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Minnesoia �awfu! Garnbling Pa�� � of z 6�0� <br />LG2Z0 Ap�p�l�cation far Exemp�t P�rmit ForE3oardtJseClnly <br />An exerr�pf perrr�i# may be issued ta a nonproff csrganization that: F�� jS �J�Q '�i�E" Check# �. <br />• conducts Iawf�E gamb€ing on five dr fewer days, a�d � <br />• awards I�ss than �50,000 in prizes during a calendar year_ ec`���il �V�1�� <br />,,. . , . . . . .. <br />QRGANlZATIE�N INF�RiUI,ATRUN. <br />�rganization name Pr�vious gambfing permit �i�mber <br />Rosevil�.e Central P�rk �ou�datian X E203� <br />Type ofi r�anprofit organization. Check ('!�) one. <br />� Fra�ernal ❑ R�ligiaus � Veisrans �X Oti�er nonproft organiza#ion <br />Mailing adrlress City Statef�ip Code County <br />2b6Q Civic Ceantex Drive Rosevilte MN 55�.13 Ramsey <br />Narne af chief executive o�'icer (CE�) i3aytime phone nurrsber <br />Monte �o�son 651-�90-94� 1 <br />ATTAGH A CQPY �F QN� Q� TH� �'ULLOWNN� �'OR PROE,�F 4� N4�NPRt3F[T,�TAiUS <br />�k Do not attach a sales tax �xernpt skatus or federal Z� empiayer nurr�bers as they are nat proof of nonpro�t sta��ts. <br />Nonpro�it Articles of lncorporaiian OR a current Certifieaie of Garad Standing. <br />�lon't have a copy? This c�rti�icate rnust be obtained eac� year ;ro�rt: <br />Secreiary of State, Susiness Services Div., 18� State O�ce B€�iiding, St. Paul, MN 55155 Phona: 651-29&-2803 <br />X ��ternat Revenue Service -!RS incom� tax �xempiior� �5fl'1(cj� letfer in ynur arganizatinn's name. <br />f�on't hava a copy? To abtain a c4py of your federal income tax exempt letier, send your federat #D number and <br />th� daYe your organization initially app[ied for fax exer�pt stafius to: <br />IRS, F.O. Box 2508, Room 4fl9 D, Cincinn�ti, Of-[ 452i3'€ <br />In€ternat Rsr�enue Sstvice � AfFi€iate of natianal, staiewide, or internat9onaI parent nanprof�t organiaatian (chari�r) <br />If yous organizatian falls under a par�:ni organizafia��, attach capies of boih ra� fhe foliawing: <br />a, iRS letter showing yaur par�ni organEzatiqn is � registsr�d nonpraft 50'f(cJ organizatinn with a group ruling <br />b. the char�er or letter from your par�nt organization recognizing ya�rr arganizatian as a subordinate. <br />�nternat Revenue Service - praof prev9at�siy submitt�d to Gambling Can�roI Board <br />lf you previously s�bmitted praaf of nonproff status from the Internal Reve�u� 5ervice, no att�eE�ment is required, <br />GA,MBLtNG PREIVii��� INF4RMA.T�ON <br />Narrre of premises where gambfing acti�ity wifl be conducted (for raf€ies, fist the site where the draw€ng wiI! taica place) <br />�oseville S�Cati�g Center �Com�tunity �iooxan. <br />Address da not use PO box) Ciiy zip Code County <br />2fi6� �vic Cen�er Drive Roseville N.�N ���.13 Ran�sey <br />T�ate(s) vf acti�ity Efor rafFl�s, indicate the date of #he drawing) <br />Uctober �, 2007 <br />Check ti�� box or boxes that Endicate the ty�e af gambling acfi�ity your arganization wiil conduet: � <br />❑ �Bir€go � RaffIes ❑ *Padd9ewheels [� *Pull-"�abs Q �Tipboarr�s <br />*�amt�iir�g equiptnent for �ufl-tabs, tipboa�-ds, paddlewheefs, anc� bir�go (binga paper, <br />haCd t�ards, anii bingo n€arnber sefet�ion de�ice) must be optained from a di5tributpr <br />IiLensed by the Gam6fing Contro! Board. To find a lice�lsed distrii�utor, ga to <br />www.gcb,state.rrE€�.us and ctick an List a€ Licensed Distributors, or call 6��.-639-4E776. <br />