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Minnesota Lawful Gambling Page 1 of 2 6/07 LG220 Application for Exempt Permit For Board Use Only An exempt permit may be issued to a nonprofit orgein zatlon that; Check conducts lawful gambling on five or fewer days, and Fee s $50 for ' — awards less than $50,000 in prizes during a calendar year, each event rganizat � n name Previous gambling permit r um ber� Type of nonprofit organization. Check one. , Fraternal [:1 Religious E] Veterans Other nonprofit organization M ilia address city State /Zip ode County Narne of chimeme emotive officer (CEO) ,r Daytime phone number Nr� 0 TT .w, m . n .:r. ..n n ... 4n v 1. .r ,, i. i... ,.a, .. ✓J ns w. S e Do not attach a sales tax exempt status or federal ID employer numbers as they are not proof of nonprofit status. Nonprofit Articles of Incorporation OR a current Certificate of Good ,standing. Don't have a copy'? This certificate must be obtained each year from: Secretary of State, Business Services Div., 180 ,Mate Office Building, St. Paul, MN 55156 Phone: 651-296-2803 Internal Revenue Service - IRS income tax exemption [501 letter in your organizationols name. Don't have a copy? To obtain copy of ,your federal income tax exempt letter, ,tend your federal ID number and the date your organization initially applied for tax exempt status o: IRS, P, , Box 2508, Room 4010, Cincinnati, OH 45201 Internal Revenue Service - affiliate of national, statewide, or international p rent nonprofit organization (charter) If your organization fails under a parent organization, attach copies of 12oth of the following: a. IRS letter showing your parent organization is a registered nonprofit 501(c ) organisation with ,a group ruling . the charter or letter from your parent organization recognizing your 6r anization as a subordinate. Internal Revenue Service - proof previously submitted to Gambling Control Board If you previously submitted - proof of nonprofit status from the Internal revenue Serwc , no attachment is required, I ame of premises wort gambling actirt will + conducted ?r raffles, list the site drawing will taro lace - it st + LA3 f\ Address d rt � � I✓" � � Zip �ode u my P -7 �ot A jr�,k ate (s) of activity (for raffles, indicate he date of the draw in Cheek the box or boxes that i ndi ate the type of gambling activity your organization will conduct', *Dingo Raffles EJ *Paddlewheels El *Pu l Tabs P4__�,*Tiphoards Gambling equipment for pull -tabs, ti hoards, paddlewheels, and bingo (bingo paper, hard cards, and bingo number selection device) rn ust e of to ined from a distributor licensed bar the Gambling Control Board. To find a licensed distributor,, go to www. .state.rnn,us and click can List of Licensed Distr €l ut6rs, or call 651-639-4076. 4076.