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Mirrn�sota LavErful Gam,6ling LG220 �4pplication for Exer�p� Permit An exempt perrnit rnay be issued to a nonprofit organization that: - conducts lawful gambling on five or fewer days, and - awards less than $�0,000 in prizes during a calendar year. o�c�r�iz�Tio� �N�oR�naT�or� Orqanization name Ramsey Caunty Bar Foundaiion Type af nonprofit organizatinn. Check orse. � Fraternal � Religiaus � Veterans Mailir�g address City 332 Minnesota Street, Suite E1401 St. Paul Nam� af chief executive of�icer (CEO} Cheryl Dalby Attachment A Page 1 of 2 7109 Application fee ff a licatior� ostrr�arked or received: less than 30 days mors than 30 days before the eveni before the event $1�Q $50 CheCk # � $ rJ�+ � �� Previous gambling permit number 5357 � Other nonprofit organization State Zip Code County MN 55101 Ramsey Daytime phone rtumber Email address 651-222-fl846 cheryl@ramseybar.org Attach a capy af QNE of the felloirving far proof oi nonprofit status. Chectc one. ao no� attaeh a sales tax exempt status ar federal ID employer numbers as t�ey are not proof af nonprofit status. ❑Nonprofit Articles of Incorporation OR a current Certificafe of Good Standing. Don'T ha�e a copy? This certificate must be ohtained each year from: Secreiary of State, Business 5ervices �iv., 180 State Office 6uilding, St. Paul, MN 55155 Phone: 551-296-2803 � tR5 incnrne tax exemption [501(c}] fetter in your organization's name. Don't haue a copy? To obtain a copy af your federal income tax exempt letter, have an organization officer contact the IRS at $7i-829-550f}. � IRS - Aifilia#e of national, statewide, or international parenf nonprofit organization (charferj IF your organization falls und�r a parent orgar�ization; attach copies of both of the �ollowing: a. 1RS letter showing your parent organizatian is a nonprofit 501(c) organization with a graup rul€ng, and b. the charter or letter from your parent organ€zation recognizing your organization as a subordinate. � IRS - proof previousiy submitted to Gambli�g Cantrol Board If you previously subrnitted proof of nonprofit status from the IRS, no attachment €s required. GAIVIBLING PRE�liISES INFQRMATIf)N Name of premises where gambling eciivity wil€ be conducted (for raffles, list the site where the drawing will take place) Midland Hills Country Club Addr�ss (do not use Pp box) City 20U1 Fulham Street Roseville Date(s) of activity (€nr ra€fles, indicate the date of the drawing) 11-14-09 Zip Code Counry 55113 Ramsey ;k the box or boxes that indicate the type of gambli�g activity your orgar�ization will conduct: �] Bingo* 0 Raffles � Paddlewheels' [] Pull-Tabs" Q:Tipb�ards' * Gambling equiprnent for pull-tabs, bingo paper, tipbaards, and paddlewheels must be obtained from a distributor licensed by the Gambling Cvntro[ Board. EXCEPTIpN: Bingo hard cards and bingo number selection devices may be borrowed from anather organization authorized to conduct bingo. � To find a licensed distributor, go to www.gcb.state,rnn,us and click or� List of Licensed Distribu�ors, or call 651-539-4076. Also complete Page 2 of this form. Print! �orrn... ::� Reset Farrri;