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MINNESaTA LAWFUL GAMBLIlVG 1/13 Page 1 of 2 <br />LG22{} Application for Exempt Permit <br />An exempt permit may be issued ta a nonprofit organization that: App11Ca#1011 fe2 (non refundab�e) <br />- conducts lawful gambling on five or fewer days, and <br />- awards less than $50,000 in prizes during a calendar year. Tf application is postmarked or received 30 days or <br />If total prize value for the year wi11 be $1,500 or less, contact the licensing more befare the e�ent $50; ofiherwise $1Q0. <br />specialist assigned to your caunty. <br />ORGANIZATIQN INFORMATION <br />Organizatian name Previaus gambling permit number <br />Parkview Center Schoal X-34418-� 0-D02 <br />Minnesota tax ID number, if any Federal emp[oyer ID number (FEIN}, iP any <br />Type of nonprofit arga�nization. Check one. <br />Fraterna] Religious Veterans X �ther nonprafii arganization <br />Mailing address City State Zip code County <br />701 W. County Rd B Roseville MN 55113 Ramsey <br />Name of c' ] Tri�.y�Y Daytime hone number E-mai ddress <br />Efizabeth Kaytor fi51 79� 6813 mlkaytor�comcast.net <br />N�NPROFTT STATUS <br />Attach a capy of ONE of the fallowing for proof o# nonprofit status. <br />Nonprofit Articles of Incarporatian OR a current Certificate ot' Good Standing. <br />Don't have a copy? This certiFcate must be ahtained eath year from: <br />Secrekary af State, Business Services Div., 60 Empire Drive, Suite 100, St. Paul, MN 55103 <br />Phane: 651-296-2803 <br />IRS income tax exempiion [501(c)] le#ter in your organization's name. <br />Don't have a copy? Ta obtain a copy of yaur federal income tax exempt letter, have an organization ofFicer contact <br />the IRS at 877-829-5500. <br />=RS - Affiliate of natidnal, statewide, ar internatianal parent nanprofit organization [charter] <br />If your arganization falls under a parent organization, attach copies af both of the following: <br />a. IRS letter showing your parent arganizatian is a nonprafit 501(c) organization with a graup ruling, and <br />b. the charter or letter fram your parent organization recognizing your arganization as a subordinate. <br />GAMBLiNG PREMISES INFORMATION <br />Name of premises where the gambling event will be conducted. Far raffles, list the site where tt�e drawing will take place. <br />Parkview Center Schaol <br />Address [do not use PO boxj City or township Zip code County <br />701 W. County Rd B Roseville 55113 Ramsey <br />Date[s] of activity. For raffles, indicate the date of the drawing. <br />March 28, 2014 <br />Check each type of g bling activity that your organizatian will conduct. <br />Singo* ,� Raffle Paddtewheels* Pull-tabs* Tipboards* <br />*Gambling equipment for bingo paper, paddlewheels, �ull-tabs, and tipboards must be obtalned from a distributor <br />licensed by the Minnesota Gambling Cantrol Board. EXGEPTION: Binga hard cards and bingo number seiection devices <br />may be barrawed from another organization authorized ta conduct binga. <br />To flnd a licensed distributor, go to www:gcb.stafe.mn.us and click on Distributors <br />under the WHO'5 WHQ? LI'ST OP LICENSEES, ar cal! 651-539-190Q. <br />