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Minnesota Lawful Gambling <br />LG220 Application for Exempt Permit <br />An exempt permit may be issued to a nonprofit organization that: <br />- conducts lawful gambling on five or fewer days, and <br />.,.,,~..1~ lee +4,~n xGn nnn in nrivoc rl~ ~rinn ~ ralanriar VPar <br />Page 1 oft 9/08 <br />Fee is $50 for each event <br />For Board Use Only <br />P`hcr4 $ Q <br />ORGANIZATION INFORMATION <br />Organization name Previous gambling permit number <br />The Church of St. Katharine Drexel 36302-08-001 <br />Type of nonprofit organization. Check one. <br />Fraternal ~ Religious a Veterans ~ Other nonprofit organization <br />Mailing address City State Zip Code County <br />7101 143rd Ave NW - Suite G Ramsey MN 55303 Anoka <br />Name of chief executive officer (CEO) Daytime phone number Email address <br />Fr. Paul Jaroszeski 76323-4424. nandrb@comcast.net <br />Attach a copy of ONE of the following for proof of nonprofit status. Check one. <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 />IRS income tax exemption [501(c)] letter in your organization's name. <br />Don't have a copy? To obtain a copy of your federal income tax exempt letter, have an organization officer <br />contact the IRS at 877-829-5500. <br />IRS -Affiliate of national, statewide, or international parent nonprofit organization (charter) <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 nonprofit 501(c) organization with a group ruling, and <br />b. the charter or letter from your parent organization recognizing ydur organization as a subordinate. <br />IRS -proof previously submitted to Gambling Control Board <br />If you previously submitted proof of nonprofit status from the. IRS, no attachment is required. <br />GAMBLING PREMISES t,NFORMATION <br />Name of premises where gambling activity will be conducted (for raffles, list the site where the drawing will take place) <br />Ramsey CentraF Park <br />Address (do not use PO box) City Zip Code County <br />7925161st Ave. NW Ramsey 55303 Anoka <br />Date(s) of activity (for raffles, indicate the date of the drawing) <br />June 13, 2009 to <br />heck the box or boxes that indicate the type of gambling activity your organiza#ion will conduct: <br />Bingo* ®Raffles ~ Paddlewheels* ~ Pull Tabs* ~Tipboards* <br />* Gambling equipment for pull-tabs, bingo paper, tipboards, and <br />paddlewheels must be obtained from a distributor licensed by the Also complete <br />Gambling Control Board. DCCEPTION: Bingo hard cards and bingo Pale ~ of this form. <br />number selection devices may be borrowed from another organization <br />authorized to conduct bingo, Print Form <br />To find. a icensed distributor, go to www.gcbstate.mn.us and click on List Rese"t Form <br />of Licensed Distributors, or call 651-639-4076. <br />_20_ <br />