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Attachment A
<br />Minnesota Lawful ling Page 1 of 2 6/08
<br />LG I l i i n for Exempt Permit For Board Use Only
<br />r An exempt permit may be issued to a nonprofit organization that,-. Flee is ZP '50 for Check#
<br />conducts law m w
<br />lawful gambling on five or fewer days, and
<br />awards less than $50,000 in prizes during a calendar year- each event $
<br />,�ORGANIZ,ATI INFORMATION
<br />Organization nal Previous gambling permit number
<br />Rose of Lima Catholic Cbtirr-h.
<br />Type of nonprofit organization. Check (4) one
<br />Fraternai Religious El Veterans Other nonprofit organization
<br />Mailing address city State/Zip Code County
<br />2048
<br />Hine Ave N, Roseville MN -55113 Ramsey
<br />--------------
<br />INamie of chief executive officer, (CEO) Daytime phone number
<br />A TT' A, COPY OF ONE OF THE FOLLOWING FOR PROOF OF NONPROFIT STATUS
<br />T,
<br />* Do not attach a salles tax, exempt status or federal ID employer numbers as they are not proof of nonprofit status.
<br />I - status..
<br />Ul
<br />Noinprolfit Articles ofi n corporation OR a current Certificate of Good Standing.
<br />Don't have a copy? This certificate must be obtained each year from:
<br />Secretary of State, Business Services Div., 180 State Office Building, St. Paul, MN 55155 Phone: 651-296-2803
<br />Intiernal Revenue Service - IRS income tax exemption 1501 (c)j letter in your organization's name.
<br />Don't have a copy'? To obtain a copy of your federal income tax, exempt letter, have an organization officer
<br />contact the IRS at 877-829-5500.
<br />internal Revenue Service - Affiliate of national, statewide, or international parent nonprofit organization (charter)
<br />If your organization falls, under a parent organization, attach copies of both of the following:
<br />a. IRS letter showing your parent. organization is a n�on�pirofit 501 (c) organization with a group ruling, and
<br />Ib. the charter, or, letter from your parent organization recognizing your organization as a subordinate.
<br />1 ntie rna I (Revenue Se rvice, - proof previously submitted to Ga mbil ii ng C o ntrol oared
<br />if you previously submitted proof of nonprofit status from the internal Revenue Service, no attachment is required.
<br />M�BLING PREMISES INFORMATION
<br />Name, of prem,ises, where gambling activity will be conducted (for, raffles, list the site where the drawing will take place)
<br />St. Rose of' Lima Parking Lot
<br />Adldress (do, not use PO box,) city Zip Code County
<br />GA M BL
<br />Na me of pr
<br />IN
<br />em
<br />G
<br />jSe
<br />P
<br />s
<br />is required.
<br />[St Rose c
<br />Address (do not u se
<br />907 9 R 1m I _j net amsey
<br />2072 Hamline Ave .1 N., Roseville 55113 — - -----
<br />Date(s), of activity ('for raffles, indicate the date of the drawing)
<br />September 20, 20 ,08
<br />,check the box,, or boxes that indicate the type of gambling activity your organization will conduct:
<br />t�J *Bingo, M Raffles ❑ *Paddlewheels [XI Tull-Tabs n *Tipboards
<br />* Giambling equipment for pull-tabs, bingo paper, tipboards, and paddlewheels must
<br />be obtained 'from a distributor licensed by the Gambling Control Board.
<br />EXCEPTION: 18ingo hard cards and bingo number sellectio,n devices may be borrowed
<br />from ainoithier, organization authorized to conduct bingo.
<br />To find a licensed distributor, go to www,gcb.state.mn.us and click on List of Licensed
<br />Distributors,, or call 651-639-4076.
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