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Attachment A <br />Pagel of 2 1/11 <br />P icatioln fee, for each event <br />PIN, <br />nnnifinnifleirt <br />Organization name <br />St. Rose of IL. ima, Church <br />Type of nonprofit organization. Check one. <br />Fra�temal E Relii g�iiou�s E]Veterans, E] Other nonprofiIt organization <br />IRS - Affillialn of nationall, statevAdlel, or international parent nonprofit organization (chafter) <br />If your oirg�a�nbmtloln falls un�dler a parent organization, attach copies of kzethi of the fbIlowing: <br />a�. IRS letter showing your parent organization is a nonprofit 5101(c) organization with a group ruling, and <br />1, <br />b. the charter or letter from your parent organizabon recognizing your organization as a subordinate. <br />'-fate(s) of activity (for raffi�les,, indicate the date, of the drawing) <br />March 26, 211011 <br />orga� <br />-Fleck the box or boxesthat indicate th�e tylpe of gambling activity ylour nization Will conduct.: <br />r-11311rigo* Raffle's r--j Paddlewheels* Pul�l-Ta�bsi* [ITIpboards* <br />i <br />