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Minnesota Lawful Gambling LG220 Application fvr Exempt Permit Attachment A Page 1 of 2 9108 Fee is $50 for each event An exempf perrnit may be issued to a nonproft org.a.nization that: �or Board E1se Only - canducts lawful gambling on fiv� or fewer days, and - awards less than $50,000 in prizes during a calendar year. Check # g ORGANIZATION 1NFORMATION Organizatiar� name Pre�ious amblin g g permit number Parkview Center School K-34418 ' Type of nonprofit organization. Check one. � Fraternal � Religious �'Vete�ans C7ther nonprofit organization Mailing address City 5iate Zip Code Coun#y T01 W. Ga�artty Rd B Roseville MN 55113 Name of chief executi�e ofFicer {CEO) Daytirr�e phone number Email address Garin Bogenholm 651 487-4360 garin.bogenY�olrn�isd623.org Attach a copy of ONE of the following for proof of nonprofit status. Check one. Do not attach a sales tax exempt status or federal ID employer numbers as they are not proof of nonprofit status. �Nonprofit Articles of In.corporation OR a currenf Certificate of Good Standing. Dan't have a capy? This certificate musl be obtained each year from: Secretary of S#ate, Business Ser�ices Div., 1$� State Ofifice Building, St. Paul, MN 55155 Phone:. 651-296-2803 � IRS income tax exer�ptian [501 {c)] letter in your organizatiort's name. Dnn't h.a�e a copy? To o�tain a copy of your federal income tax exempt letter, ha�e an organization officer contact t�e IRS at 877-829-5500. CRS - Affifiate af national, statewide, or international parent nonprafit organization (charter) If your organizatior� fafls und�r a parent organization, attach copies af both of the foflowing: a. IRS letter showing your parent organizatior� is a nonprofiit 50'i(c) organizatian with a grc�up ruling, and b. the chartsr or letter from yaur parent organization recognizing yaur organizatian as a subard.inate. � IRS - proof previously submitked to Gambling Gan.trol Board If you previously submitted praof of nonprofit status from the IRS, no atfachment is required. GAMBLING PREMISES INFQRMATION Name of premises where gambling activity will be conducted (for raffles, list the site where the drawing wifl take plaae) Park�e�w Ce�,ter Schoai Address (do nat use PO box) Ciiy Zip Cade County 701 W. County Rd B Roseville 55'113 Date(s} of activity (far raffles, indicate the date of the drawing) March 27, 2009 to 3127109 Check the bax or boxes that indicate the type af gambling activity yaur organization will conduct: � Bingo* Rafffes � Paddlewheels* [� Pull-Tabs* � Tipboards' * Gatnbling eq.uipment for pull-tabs, bingo paper, tipboards, a�sd paddlewheels must be obtained from a distributnr licensed by the AJso camplete Gambling Control Baard. EXCEPTION: Bingo hard cards and bingo Page 2 of this focrr�. riumber selection devices may be borrowed from ar�other organization authorized to canduct bingo. Print Form: To fnd � licensed distributor, go to vuww.gcb.state.mn.us and click an List af Licensed Distributors, or call 651-639-4076. Reset:Forrri';