Laserfiche WebLink
<br />Minnesota Lawful Gambling <br />LG240B Application to Conduct Excluded Bingo <br />ORGANIZATION INFORMATION <br /> <br />6/08 <br />Page 1 of2 <br />No fee <br /> <br />O~anization name ..:w <br />l.- (VI \ _ \ ~ <br />Type of nonprofit organization. Check ('oJ) one. <br />D Fraternal D Religious D Veterans <br /> <br /> <br />18.1' Other nonprofit organization <br /> <br /> <br />City StatelZip Code <br />~\!e un-\e(v, lie. MN 5':'" <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 federal 10 employer number as they are not proof of nonprofit status. <br /> <br />_ NonprofitArticles of Incorporation OR a currentCertilicate of Good Standing. <br />Don't have a copy? This certificate must be obtained each year from: <br />Secretary of Stale, Business Services Div., 180 State Office Building, SI. Paul, MN 55155 Phone: 651-296-2803 <br /> <br />_ Intemal 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. Affiliate of national, statewide, or international parent nonprofit organization (charter) <br />If your organization falls under a parent organization, attach copies of.QQ1h 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 _Yes Has your organization held a bingo event in the current calendar year? <br />If yes, list the dates when bingo was conducted <br /> <br />2. The proposed bingo event for which we are applying will be: <br /> <br />,/one of four or fewer bingo events held this year. Dates l \ 11~/ifll/2ltlm <br /> <br />OR <br /> <br />_conducted up to 12 consecutive days in connection with a: <br /> <br />_county fair. <br />_civic celebration. <br /> <br />Dates <br />Dates <br /> <br /> <br />3. <br /> <br />Daytime phone Ll5t-l/'j5-1C(tJ 0 <br />(Y)fn-ft-l ("; <br /> <br />5. Premises street address <br />6. City C f.xlJ.f nl i \ \ P <br /> <br />If township, name of township <br /> <br />County _~;y) ICCt. <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 Control 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 />