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Minnesota Lawful Gambling Page 1 of 2 6108 LG220 Application for Exempt Permit For Board Use Only An exempt permn may be issued to a nonprofit organization that Fee is $50 for Check# . conducts lawful gambling on five or fewer days, and . awards less than $50,000 in prizes during a calendar year. each event $ ORGANIZATION INFORMATION Organization name Previous gambling pennn number C'rWJ C'-\ C> ~ ~~ c;~ ~ ~ \J l ~ " e... ){-'1'801.:::18 Type of nonprofit organization. Check (-.J) one. D Fraternal G2!'Religious D Veterans D Other nonprofit organization Mailing address . r~ . StatelZip Gode County Jo&1 ~\~~<:>,.., <.'.J. (",J .\'e MN. SS~~-r A~<::.'KC>. Name of chief executive officer (CEO) Daytime phone number ~ -( . "'" <::> IY'\ 0.. \ ~. l="~J?ri!r<tld. l, S \- 4"LQ..., Q'31 ATTACH A COPY OF.Q.HE OF THE FOLLOWING FOR PROOF OF NONPROFIT STATUS * Do not attach a sales tax exempt status or federal ID employer numbers as they are not proof of nonprofit status. _ Nonprofit Articles 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, SI. Paul, MN 55155 Phone: 651-296-2803 _ Internal Revenue Service . IRS Income tax exemption [501(c)) letter in your organization's name. Don't have a copy? To obtain a copy of your federal income tax exempt letter, have an organization officer contact the IRS at 877-829-5500. _Internal Revenue Service. Affiliate of national, statewide, or international pal8nt nonprofit organization (charter) If your organization falls under a parent organization, attach copies of l1Qlll of the following: a. IRS lelter showing your parent organization is a nonprofit 501(c) organization with a group ruling, and b. the charter or letter from your parent organization recognizing your organization as a subordinate. v'lntemal 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 Nr:e of premises where gambling activity will be conducted (for rallies, list the site where the drawing will take place) un.>-~"; S..... bA__",..,,~ Grr..~^~~ \\.,1.~ ~on\. LO.lr '.\,\ Address (do not use PO box) I~~, I lip Code I A;ty IC)~\ c,..,~~" ~... - \~-'" \ \~ 55~~ ",,.:P. Da~~) of activity (for rallies, indicate the date of the drawing) "'~\lo.~'T \lA -'?\::>oC'l \t>~..... - L.Pf'>oI Check the box or boxes that indicate the type of gambling activity your organization will conduct: Q .Bingo QRaflles G .Paddlewheels 13 'Pull-Tabs D "Tipboards * Gambling equipment for pull-tabs, bingo paper, tipboards, and paddlewheels must be obtained from a distributor licensed by the Gambling Control Board. EXCEPTION: Bingo hard cards and bingo number selection devices may be borrowed from another organization authorized to conduct bingo. To find a licensed distributor, go to www,gcb.state.mn.us and click on Ust of Ucensed Distributors, or call 651-639-4076.