Laserfiche WebLink
MINNESOTA LAWFUL GAMBLING 1/13 Page 1 af 2 <br />LG22Q Application for Exempt Permit <br />An exempt permit may be issued to a nonprofit organizatfon that: Ap�]�[C��1011 f@� (non refundable} <br />- conducts lawful gambling on five or fewer days, and <br />- awards less than $50,Q00 in prizes during a calendar year. If application Es postmarked qr received 30 days or <br />If total prize value for the year will be $1,500 or less, contact the licensing more before rhe e�ent $5a; otherwise � i00. <br />specialist assigned to your county. <br />QRGANIZATION INFORMATION <br />Organizatio ame Pre�ious mbling permit number <br />�c' � �v�, � <br />Minnesota tax ID n aer (� any Federal � p ye�TD number (FEiN), iP any <br />� <br />Type of nonprofit arganizatinn. Chec[c one. <br />Fraternaf Religious Veterans �Other nonproflt organization <br />Mailing Cit� St�te Zip ode County � <br />J ,, <br />Na of ief exe utive a �cer [CEO Day ' e�h ne�t�-� E-maif addresC�� �� Af� <br />� �j t � ` � . <br />NONPROF T STATUS <br />Attach a copy af UNE af the fpilpwing far prap# of nonprofit status. <br />Nanprofit Artictes af Incorporatian OR a current Certificate af Goad Standing. <br />Don't have a copy? This certificate must be abtained esch year from: <br />5ecretary of State, 6usiness Services Div., 6b Ernpire Drive, Suite 100, St, Paul, MN 551d3 <br />Rhone. G5i-Z9b-2803 <br />IRS income tax exemption [50].(c)] fetter in yaur organizatian's name. <br />Don't have a copy? To obtain a copy of your federal income tax exempt letter, have an arganizatian officer cantact <br />the IRS at 877-829-5500. <br />IRS - Affiliate of naYionat, stateuvide, or international parent nanpro�t arganizatian [charter] <br />If your organization falls under a parent organization, attach copies of both of t[�e foflowing: <br />a. IRS (ettershawing yaur parent organization is a nonproflt 5Q1{c} organiza�lort with a group ruling, and <br />b. the charter ar letter from your parent organization recognizing your organizaiion as a subardinate, <br />GAMBLING PREMISES INFORMATION <br />EVarne of premises w ere the gambling„�vent wi]! be c�duct d. For rafFles, list the site where the drawing will take �lace. <br />i l� <br />Address [da ot use PO box] Ciiy or ownship � zt code aunty <br />� ���.. `���,� <br />Date[s] of activity. For ra lndi�'ca�te the date o�� drawing. <br />. `� <br />c� <br />Check each type of gambling activity that yaur arganEza�ion wil! conduct. <br />Binga* � Raffle �Paddlewheels* Pull-tabs* Tipboards* <br />*GambCing equipment for bingo paper, paddlewheels, puEl-tabs, and tipbaards must be abtained from a distributor <br />licensed by the Minnesata Gambling Control B�ard. EXCEP"fION: Bingo hard cards and bingo number selection devfces <br />may be borrowed from another organization authorized to canduct binga. <br />To �nd a licensed distributor, go to www,qcb.state.mn.us and click on Distributars <br />under the WHD'S WHO? LIST OF LICENSEES, or calf 651-539-1900. <br />