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2010-07-14 CC Meeting Packet
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2010-07-14 CC Meeting Packet
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1/10 <br />Minnesota Lawful Gambling Page 1 of 2 <br />LG240B Application to Conduct Excluded Bingo No fee <br />ORGANIZATION INFORMATION <br />Organ' tion name Previous gambling permit number <br />Type of nonprofit organization. Check (') one. <br />I - <br />❑ Fraternal ❑ Religious ❑ Veterans (] Other nonprofit organization <br />Mailing address City State /Zip Code I County <br />1 W tsiv e w' - A-V-e. 0 n+c.r vi I le M N 1;5 S A-In 0 Kai <br />ATTACH A COPY OF ONE OF THE FOLLOWING FOR PROOF OF NONPROFIT STATUS <br />* Do not attach a sales tax exempt status or federal ID employer number as they are not proof of nonprofit status. <br />Nonprofit Articles of Incorporation OR a current Certificate 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 />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 />_Internal Revenue Service - Affiliate of national, statewide, or international parent nonprofit 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 />_Internal Revenue Service - proof previously submitted to Gambling Control Board <br />If you previously submitted proof of nonprofit status from the Internal Revenue Service, no attachment is required. <br />EXCLUDED BINGO ACTIVITY <br />No &Yes Has your organization held a bingo event in the current calendar year? <br />If yes, list the dates when bingo was conducted T Z 6 -L4 J7,4 2 (e i 2 o l <br />2. The proposed bingo event for which we are applying will be: <br />one of four or fewer bingo events held this year. Dates <br />OR <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 5 vo - Yt.vuUVl <br />4. Name of premises where bingo will be conducted �✓ I < <� <br />5. Premises street address I 2 I aj e-S�' i� Vv , <br />6. City Le_V V I 1 1e If township, name of township <br />Daytime phone (p ( `4 "D2U2- <br />County AV <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 />Be sure to complete page 2 <br />14 <br />
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