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<br />2009-02-27 11:43 <br /> <br />NORTHWEST AIRLINES INC <br /> <br />6127263761 >> <br /> <br />6516530071 <br /> <br />P 2/3 <br /> <br />Minnesota Lawful Gambling <br />LG220 Application for Exempt Permit <br />An exempt permit may be issued to a nonplOfit organization that: <br />-- conducts lawful gambling on five or fewer days, and <br />- awalds less than $50,000 in prizes during a calendar year, <br /> <br />Page 1 012 9IQ8 <br />Fee is $50 for each event <br /> <br />For Board Use Only <br /> <br />Check. <br /> <br />s <br /> <br />RGANIZA TION INFORMATION <br /> <br />Organization name Previous gambling permit number <br />,~, ~e.~e.."'Ie.Ve.'s ~a...~" \', ~ t.}\~~(;.~, X - 9<6D?_?::(?~_:...9_.s>~_ <br />Type of nonprofit organizalion, Check one, <br />10 Fralet"na' ~ Retigious []Vet"""'. ..ID Other nonprofit ",ganizalion <br />Maili;.g addre.. ... CitY' ...--.--.-....---.. Slate Zip Code County <br /> <br />10'i;('7 fl,cif.fon R.Ol>.<L te...,+erv'dle.. ty\ fI 55oJ:i/ u.sA <br />-~ of chief execulive officer (CEO) Daytime phone number "EriUiii-addre.. <br /> <br />F-llI..",^ex TtlWl Fi'b. e,nJt! 651- L/aCj - 7'1]'7 51- e.V\.S(~U: ......., .'IeA- <br />Attach a copy of ONE of following for proof of nonprofit status. Chec~ ne. <br /> <br />Do not atlad1 a sales tal( exempt sbltus or federallD empl(Yfel' numbers as they are not proof of nonprofit status. <br /> <br />I 01 Nonprollt Anlcles of Incorporallon OR a current Certificate of Good Standing. <br />Don't have a cop>,? This certificate mUEil be obtained each year from: <br />Secretary of State, Buslness ServICeS DIV., 180 Slale Office Building. SI Paul, MN 55155 Phone: 651-291>-2803 <br /> <br />[g] IRS income tu exempllon [501(c)) letlltr In your org.nlullon'a name. <br />Don' ha.... a copy? To obiain a copy of your federal income tal( exempt letter, have an organization officer <br />contad the IRS atSn4129-5500. <br /> <br />[g] IRS A AfflU... of national, .tatDwldo, or IntAmaUonal parent nonpl'Qf1t organization (ehart.r) <br />If your organization falls under a parent organization. attach copies of b_'?th_ of the foDowing: <br />a. IRS Ie<<er 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 suboldinate. <br /> <br />~ IRS - proof previously __ to Gambling Co""""_ <br />If you preViously submitted proof of nonprofit status from the IRS, no attachment is required. <br /> <br />GAMBLING PREMISES INFORMATION <br /> <br />Name of premi... where gambling activit}' will be conducted (for rnffles, list the stte where the drawing will take place) <br /> <br />~'(d~;;V:~~~;s. ~CU'i~>v.. c.OYr\~!,L.t~'1.ctr._. ...._..__fi;{~~~L_-c~~~------ <br /> <br />b 'f('I...~ t!.e.n1e.rvi lIe. R.ca.,rL (!.er.t/!.fVlllt:.... ...5S{)".."\ g <br />~te(.) of activit}' (for rnfftes, Indicate the date of the'~aWingr"'-' _. ... ... <br /> <br /> <br />heck the box or boxes :a;~~~~am~activ <br />o Bingo" 51 Ralftes 0 Paddlewlleels" 0 Pull-Tabs' 0 Tlpboanls' <br /> <br />usA <br /> <br /> <br />. 6alnbling equipment for pull-tabs, bingo paper, tipboatds, and <br />paddlewheels must be obtained from a d151rbJlor licensed by the <br />Gambling Control Boald. EXCEPTION: Bingo hard cards and bingo <br />number selection deVices may be borrowed from another organization <br />authorized to conduct bingo. <br /> <br />To find a licensed distributor, go \0 www.gcb.sblte.mn.U$and did< on us! <br />of Licensed Dis\riblJtors, or call 651-639-'107G. <br /> <br />Also camplel:e <br />Page 2 of this form. <br /> <br />I Prlnt Form , <br />I Reset Form I <br />