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<br />T0: 7927030
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<br />Minnesota Lawful Gambling
<br />L�G2�� Application for Exemp��E Permi# �� $�g
<br />A n exempt permit may be issued'tp nanpro�it oPgantz�tfert5
<br />conducting ��yy[u� gambling activity on fivQ or fewer days, aq�
<br />_ awarding lr��than $50.000 ln prizes during a p��p�dmr year.
<br />�17g�nizaliOri �r1fa�-n,�tion
<br />Q�{��'��':8r uyN. M1B��r.
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<br />_� ��� � �� �� 5�
<br />��I�i�9 01 �hi� •3�8MLr?+�C ��r S�E�}
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<br />Page 1 of 2 111qA
<br />Fbr 8oard Use Only
<br />Fee Paid
<br />C:haC,kN4.
<br />Pr�uiae�3 license or a�,ern�a;i�, number, if �r�y
<br />��'� ar� ��c eodr
<br />��� ��
<br />�y�9 OrY_�I� 15JI'Y�FJ6�
<br />fi �'?' - +�� � ' $' �f
<br />Type of nc,nprpfj# organization (BheG 4s1E�
<br />0 Fraternal Religiau5
<br />r V�t�r�� � Dtt��� nonprofit organization
<br />Typo of proof of nonprofit - attach a r�c�p� (see instructions)
<br />Q Nonprofit Articles of Incorporation or CeltlflCate of Good Standing� Minnesota Secretary of State's ���g
<br />� Internal Revenue Service
<br />� R'f �liatp of parent nanF�rfiloP��ni�atl0l� (charter)
<br />Gambling Premises Information
<br />Namo o�pr�mises where gambling activity �vili ba crandu.t�d (for raffias, fist the site where the drawing wili �ke pl�ce}
<br />����� ��.� �� �^T�n�ru � _��.c�
<br />�ddres�s (da �1GC �4 PO box) City
<br />!.�_�'✓ � -�1�.; '� + , "" ' �r: li� ��L�-
<br />�I+�;njpfar��1:� (f+�rtames, indicatethe,tal��th�drawing)
<br />Zip G4d� Car�`r
<br />� ., �.�:� �
<br />�1��'�=�`� f � f ��
<br />�h��k Ih� Aox or t�ax�� that ir�dycate 95� ty�� of gaf't�k�li��g activity your ar�anlzatir�n wil I be conducting;
<br />�'BIn�� �an,�s [� "Paddlewh��f� ❑ *°_1 Tab� � "'iipbc>ards
<br />`��mbl�r�� cqulpm�nkfor pull-tabs, Yiprboards, paddlewheels, and Eafn�a (bingo paper, hard ��rds, and bi ngo paEi
<br />�c�ic,�tlon d�veGe� must be o6t��r�ed from a d9�t�raputor licensed By the Gambling �ar��r�pr Board. To find a Il�en���
<br />distrtbutor, go tv V�.ru �ot.sCdd. m,n.�c ��d click an List of Licenssd Distributors. Or call 651.63�J4000.
<br />m� �orm +,�� �e n�e�7a a� �v�s �7,�t�r,ti�,�
<br />;prl'M18t ;I r� 1� ,y�Ri111T� �'alFort[Pun'�q�r
<br />ThE M�**a+Ofln �eq.leg�d er �'arm j.vid
<br />u�ny:�k�d i m�r,c� .ri i�#,�d � L'ro �b+r�g
<br />�r7G� goard {8c,ard} to d4termine your
<br />qu�fiflcatlans ta I� inv��y� �n IawPul ��mblir�g
<br />3{�f,�1101 in Minnesota. Ytau h,a,re th� righcta
<br />e�tuao !o Rcrp�ty kh� informstion requested;
<br />hpwe�vnr, ff ya� refuse lo supply �bis
<br />tnf�irmntPVn, Utia 95�: ms�� not � able to
<br />t}aterm€n� pw� a�s��;�y�,$ and, as a
<br />CPn�+�quAn�e, may ro'f�sa to issue you a
<br />perrns4, I� you supply the information
<br />reque�l�d � th� @�rd wi I I be ab#� to ptr:rces�
<br />yourrlp�illCatlDn_
<br />and addresswill be pufilic iriformation wt7an
<br />received by1�e Board. ,AtI}1�eoih�riftfarmaGan
<br />that you p�ravi��wilf be prtvat� data�bput you
<br />unlit4�eBc��issur�syaurp�rn�;t. Wh�tt#ita
<br />Bdard issues yavr p$m�i�, �I� �#he in'folm�Ran
<br />that you ttau�s �,+R� to the Board in the
<br />�roGess of apP�.ym9luryaur perrrr�t �vii� b�r�,me
<br />public. If the B�ord does not issue you a
<br />permit. akitf�9 infnrm�fioY� you have prpvid�;d
<br />in the pra�ess o�sppiying foY a�iermitrem�ins
<br />private. wilh k11� exceptionof your name ar�d
<br />j/DUE' QY�1tliz�tiPn'S 1'1HI71E 81'1(i �ddre5� wh ICh
<br />Wlllramai�pu�lic,
<br />Private dataabout �rou are avai�sr�re only to
<br />Jq �.Y,{F#,.r.5a' �r.�:1 r.{ti:°•Sb$�'. 'r'.�= � ��•`•e
<br />6w�wheZa,�,•k r� �w�r.m�r- ro�;�i•ec Ih�L
<br />i'19y w3'rt rf�[��xx I] Iht� �M7fr"'�" rr5 -�?
<br />IWrw� papa•iner.ivfi?�w Sa(ety; Il�r
<br />Mi nnesoka AttomPy Ger er I� thalU�innegou�
<br />Commisson�rS,�A�m,'n stra:ion, France.
<br />ana 4c••��:r; the ME�n�spta I.eg�siat�ve
<br />Au�i�a' •�ir�inlandintemakonafgaMO�ng
<br />re�� ��w} .�'r „'� sn� ane �,�rs :an� m cturt
<br />xC?r„;h?r�7�CU8SSnGg encesl!Idlere
<br />specfi;ail; a4tno��dG� ��ar'r��ara inv�
<br />tono+4 �ccesstoh e n��r,a4„�� sratvd�a�s
<br />Ni•� Jt�r.:l::x 4 r ri'iir IyN. #�L�EI xdr.r
<br />ar�nac�v�o-nr ��+ccr graa� r�fF+'u�r-aH6�i
<br />�M u:� Nd+�.++�4 �Fr�r:: e�5d �aq�vne,rtte
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