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Minnescita Lawful Gambling <br />01 <br />LG220 Appli I cation for Exempt Permult <br />Ain exempt pennit may be issued to a nonprofit organization thai <br />conducts lawful garnbling on five or fewer days, and <br />awards l�ess thari $50,100�O in priizes, dudng a callendar year. <br />lorlkli"Zli t 11111'"Vflil T <br />Oirc <br />ganization name <br />y 0 <br />Previous gambling permit number <br />Do not atta�ch a sale�s tax exempt status or federal M employer numbers as they are not proof"of nonprofit status. <br />Noinprofft Articles ofincorporation OR, a current Certi'Mciate of'Good Standing. <br />Do n"t h�ave a cop�y? This certificate mu�st�, be obtained each year tom: <br />Secretaq, of'State, Business Services Div., 180 State O�ffice Building, St. Paul, MN 55155 Phone: 651-296-2803 <br />IRS income, tax exemption [601(c)) letter in your organization's name., <br />Don't have a copy? Tol obtain a copy of your federal income tax exempt letter,, have an organization officeir <br />contact the IRS at 877-829-51500., <br />IRS - Affil'ilate of national, statevvide, or, International parent nonprofit organization (charter) <br />If your organization falls under a parent oirganizaboin,, attach coples of both Of the following: <br />a. I IRS, letter showing your parent organization is a non Tilt 501(c) organization with a, group ruling, and <br />b. the charter or letter from your parent organization recognizing your organization as a sulblordinaite�. , <br />HI taike Me* <br />Name of prem,ises where gambl�in�g activity will be conducted raffles, list the!, sbi where the drawing wi <br />SAINT' ROSE, OF LIMA S,CHOOL <br />Address (do not use PO box), CRY Zip Ciolde County <br />2014,19 T4Abff,,TNR AV=E <br />Date(s) ofactivity (fori raffles, 'Indicate the date of the drawing) <br />;.k the box or boxes that indicate, the type of gambling activity your organization will con�dl�u <br />IR Bingo* E] Raffle's Peddlewheells* Pul]-Tabs* E]TIpboarW <br />authon'zeid to conduct bingo. Print Form <br />To find a licensed distributor, go to, www.gcb.state.mn.us and click on list <br />Pqpw . M. <br />ofTicense utori or call 6151-i63 -4000, <br />