2023-05-10 CC Packet - Laserfiche WebLink

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MINNESOTA LAWFiJL GAMBLING LG220 Application for Exempt Permit 4/22 Page 1 of 4 An exempt permit may be Issued to a nonprofit Application Fee (non-refundable) organization that: Applications are processed In the order received. If the application . conducts lawful gambling on five or fewer days, and is postmarked or received 30 days or more before the event, the . awards less than $50,000 In prizes during a calendar application fee Is $100; otherwise the fee Is $150. year. If total raffle prize value for the calendar year will be Due to the high volume of exempt applicaticns, payment of $1,500 or less, contact the Licensing Specialist assigned to additional fees prior to 30 days before your event will not expedite your county by calling 631-539-1900. service, nor are telephone requests for expedited service accepted. ORGANIZATION INFORMATION Organization Previous Gambling 98008 Name: _ Church of St, Genevieve Permit Number: X- Minnesota Tax Id Federal Employer ID Number, If any: 4361808 Number (FEIN), if any: 41-1417861 Mailing Address: 7087 Golffon Rd city: Centerville state: MN zip: 55038 County: Anoka Name of chief Executive Officer (CEO): Fr. Greg Est CEO Daytime Phone: 651-429-7937 cE0 Email: siribeck@stgens.org (permit will be emwted to this email address unless otherwise Indicated below) Email permit to (if other than the CEO): NONPROFIT STATUS Type of Nonprofit Organization (check one): 0 Fraternal 0 Religious 0 veterans ® Other Nonprofit Organization Attach a copy of nne 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 Certificate of Good StandingA`)��i� Dort have a copy? Obtain this certificate from: MN Secretary of State, Business Services Division Secretary of state websiter phone numbers: 60 Empire Drive, Suite 100 www.sos.state.rnn.us St. Paul, MN 55103 651-296-2803, or tall free 1-877-551-6767 ❑ IRS income tax exemption (501(c)) letter in your organization's name 6en'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 1-877-829-5500. IRS - Affiliate of national, statewide, or International parent nonprofit organization (charter) If your organization Falls under a parent organization, attach copies of DjaI 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, 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 Physical Address (do not use P.O, box): 6995 Centerville Rd Check one: [7,1clty: Ce tervii zip, 5503j$ county: Anoka Township: zip: county: Date(s) of activity (for raffles, indicate the date of the drawing): August 20 2023 Check each type of gambling activity that your organization will conduct: EE Bingo =1 Paddlewheels l E Pull -Tabs =Tlpboards Raffle Gambling equipment for bingo paper, bingo boards, raffle boards, paddlewheels, pull -tabs, and tlpboards 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.m►t.gov/gcb and click on Distributors under the List of Licensees tab, or call 651-539-1900,