Agenda - Council - 03/25/2008 - Laserfiche WebLink

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Minnesota Lawful Gambling LG220 Application for Exempt Permit REC'D MAR 18 2008 Page 1 of 2 6/07 An exempt permit may be issued to a nonprofit organization that: • conducts lawful gambling on five or fewer days, and • awards Tess than $50,000 in prizes during a calendar year. Fee is $50 for each event Organization name 0 L - t avVr5 { 1 4 - c5 Type of nonprofit organization. Check (V) one. ❑ Fraternal ❑ Religious ❑ Veterans Address (do not use PO box) lg50 f Blvd AlW City ira(�/In f ,, Mailing address II Z50 f OW M Name of chief executive officer (CEO) M i ' r h /11 mo gar City Iv so/ e the date of the drawing) For Board Use Only Check# ORGANIZATION INFORMATION Previous gambling permit number q5 - - z? ., 7 COQ / Other nonprofit organization State /Zip Code III i55 unty Daytime phone number - 'f2 e(7-0(q0 ATTACH A COPY OF ONE OF THE FOLLOWING FOR PROOF OF NONPROFIT STATUS not attach a sales tax exempt status or federal ID employer numbers as they are not proof of nonprofit status. __ Nonprofit Articles of Incorporation OR a current Certificate of Good Standing. Don't have a copy? This certificate must be obtained each year from: Secretary of State, Business Services Div., 180 State Office Building, St. Paul, MN 55155 Phone: 651 -296 -2803 ___ Internal Revenue Service - IRS income tax exemption [501(c)] letter in your organization's name. Don't have a copy? To obtain a copy of your federal income tax exempt letter, send your federal ID number and the date your organization initially applied for tax exempt status to: IRS, P.O. Box 2508, Room 4010, Cincinnati, OH 45201 _ Internal Revenue Service - Affiliate of national, statewide, or international parent nonprofit organization (charter) If your organization falls under a parent organization, attach copies of both of the following: a. IRS letter showing your parent organization is a registered nonprofit 501(c) organization with a group ruling b. the charter or letter from your parent organization recognizing your organization as a subordinate. _Internal Revenue Service - proof previously submitted to Gambling Control Board If you previously submitted proof of nonprofit status from the Internal Revenue Service, no attachment is required. GAMBLING PREMISES INFORMATION Name of premises where gambling activity will be conducted (for raffles, list the site where the drawing will take place) Zip Code 55303 C unty /c Date(s) of activity (for raffles, indica . ) g Check the box or boxes that indicate the type of gambling activity your organization will conduct: *Bingo [� Raffles ❑ *Paddlewhe *Tipboards ❑ Pull - ❑ Tipboards * Gambling equipment for pull -tabs, tipboards, paddlewheels, and bingo (bingo paper, hard cards, and bingo number selection device) must be obtained from a distributor licensed by the Gambling Control Board. To find a licensed distributor, go to www.gcb.state.mn.us and click on List of Licensed Distributors, or call 651 - 639 - 4076. '9