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RECT nJ A N 2 12008 <br />Minnesota Lawful Gambling <br />Prnt._Fom <br />3 Gun Secondary Raffle <br />Page 1 of 2 6/07 <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 IS $50 for <br />• conducts lawful gambling on five or fewer days, and <br />• during a <br />$ <br />awards less than $50,000 in prizes calendar year. each event <br />ORGANIZATION INFORMATION <br />Organization name <br />Previous gambling permit number <br />I santi Chapter 0r- IPi^1nliE_S,97-4 0EP—, 1161-nf-7-4-2Si<-0s4 <br />/0,02—vat, <br />Type of nonprofit organization. Check M one. <br />❑ Fraternal ❑ Religious ❑ veterans M Other nonprofit organization <br />Mailing address <br />City <br />StateiZip Code <br />County <br />205-1 st Ave. East <br />Cambridge <br />MN. 55008 <br />Isanti <br />Name of chief executive officer (CEO) <br />Daytime phone number <br />John Erlandson Pi?Si �RE�Jd�E�1 <br />763-689-4992 <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 />_ Nonprofit 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 Services Div., 180 State Office Building, St. Paul, MN 55155 Phone: 651-296-2803 <br />Internal Revenue Service - IRS income tax exemption [501(c)] letter in your organization's name. <br />_ <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 />x Internal Revenue Service - proof previously submitted to Gambling Control Board <br />If you previously submitted proof of nonprofit status from the Internal Revenue Service, no attachment is required. <br />GAMBLING PREMISES INFORMATION <br />Name of premises where gambling activity will be conducted (for raffles, list the site where the drawing will take place) <br />Armstrong Ranch/Game Fair <br />Address (do not use PO box) <br />8404-161 st Ave. NW <br />City <br />I A92110a A 4VIA <br />Zip Code <br />155303 <br />County <br />Anoka <br />Date(s) of activity (for raffles, indicate the date of the drawing) <br />August 17,2008 <br />Check the 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 />=2.0- <br />