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Attachment A <br />Minnesota Lawful Gamhling Page 1 of 2 sioe <br />LG220 Application for Exempt Permit Fee is $50 for each event <br />An ezernpt permit may be issued t.o a nonprafit organization that For Board Use pnly <br />- conducts lawful g:ambling on five or fewer days, and <br />.,..a.. i....,. u-.,.., ccn nnn : <br />�..�..,� �� � w.,t.,,..,� ��� }�ncw �uiiny a caiciivai ycci. Gh2Ck # $ <br />ORGAMiZATIQN INFORMATION <br />Orqanization name Previous gambling permit n�mber <br />Pope John Paul Il Catholic Schaal X- 2�128 <br />Type of nonprofit organization. Check one, <br />� Fraternal 0€�eligious � Veterans � Other nonprof# organization <br />Mailing address City State Zip Code County <br />1630 �th Streef NE Minneapol'rs MN 55413 Wennepin <br />Name of chief executive afficer (CE�) Daytirne phane number Email a.ddress. <br />Dehra King, prineipal 612-7$9-$$5i dking@popejohnpaul2schoal..arg <br />Attach a copy of QNE of the fallowing �or proof of nonprofit status. Check one. <br />Do not attach a sales tax exempt status or federal ID empioyer numbers as they are not proof of nonpro�it status. <br />�l�anprofit Articl�s of lncorpqratian OR a current Certiiicate o# Good Standing. <br />Don'E have a copy? This csrtificate rnust be obtained each year from: <br />Secretary of State, Business 5ervices Div., 180 State O€fice Building, St. Paul, MN 5515� Phone: 651-296-2$�3 <br />�]X fRS income tax exemption [50i(c)] letter in yaur argan.ization's name,. <br />Dan't have a copy? To obtain a copy of your federal income tax exempt letter, ha.ve an organizatia� officer <br />contact ihe IRS ai 877-829-5500. <br />� IRS - Affil.iate af national, statewide, or international parent nonprofit organization (charter} <br />If yat�r organization falfs und�r a parent organization, atfach copies of both of the Pollawing: <br />a. IRS letter showing your parent organization is a nonprofit 501(c) organization with a group ruling; and <br />b. the charter vr letter from your parent arganization recagnizing your organiza#ion as a subordinate: <br />� IRS - proof previously submitted to Gamtrling Contral Board <br />!f yau previously s�bmitted proof of nonprafit status from ttte iRS, na attachment is requirad. <br />GAMBLIMG PREMISES 1N�QRMATION <br />Name of premises where gambling acti�ity vuiil be conducted (for raffies, lisE the site where t�e drawing will iake place) <br />aadisson Hatel Roseville <br />Address (do nok use PO box) City Zip Cade County <br />2540 North Cleveland Avenue Roseville 551'I3 Ramsey <br />Date(s) of activity {for rafffes, indicate the dat� of the drawing) <br />4-24-2.009 to 4-24-2009 <br />Check E#�e box or boxes that indicate the Eype af gambling activity yaur organiza.tion will conduct: <br />Q 8ingo" Q Ra.ffles �Paddfewheels' �P�II-Taba' �Tipboards' <br />* Gambling equipment for pull-tabs, bingo paper, tipboarcis, and <br />paddlewheefs must be ob�ained from a distributor ficensed by the AISO complete <br />Gambling Control 8oard. �XCEPTION: Bingo hard cards and bingo Page 2. of this form. <br />number selectian devices may be borrowed from another organization <br />authorized to conduct bingo. Pnnt Form <br />To fir�d a licensed dis�ributor, go ta www.gch.state.mn,us and cfick on List Reset Form <br />of Licens�d Distributors, or cal! 65i-639-4076. <br />