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<br />Minnesota Lawful Gambling <br />LG240B Application to Conduct Excluded Bingo <br />ORGANIZA TION INFORMA TION <br /> <br />6/08 <br />Page 1 of2 <br />No fee <br /> <br />Or anization name <br />~\ \\ ~ <br />Type of nonprofit organization. Check (..J) one. <br />D Fraternal 0 Religious 0 Veterans <br /> <br /> <br /> <br />Previous gambling permit number <br />- 4Wl-Oi- <br /> <br />g] Other nonprofit organization <br /> <br />Mailing address . StatelZip Code <br />" \ e... \h' \e.. '0'-' <br /> <br />ATTACH A COPY OF ~ OF THE FOLLOWING FOR PROOF OF NONPROFIT STATUS <br /> <br /> <br />* Do not attach a sales tax exempt status or federallD employer number as they are not proof of nonprofit status. <br /> <br />_ NonprotltArtlcles of/ncorporatlon ORa currentCertltlcate of Good Standing. <br />Don't have a copy? This certificate must be obtained each year from: <br />Secretary of State, Business Services Div., 180 State Office Building, St. Paul, MN 55155 Phone: 651-296-2803 <br /> <br />_ Internal Revenue Service -IRS Income tax exemption [501(c)) letter In your organization's name. <br />Don't have a copy? To obtain a copy of your federal income tax exempt letter, have an organization officer <br />contact the IRS at 877-829-5500. <br /> <br />{,nternal Revenue Service -AmI/ate of national, statewide, or International parent nonproftt organization (charter) <br />If your organization falls under a parent organization, attach copies of both of the following: <br />a. IRS letter showing your parent organization is a nonprofit 501 (c) organization with a group ruling, and <br />b. the charter or letter from your parent organization recognizing 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 attachment is required. <br /> <br />eXCLUDeD BINGO ACTIVITY <br /> <br />1. _No <br /> <br />Yes Has your organization held a bingo event in the curr_e~t calenqar yea;;,? ? <br />If yes, list the dates when bingo was conducted ~V'Y)be (' "I, )..DD_ <br /> <br />2. The proposed bingo event for which we are applying will be: <br /> <br />"6.. one of four or fewer bingo events held this year. Dates ~ <br /> <br />OR <br /> <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 .:::I)b <O(\~~ <br />4. Name of premises where bingo will be conducted <br />5. Premises street address } <br />6. City tt (\W' \l', \\ P If township, name of township <br /> <br /> <br />'("" <br /> <br /> <br />County <br /> <br />Bingo hard cards and bingo number selection devices may be borrowed from another organization <br />authorized to conduct bingo. Otherwise, bingo hard cards. bingo paper, and bingo number selection <br />devices must be purchased from a distributor licensed by the Gambling Con1ro1 Board. To find a licensed <br />distributor. go to www.gcb.state.mn.us and click on List of Licensed Distributors. Or call 651-639-4076. <br /> <br />Be sure to complete page 2 <br /> <br />I~ <br />