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<br />81MeSOta Lawful Gambling <br /> <br />LG220 A IlcatIon for Exern <br /> <br />An exempt permit may be issUed to a nonprofitorganlzatlon <br />conduc1ing lawfUl gambling activily on five or fewer days, and <br />awardinQ lessthan $5(),OOO inprizescSurinpa calendar year. <br /> <br />'ORtMlIIIR <br />,', '_ ,,- c- : ' , -, - - _' , ", -" '. - , . ,'_ " -- ~,--'-,.:,_ .' ,,~- :. -,',- , <br /> <br /> <br />Page 1 of 2 4Kf1 <br />For Board Use 0nIJ <br />Fee PaId <br /> <br />CheckNo. .. <br /> <br />Organlza1lon name <br />St. ~eV"t.vi, C~O\I(. c.hwch <br />Type of nonprofit organization. Check ( one. <br />o Fratemal 131 Religious 0 Veterans 0 Other nonprofit organization <br />MalUngaddJeS1l Y.IlY <br />lQ<&l b-01f.fon Rcl- tertervlll>> <br />Name of chief exec:utlve ofticer (CEO) <br />om ~ uaJd <br />PROOFQF:Nc)ttflttQt$".TQ.' <br /> <br />PreYlouslawful gambling exemption number <br />9~OOcg <br /> <br /> <br /> <br />Chec:k one of the following and attach a copy of your proof of nonpr.aftt ....... <br />NOTE: Sales tax exempt status or federal ID employer numbers are not proof of tncome tax exempt status. <br /> <br />_1. NonprofltAltlclesof .J 2. ......alRevenueServlce-natlonalorganlzatlon <br />InoorpOratIon ~ Check if proof previouSly submiIled to GarnbIlI1a Control Board. <br />OR OR <br />certltlcate of Good Standing. _ Attach a copy of the IRS incoma 1ax exemption [501 (e)] letter in your <br />organ1zatIon's name. To obtain a copy of your federal \ncom8 tax <br />exempt letter. send your feclerallD number and the date your <br />organization initially applied for tax exempt status to: <br />IRS <br />P.O. Box 2508. Room4010 <br />Cinclnnati, OH ~1 <br /> <br />Attach a copy of your organization's <br />Nonprofit ArtIcles of Incorporation <br />OR current Certificate of Good <br />standing. <br /> <br /> <br />_3. Internal Reveftue8erVlce-Afftllateofparentnonproftt <br />organization (charter) <br />_ Check if proof previously submitIBd to Gambllng Control Board. <br />OR <br />_ If your organization fa1ls wtder a national organ\Z8tion, attach both <br />of the following: <br />a. a copy of the IRS letter showing that your national organization <br />has been a regist&red nonprofit 501 (e) organlzation and carries <br />a group ruling, and <br />b. a copy of the charter. or IetlBr from your national organization. <br />raccgnlzing your organization as a subordlnate. <br /> <br />f.JAIIBU,.g~l_lSI'INFORMAnON<. <br />Name of ~ .gamb!!ng actMty VfBl be conduct8d. (for ra~ list the site where ~ drawing wlll1ake place) <br />..~ VlJ~ toro""un,. ... c.. ldro ,it t <br />Address do not PO box) , nx. Zip Code ~ <br />I\ll Qd- Ltn+e.rVI\l.o .....ru "~03cg <br />Date(s) of ~ (for rafl\eS, indicate the date of the drawlng) <br />~~ 0 '1 <br />Check 1he boX or boxes 1hat Incicate the type of gambllng activity your organization wftI be conducting: <br />o "'Bingo "Sl Raffles 0 "PaddI8whaele 0 *Pull-Tabs 0 "1lpboards <br />"GamblIng equIpnaent for puII-tabs, tIpboards, paddIewheeIs. and bingo (bingo paper, <br />hard cards, and bingo runber seIedion devICe) must be obtained from a d1stributDr <br />IItenSed by the GamblIng ContrOl Board. To find a Bcensed dIstributDr, go to <br />www.gcb.sla1e.mn.us and click on lISt of uc:ensed D\strIbutOrS. Or call 65Hi39-4)OO. <br /> <br />ThIs certificate must be obtained <br />each year from: <br />Secretary of State <br />BusIness Services Div. <br />180 S1ate Office Building <br />St. Paul, MN 55155 <br />Phone: 651-298-2803 <br /> <br /> <br />330--/ <br />