit status: Nonprofit Articles of Incorporation OR a current Certificate of Good Standing. Don't have a copy? This certificate must be obtained each year from: Minnesota Secretary of State Business Services Division 60 Empire Drive, Suite 100 St. Paul, MN 55103 Phone: 651-296-2803 IRS income tax exemption (501(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 at 877-829-5500. IRS-Affiliate of national, statewide,or international parent nonprofit organization (charter). If your organization falls under a parent organization, attach copies of both of the following: a. an IRS letter showing your parent organization is a nonprofit 501(c) organization with a group ruling, and b. the charter or letter from your parent organization recognizing your organization as a subordinate. Gambling Premises Information Name of premises where the gambling event will be conducted (for raffles, list the site where the drawing will take place): Church of St. Genevieve Parish Grounds Address (do not use PO box): City or Township: Zip Code: County: 6995 Centerville Rd Centerville 55038 Anoka Date(s) of activity (for raffles, indicate the date of the drawing): August 16 2015 Check each type of gambling activity that your organization will conduct: Bingo* =Paddlewheels* Pull-Tabs* =Tipboards* Raffle (total value of raffle prizes awarded for the year: $ 3200 ) *Gambling equipment for bingo paper, paddlewheels, pull-tabs, and tipboards must be obtained from a distributor licensed by the Minnesota Gambling Control Board. EXCEPTION: Bingo hard cards and bingo number 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, or call 651-539-1900. 20