Laserfiche WebLink
Minnesofa Lawfu! Gambling <br />LG22Q ,Appfication �or Exempt Permit <br />An exempt pexmi:t may be issued fa a nonprofit organization that: <br />- conducts lawful gambling on five o� fewer days, and <br />- awa�ds. less than $50,000 in prizes during a calendar year. <br />RGANfZATION INFORMATiON <br />�rqanizatian name <br />Parkview CenEer Schooi <br />Page i of 2 7109 <br />plication fee <br />le5s than 30 days moce than 30 days <br />befare the evenT . before the event L <br />$100 $50 <br />Check# �� $ �•� <br />Previous gambling p�:rmit number <br />X-34418 <br />Type of nonprofit arganization. Check ane. <br />� Fraternal �. Religious �Veterans � Other nonprofit organization <br />flriailing address City State Zip Code County <br />701 W. Counfy Rd B Rose�ille MN 55113 Ramsey <br />Name of chie€ executi�e o�cer (CEO) Daytime phone number Email address <br />Kristen Smith Ofsan 651 4$7-4360 kristen.smith-olsan@isd623:org <br />Attach a copy af ONE of the following for proof of nortprofi# status. Check one. <br />Do not attach a sal�s tax exempi status or federal ID emplayer numbers as they are not proof of nonprofit status. <br />❑NonprofiE Arficles of IncorporaEion OR a current Certificate of Good 5tanding. <br />i�on't have a capy? This certificate must be obtained each year from: <br />Secretary of State, Business Services �iv., 18d State O�fice Building, St. Paul, MN: 55155 Phone: 651-296-2803 <br />� IR5 income tax exemption [501(c}] letter in your arganization's name. <br />Don't have a copy? To obtain a copy of your federaf income tax exempt letter, have an organ.izafion afficer <br />contact ihe IRS at 877-829-5500. <br />�IRS = Affiliate af national, sta#ewide, or international parent nonprofit. organizatian (thartery <br />l� <br />If your organization falls under a parent arganization, attach copies of bath af the following: <br />a. IR8 letfer s.hpwing your parent org.anization is a nanpra.fi.t 541(c) arganizafifln with a group ruling,. and <br />b. t�e charter ar letter from your parent organization recognizing your arga�izaiion as a subordinaie: <br />� IRS - proof previously submitted to GambEing ConErol Board <br />if you previausly submitted proof of nonprofit status from th.e IRS, no attachment is required. <br />GAMBLING PREMISES INFORMATION <br />Name of premises where gambling acti�iiy will be conducted (for raffles, list fhe siie where the drawing will take place) <br />Parkview Center Sehool <br />Address (do not use P� box) City <br />701 W. County Rd B Ros�ville <br />Date(s) of activity (for raffles, indicate the date of the drawing) <br />March 26, 2010 <br />Zip Code County <br />55913 Ramsey <br />heck the 6ax or boxes that indicafe the type of gambling activity your organization wFll conduct: <br />� Bingo' �Raffies �Paddlewheels' �Pu:ll-Tabs' �'Tipboards` <br />* Gambling equipmen.t for pull-tabs, b'rngo paper, tipboards, and <br />paddfewheels must be obtained from a distributar licensed by the <br />Gambling Control Board. EXGEPTION: Bingo hard cards and bingo <br />number selectian devices may be borrowed from another org.anization <br />autharized to concluct bingo,. <br />To find a licensed distributor, go to www.gcb.sCate.mn:us and clicic o� List <br />of Llcensed Distributors, or call 65f-539-4076. <br />Afsa complete <br />Page 2 of this form. <br />Print Form <br />Reset Farm <br />