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<br />Minnesota Lawful Gambling <br />LG240B Application to Conduct Excluded Bingo <br />QRijANJZAfJoN:tNFOrtMAtION.. <br />,- - ' - .--, ~ - '; , ~.' - -', - - - ,- " " - ,-' '-, - ' ',', - -' --,'., , .'" , <br /> <br />6107 <br />Page 1 of2 <br />No fee <br /> <br /> <br />Previous gambling permit number <br /> <br />.l8l Other nonprofit organization <br /> <br />* Do not attach a sales tax exempt sla1LIs or federal 10 employer number as they are not proof of nonprofit status. <br /> <br />_ Non profit Articles of Incorporation ORa current CertIfIcate of Good Standing. <br />Don't have a copy? This certificate must be oblained each year from: <br />Secretary of Slate, Business Services Div., 180 S1atB Office Building, Sl Paul, MN 55155 Phone: 651-296-2803 <br /> <br />_ Internal Revenue Service -IRS Income tax exemption [601(c)] letter In your organtzaUon's name. <br />Don't have a copy? To obtain a copy of your federal income tax exempt letter. send your federal 10 number and <br />the date your organization initially applied for tax exempt status to: <br />IRS, P.O. Box 2508, Room 4010, Clnclnnati,OH 45201 <br /> <br />Xlntemal Revenue ServIce -Amllate ofnaUonal, statewide, or IntemaUonal parent nonprofit organization (charier) <br />If your organization falls under a parent organization, attach copies of mnb. of the foUowing: <br />a. IRS letter showing your parent organization is a nonprofit 501 (c) organization with a group ruling <br />b. the charter or Ietl8r from your parent organization I8COgnizing your organization as a subordinate. <br /> <br />_Internal Revenue Service - proof previously submItted to Gamblng control Board <br />If you previously submitted proof of nonprofit status from the Internal Revenue Service, no atlachment is required. <br /> <br />EXCLUDED BINGO ACTMTY <br /> <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 <br />2. The proposed bingo event for which we are applying will be: <br />A one of four or fewer bingo events held this year. Dates ut 9/ 01 <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 II trCl <br />4. Name of premises where bingo will be conducted <br />5. Premises street address W <br />6. City (-R..-~ ( ~ \ \ \ P - If township. name of township' <br /> <br /> <br />County ~Q 'L.ct <br /> <br />Bingo hard cards, bingo paper, and bingo number selection devices must be purchased <br />from a distributor licensed by the Gambling Control Board. To find a licensed distributor, go <br />to www.gcb.sIate.mn.ue and click on Ust of Ucensed Distributors. Or call 651 ~7e. <br /> <br />Be sure to complete page 2 <br /> <br />3~ <br />