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Organization name Smiles In Life Foundation Attachment A zff :ess than 30 days ore the event $100 Page 1 of 2 7/10 or each event more than 30 days before the event $60 JON% jr Check # 2;� Previous garribling permit num�bel Type of nonprofit organization. Check one. r fraternal L I us El Veterans LX Religio _j Other nonprofit organ ization MaIlling address city State Zip Code Cou�n�ty 2489 Rice, Street #70 Rosevill N 65113 Ramsey Name of chief executive offi cer (CEO), Daytime phone number Email address Frank Slerna, 651-7166-6866 info4srnillesinlife.c= pi 1111p 11 11 Do not attach a sales tax exem�pt status or federail I'D employer numbers as th�ey are not proof of"nonprofit status, I Nonprofit Articles of Inclorporation OR a current Certificate of Good Standing. Don't h�a�ve a copy? This certificate must be obtained each year from: 180 Sti,ate 011ice Build"Ing, St. Paul, MN 55155 Phone" 651-2,96-2803 Secretary of State, Business, Services Div.,, IRS, income tax exemption [601(c)] letter In your organization's namne�, Don't have a copy? To obtain a copy of your federal income tax exempt letter, have an organization officer contact the IRS, at 87'7-829-55,010. Ell IRS - affil llate of' national,, istatewilde, or Intornational parent nn refit organization (charter) If your organization falls undler a, parent organization„ attach, copies of bglh of the following: a. IRS letter showings our parent organization is a nonprofit 501(c), oirganiz�ation with a group ruling, and b. the charter or letter from your parent organ ization recognizing your organization as a subordiinate. IRS .1 proof Previously su�bmiltted to Garnbling Control Boa�rd Ifyou p revi o uisly submitted p r,00t of non p rofit statu s from the I R S , no attachment 'I's required, Name of Premises where gambling activity will be conducted (for, raffies, list the site where the drawing will take place) 2�489 Rice Street #70 - --------- - - Address, (do not use PO box), C11 Ity Zip Code County Roseville Minnesota 66113 Ramsey Date(s) of acbvity (for raffles,, indicate the date of the drewing) Au g u�st, 16, 211011 . .. .. ... . ..... "J'.'heck the box or boxes, that indicate the! type of gambling activity your organization wi�ll coind�uct: [:] Bingo* Z Raffles E] Paddlewheels* 0� Pull-Tabs* OTIpboards* authorized to condui ct bingo. Print -Form . . . . . To find a llice�n�sed distributor, go to www.gcb. state, mn. us and click on List Pacat Pn . rmil of Licensed Distributors, or call 651-6391-40010.