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r. <br /> L 220 For Board Use Only <br /> VOW5 Minnesota Lawful Gambling <br /> Application for A uth for are Check# do.......bmmmp� <br /> Exemp tion from La wfu! Gambling Licens� <br /> lnftals <br /> sate Recd <br /> 1 _ p.,',~1 •. 1• ..ri•!!- -.t rill! -H-{ •- '' _ -1 - _ <br /> • •. <br /> dj(ih Inhirinathin <br /> Organization Name <br /> Previous lawful gambling exemption number <br /> Church of St, Rose of Lima -6200 <br /> Street <br /> City qtate zip Code County <br /> 2048 N. Hamline Avenue Roseville IAN 55113 Ramsey <br /> Name of Chief Executive Officer of organization (CEO) Daytime Phone number of CEO <br /> First Name Last Name <br /> Walter Soehacki (612) 645-9389 <br /> Name ot organization Treasurer Daytime Phone Number of Treasurer <br /> First Name Last Name <br /> Reinart (612) - 645-93,99 <br /> ,99 <br /> r <br /> Type ofN o'n' pro .. <br /> describes heck the box that indicates the type of proof attached to this application <br /> ,1e�r�k f[�e b��helo��rr Vllh}�h best decor+ <br /> your organization <br /> rbly your organization: <br /> K]IRS letter indicating income tax exempt status <br /> � Prat <br /> ema{ CDCerfificate of good standing frorn the Minnesota Secretary <br /> of State's office <br /> Veterans [:]A charter shoving you`re an affiliate of a parent <br /> Religious nonprofit organization <br /> F1 ether nonprofit <br /> proof previously submitted and on file with the Gambling Control <br /> Board <br /> "Is r <br /> ;•i _... <br /> Ga b fi Prdm, js a S,Info r ation' <br /> Name of Establishment where gambling activity will! be conducted <br /> St. Rase of Lima school <br /> City state dip Code County <br /> Street <br /> 2072 Hamline Avenue N. Roseville MN 55113 Ramsey <br /> Date(s) of activity (for rafnes, indicate the date of the a drawing) <br /> September 20, 1998 <br /> Check the boy <br /> or boxes which indicate the type of gambling activity your organization will be conducting <br /> FL] Bingo Raffles Paddlewheels Pull-tabs ED Tiphoards <br /> For Board Use Only <br /> Se sure the Local Unit of Government and the CEO of your organization sign Date& Iaiti als of Specialist <br /> the reverse side of this application. <br />