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0 2" 0 4 19'99 0 1 : 11 6512238344 RAMSEY CT'Y BAR ASSOC PAGE 02
<br />Attachment A
<br />0
<br />Minnes-otal Lawful Gambling P%7
<br />Page I of 2 910a
<br />LG220 A fl i for Exempt Permit Fee "I's $50 for each event
<br />An lexompt permit may W issuad to a nonprofit organization that, For Board Use Only
<br />- cofndul icts, lawful gambling on five or fewer days, and 0 C)
<br />_ awards less t,ha�n $50,1000 In prizes during a calendar year. fuze r7p.-, i k 4,e ji� g., 4j
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<br />]on name' Priaviouu gambli rmit nu b r
<br />widnizielt, r
<br />Ramsey Clounty Bar, Foundation
<br />Mr
<br />T pe of nonprofit. Ior ,ganilza,tilon. Check one,
<br />LLJ! Fraternal [MlReligious [CjVeterans Othe Ir nonprofit org a nizat ion
<br />....................... ....
<br />Mailing aidldress, City State Zip Code County
<br />332, MInnesota $treat, Suite E1401 St. Paul MN 55101 Ramsey
<br />Name of chief exec utivie officer (CEO) Daytime phone number
<br />Cheryl Dal by 651-222-08
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<br />Do not attach a sales tax exempt sWtus or federal ID employer, numbers as they are not proof of nonprofit status,
<br />(Nonprofit, Articles, of'. Incorporation OR a current Canti fic;ite, of Ooo<J Standing.
<br />Don't have, a copy�l Thies certificate must �e obtained I eec;h year from:
<br />Secretary, of S�tate,, Business Services Div., 180 State, Office BUIlding, St, Paul.. M 1h 96-2803
<br />IRS Incorne tax exe�m�pition 1501(c)] lettOr in your organ ization"s name eIS
<br />QIQn't have a copy? To obtain a copy of your federal income ta)(. exempt lett dve.,qn c I n officef,,.�
<br />contact the IRS at 8774�2
<br />IRS - Affillate lof national:, statewide,, or Internatiorval parent inoinpirofit. arG4 i tion C)
<br />If our organizatlon falls under a parent Organization, attach copies of 4Dt!Lpf t' Ilowing j -%�
<br />a., IRS lattler showing your parent 0�garflzation is a nonpirofit 5011 ('c) o aniz tio 4
<br />rg a a group ruling, and
<br />b
<br />thin charter or Metter from your parent orgarflzation recognizing your organization' Ina 6".
<br />IRS - proof orsviously, sue muted to G- ambling Control'acard
<br />if You PrOVIO.U61Y60mitted proof of nonprofit status from the IR6, no attachment is required.
<br />P P . . 41
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<br />Narne of Premises whiere gambling activity wiH be conducted (for raffles, list', the site Where the dcawing will take place)
<br />MIDI'lan-d Hili uhtry Club
<br />Addres•s (do not', use of box) City Zip Code County
<br />21001. FulhaivI Street Rosevillie 55113 Ramsey
<br />Date(g) Of activity ('for raffies, in,dicats trio dates Of th0 drO.Wing)
<br />1108-2008 t 1-03-2008
<br />?
<br />ook the box ' oir boxes that', indicate the tYPO of gam-blingactivity' your organization will conduct:
<br />I
<br />17 Binge 19, Raffles Padd1Gwh9a1s* -d.
<br />P,ul I Tipboai s*
<br />am billing equipment for pull-tabs,, bingo paper, tipboards,, and
<br />ta
<br />pladdlliewhe�els must be ob ined from a distributor licensed by the Also corn
<br />G'amblin,g Co�ntrol Board. EXCEPT p
<br />ION: Bingo hard cards and bingo Page 2 of this form.l.
<br />number selection devices may be borrowed from �inoither organization
<br />authorized to conduct bingo,
<br />To finid a licensed distdbutot, go to ww-w-gcb,state.m.n.us and click on List
<br />of 4icensed Distdbutors,, or call 651-639-4076,
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