Laserfiche WebLink
1VIINN. '�OTA LAWFUL GAMBLTNG 12/I2 Page 1 of 2 <br />LG220 Application for F�cempt Permit <br />An exempt permit may be issued to a nonprofit organization that: Applicatlon fee (non refundable) <br />- conducts lawful gambling on five or fewer days, and li tio e or ce� ed• <br />- awards less Yhan $50,000 in prizes during a calendar year. less than 30 days more than 3d days <br />If total prize value for the year will be $1,500 or less, contaet before the event before the event <br />the licensing specialist assigned to your county. $100 $50 <br />ORGAN�ZATIQN INFORN�ATI4N > <br />Organization_name Previous gambl9ng permit number <br />`' ' 7: - 3�f`f/�S � lL� _�C} �. <br />f ?tLi-��'fCC,�.� f�.�e��cr° `�c_7vc� 1 <br />Minnesota tax ID n�mber, if any Federal emp{oyer ID number (FEIN), if any <br />Type of nonprofit organization. Cfieck one. <br />Fraternal Religious Veterans �Other nonprofit organization <br />MaiEing adclress City State Zip code County <br />7C / LL� +�:�3�' «� t�' �c� ; ?� ,•;� .��: �°t i�i,� !1?! ��f/ 3 �f�c�,��.�e: % <br />pa ��P nhnne numbel' �-ma�l address <br />Name of chiefp executive officer [CEO] `,,,� Yt� r- <br />!'S!'''-�t��i�.5� �-� L; �%Yl d f ('1(l�{ , �` -' -' - <br />, <br />NONPR.QFIT ST�►T!;!S <br />Attach a copy of ONE of the following for proof of nonprofit status. <br />Nonprofit Articles of Inwrporation 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 Dlv., 60 Empire Drive, Suite 100, St. Paul, MN 55103 <br />Phone: 651-296-2803 <br />IRS income tax exemption [501(c)] letter in your organization's name. <br />pon't have a copy? 70 obtain a copy of your federal income tax exempt letter, have an organization officer contact <br />the IRS at 877-829-5500. <br />� IRS - 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 folfowing: <br />a. IRS letter showing your parent organization is a nonprofit 501(c) organization with a group ruling, and <br />b. the charter or letter from your parent organization recognizing your organization as a subordinate. <br />GAMBLING PREMISES INFURMATIOM . <br />Name of premises where the gambling event wi11 be conducted. For rafFles, list the site where the drawing wifl take place. <br />i��:�T KU a r;;:.► C�_��l-}-�l— .`_�<--l1 C� t� � <br />Address [do not use P� box] City or township Zip code County <br />%UJ L�l.� :.c.�Z.�.il( (�c'� °�.) i�c,S�:.v'I i1� S�i Jl3 �`�C�r'vl.�L. <br />Date[s} of activity. For rafFles, inditate the date of the drawing. <br />�}^I"; � �; <�Lf._� � <br />Check each type of gambiing activity that your organization will conduct. <br />Bingo* � Raffle Paddlewheels* Pull-tabs* Tipboards* <br />*Gambling equipment for bingo paper, paddlewheels, puil-tabs, and tipboards must be obta9ned from a distributar <br />licensed by the Minnesota Gambling Contro! Board. EXCEPTION: eingo hard cards and bingo number selectian de�ices <br />may be borrowed from another organization authorized to conduct bingo. <br />To find a licensed distributor, go to www.gcb.sfate.mn.us and click on Drstributars under <br />the WH�'S I�VH�? LIST OF tYCENSEFS, or call 651-639-4000. <br />