2023-06-14 CC Packet - Laserfiche WebLink

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MINNESOTA LAWFUL GAMBLING LG220 Application for Exempt Permit 4/23 Page 1 of 3 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 applications, 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 651-539-1900„ service, nor are telephone requests for expedited service accepted. ORGANIZATION INFORMATION Organizatlon Previous Gambling Name: Centerville LIons Club Permit Number: x- 04725 Minnesota Tax ID Federal Employer ID Number, if any: Number (FEIN), if any: 92-0905708 mailing Address: 1784 Meadow Lane City: Centerville State: MN zip: S5038 County. Anoka Name of Chief Executive (officer (cEo): Roll Hogan CEO Daytime Phone: 651-353-0882 CEO Email: rhogzC�yahoa.Com ;permit will be emalled to this email address unless otherwise indicated below) Email permit to (if other than the CEO): NA NONPROFIT STATUS Type of Nonprofit Organization (check one): Fraternal Religious Veterans Other Nonprofit Organization Attach.a cojpya-frM of the foHawl: , . re9 showing proof p�F rr6npraflR stag,. (Da 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 Standing Don't have a copy? Obtain this certificate from: MN Secretary of State, Business Services Divisio- Secretary of State website, phone numbers: 60 Empire Drive, Suite 100 W-WVV_CQS,Statewmin Li St. Paul, MN 55103 651-296-2803, or toll free 1-877-551-6767 IRS income tax exemption (501(c)) letter in your orgainization's name Don't have a copy? To obtain a copy of your federal income tax exempt letter, have an organisation officer contact the IRS toll free at 1-1177-829-5500. IRS - Afflllate of national, statewide, or international parent nonprofit organization (charter) If your organization falls under a parent organization, attach copies of b-Qt 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 INFOR1 ATION Name of premises where the gambling event will be conducted (for raffles, list the site where the drawing will take place): Laurie LaMotte Memorial Park Physical Address (do not use P.O. box): 6970 L4Mgtte Drive Check one: .71 city: Centerville zip: _5038 county. Anoka ❑ Township: zip: County: Date(s) of activity (for raffles, indicate the date of the drawing): July 16th 2023 Check each type of gambling activity that your organization will conduct: 21 J Bingo F] Paddlewheels = Pull -Tabs = Tipboards ® 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. FXCEPTI©N: 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 dick on Distributors under the List of Licensees tab, or call 651-539-1900.