Laserfiche WebLink
1\ECT � � B0 Page 1 of 2 8107 <br />Minnesota Lawful Gambling <br />LG220 Application for Exempt Permit <br />For Board Use Only <br />Check# <br />An exempt permit may be issued to a nonprofit organization that Fee 10, $50 for <br />• conducts lawful gambling on five or fewer days; and <br />• awards less than, $50,000 in prizes during a calendar year.each event <br />$ <br />ORGANIZATION INFORMATION <br />Organization name <br />Previous gambling permit number <br />C' A_PAIP3Lt _JYZ1 J(i—C--P'`> v ' . <br />Type of nonprofit organization. Check M one. <br />❑ Fraternal ❑ Religious ❑ Veterans �'bther nonprofit organization <br />Mailing address <br />City ( <br />State/Zip Code <br />County <br />Name of chief executive officer (CEO) <br />Daytime phone number <br />C..v zZ l <br />ATTACH A COPY OF ONE OF THE FOLLOWING FOR PROOF OF NONPROFIT STATUS <br />Do not attach a sales tax exempt status or federal ID employer numbers as they are not proof of nonprofit status. <br />Non profit Articles of Incorporation OR a current Certificate of Good Standing. <br />Don't have a copy? This certificate must be obtained each year from: <br />Secretary of State, Business Serve es Div., 180 State Office Building, St. Paul, MN 55155 Phone: 651-296-2803 <br />_ Internal Revenue Service - IRS income tax exemption 1501(c)] letter in your organization's name. <br />Don't have a copy? To obtain a copy of your federal income tax exempt letter, send your federal ID number and <br />the date your organization initially applied for tax exempt status to: <br />IRS, P.O. Box 2508, Room 4010, Cincinnati, OH 45201 <br />Revenue Service -Affiliate of national, statewide, or international parent nonprofit organization (charter) <br />_Internal <br />If your organization falls under a parent organization, attach copies of both of the following: <br />a. IRS letter showing your parent organization is a registered nonprofit 501(c) organization with a group ruling <br />b. the charter or letter from your parent organization recognizing your organization as a subordinate. <br />Revenue Service - proof previously submitted to Gambling Control Board <br />_Internal <br />If you previously submitted proof of nonprofit status from the Internal Revenue Service, no attachment is required. <br />GAMBLING PREMISES INFORMATION <br />Na a of premises where gambling activity will be conducted (for raffles, list the site where the drawing will take place) <br />Nlecu l <br />Address (do not use PO box) <br />194 `lS1st �e N LZ3 <br />C <br />1 <br />Zip Code <br />�"j <br />County <br />(for raffles, indicate the date of the drawing) <br />"Date(s)activity <br />box or boxes that indicate the type of gambling activity your organization will conduct: <br />❑ *Bingo ® Raffles ❑ "Paddlewheels ❑ -Pull-Tabs ❑ "Tipboards <br />* Gambling equipment for pull -tabs, tipboards, paddlewheels, and bingo (bingo paper, <br />hard cards, and bingo number selection device) must be obtained from a distributor <br />licensed by the Gambling Control Board. To find a licensed distributor, go to <br />www.gcb.state.mn.us and click on List of Licensed Distributors, or call 651-639-4076. <br />CH -V <br />