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Mi11PTesag� L�vvful G�mbllrty Pag� � ot z s�a� <br />�C�220 App�ica���n fc�r Exeta�pf Perrni� ForBoardUseQn€y <br />An exempt permit may be issued to a nonprofit arganization ii�at: F��' �S �5O ��Y ���e�� <br />° cond�cts Iawfui gambling on fi�e or Fewer days, and <br />• awards fess than $50,000 in prizas during a calendar year. ���h �i�e�� � <br />(��ZGAhdfZATiON [PIF�RM�T14N <br />Osganizaiion name � Previous gambling permit number <br />St. Rase af Taxua � �-52002 <br />! .��. <br />iype of nonprofit arganiza�ion_ ChecEc (�) one. <br />� Fraterr�aE � Religious ❑ Veterans ❑ Other nonprpfit organizafion <br />Mailing address City Sfate2ip�Cod�; Cour�ty <br />2�48 liamline ,�.r��o i�< Rflse�il.Ie 55113 Ramse� <br />�lam� of chief exeeutiue offcer (CEQ) C3aytime phtnne number <br />Raher�C ,�. �i�zpatrick 65I— 3�7=120� <br />':��'T'�CH ,� �{?F?Y O� �E �F TH� �OC:L�-�i�% �'C3R P�t�i3F C�� N�P�P1���1T STA"��65' <br />�-� [b not atYach a saies tax exempt status or fedefal IQ employer numbers as tt�.y are riot proof of nonprofit s�,atus. <br />PJnnpro4itArticles of Incarporation E3R a current Certifcate of Good Standing. <br />Qnn't h�ve a copy? �fhis certificate must be obtained each year from: <br />Secretary of 5tate, Busines5 S�nrio�s Div., 180 State Off'ice Building, St. Paul, M�! 55155 Phnn�: 651-296-2803 <br />lnternai Revenue 5�rvic� - iRS ir►come taz �x�mption [501(c)� letter in your organization`s name. <br />Qon't �ave a copy? To obtain a copy of your �derai in�me tax exerrapt Eetter, send your federal 1D nurnber and <br />the daie your organi�ation initiatly appiied far iax exempt status to: <br />IRS, P.O. Snx 25Q8, Room �4090, .Gincinnati, ON 45201 <br />____Interrial Revertue Service - Affiliate vf nationat, statewide, nr internafionaE parent no�profit or�Janizatior� (charEer} <br />I€ your drganization falls under a parent organizatian, atfach capies nf bnth of the follawing: <br />a. tRS let#er showi�g your parent organization is a reg�sterec� reonprof�t 50'i(c) organization with a group ruling <br />b. ihe charter 4r {ette� fram your parenf o�gacsizai'son recogn�zi�g Ypur qrganization as a subordinate_ <br />glnternal Revenue Service -proof pr�viously submifted ko Gamblistg ControE Board <br />tf yflu previousfy submifted proof af nonprofit statvs frorri the lntemat Revent�e Serv�oe, no a#fach€nen# is requieed. <br />; 1 ,� , .. <br />.. . :. , _ <br />�.���;#VIBLIi�C�� P�K�IVIIS�� 11�1�C�RN1�4Tt��i' , ._' <br />i�ame of premises where gambiing aciivfty will be conducted (for ra#fles, iis# fhe site where the drawing wi[I take ptace) <br />Slt. Rose of �.ima Ghurch parkiug loti. <br />Address {do nnt use PO bpx) City Zi Code County <br />2U72 Ha�ula.ue Ave, Na Roseville �5113 Ramsey <br />Date(s) of activity (for raffles, indicate the daie af the cirawing) <br />S� ��uber 29, 2Q(i7 <br />Check the box or boxes that indicate the type of ga:nbiing activiEy your organ�zation will cpnduct: <br />[,�] 'Bingo 0 F�afi�es ❑ *Paddle+�vheels � "pul�-iabs ❑ 'Tipboards <br />* Gambling equi{�ment for putl-tabs, tipboards, pac�d{ewheels, and binc,�o (bingo paper, <br />hard cards, and bingo number selection dev�ce) rnust be o�tai€�ed from a dis#ibutor <br />licensed by ti�e C�amhling Co€�tro� Baard. i'o find a licensed dis�rib�rtnr, gv to <br />www.gcb.5tate.mn.us and dick or� List of Lic�nsed [3istributars, a' catl 651-G39�a76. <br />