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Minnesota Lawful Gambling LG220 A lication for Exem t Permit Page 1 of 2 6/07 An exempt permit may be issued to a nonprofit organization that: . conducts lawful gambling on five or fewer days, and . awards less than $50,000 in prizes during a calendar year. Fee is $50 for each event For Board Use Only Check # $ ORGANIZATION INFORMATION Organization name ~~I~ Type of nonproffl organization. Check (...j) one. o Fraternal 0 Religious 0 Veterans ~er nonprofit organization City StatelZlp Code ,?, Po V< ~.....J"\e t;;?t:>;;.f, Name of chief executive officer (CEO) Daytime phone number ~b I~l.-t 1.e:P!!-j .b12--- :?-;2-' --CJI'2-2- ATTACH A COPY OF.QN.& OF THE FOLLOWING FOR PROOF OF NONPROFIT STATUS Previous gambling permit number -1:>4-72J .....t>f,. -00'2- County ~ * Do not attach a sales tax exempt status or federal ID employer numbers as they are not proof of nonprofit status. _ NonprofltArtlcles of Incorporation OR a current Certificate of Good Standing. Don't have a copy? This certificate must be obtained each year from: Secretary of State, Business Services Div., 180 State Office Building, St. Paul, MN 55155 Phone: 651-296-2803 pnternal Revenue Service - IRS income tax exemption [501 (c)lletter in your organization's name. Don't have a copy? To obtain a copy of your federal income tax exempt letter, send your federal ID number and the date your organization initially applied for tax exempt status to: IRS, P.O. Box 2508, Room 4010, Cincinnati, OH 45201 _Internal Revenue Service - Affiliate of national, statewide, or International parent nonprofl1 organization (charter) If your organization fells under a parent organization, attach copies of ll2!Il of the following: a. IRS letter showing your parent organization is a registered nonprofit 501 (c) organization with a group ruling b. the charter or letter from your parent organization recognizing your organization as a subordinate. _Internal Revenue Service - proof previously submitted to Gambling Control Board If you previously submitted proof of nonprofit status from the Intemal Revenue Service, no attachment is required. GAMBLING PREMISES INFORMATION Check the box or boxes that indicate the type of gambling activity your organization will conduct: ~BingO )2fRaffles 0 *Paddlewheels 0 *Pull-Tabs 0 *Tipboards * Gambling equipment for pull-tabs, tipboards, paddlewheels, and bingo (bingo paper, hard cards, and bingo number selection device) must be obtained from a distributor licensed by the Gambling Control Board. To find a licensed distributor, go to www.gcb.state.mn.us and click on Ust of Licensed Distributors, or call 651-639-4076.