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6ro7 <br />Minnesota Lawful Gembling page i of 2 <br />LG240E Application to Conduct Excluded Bingo No fee <br />OI(GAIA.1'I( 11:1=t1IiEIATIl1 .... <br />Org atian name <br />Previous gambling permit number <br />e W <br />Type of nonprofit a ganization_ Check (4). -one. <br />[] Fraternal E) Religious ❑ Veterans 00ther nonprofit organization <br />Mailing address <br />Ci <br />State/Zip Code <br />County <br />G <br />ss3o3 <br />ATTACH A C 00 GQ� ONS: Or- THE VOLC..O'�Sl`:IN?- -:FOR, f C1Q�' t : NdROKWIT STAWS- <br />Do not attach a Was tax exempt status or federal ID employer number as they are not proof of nonprofit status. <br />XNonpro itArticles 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: 551-296-2803 <br />Internal Revenue Service -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, 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 4090, Cincinnati, OH 45201 _ <br />—Intemal Revenue Service -Affiliate of -national, statewide, or International parent nortprofit organization (charter)- <br />charterIf <br />Ifyour organization falls .urider a parent organization_ attach' copies of ko& of tha following: <br />a. IRS letter, showing your parent eraahizaiion is a nonprofit 501(c) organization with a group ruling <br />b. the charter or letter from your parent organization recogrnizing your organization as a. subordinate. <br />_Internal Revenue'Service - proof previouslysubmitted to Gambing Control Board <br />If you previously submNed proof of nonprofit status from the Internal Revenue Service, no attachment is required. <br />1.NoYes Has your organization held a bingo event in the current calender year? <br />If yes,. list the dates when bingo was conducted <br />2. The proposed bingo event For which we are applying will be; <br />one of four or fewer bingo events held this year, Dates <br />OR <br />koonducted up to 12 consecutive days in connection with a: <br />—county fair. Dates. <br />civic celebration. Dates 9-1q -OeY <br />state fair. Dates <br />,,,_Minnesota <br />3. Person in charge of bingo event S DaaIrlime phone V2N <br />4. Name of premises where bingo will be conducted Z <br />5. Premises streat address 5'!5O do J <br />6. city If township, name of township County <br />Bingo hard cards, bingo paper, and bingo number selection devices must be purchased <br />from a distributor licensed by the Gambling Control Board. To find a licensed distributor, go <br />to www.gcb.state,mn,us and click on List of Licensed Distributors, Or call 651-639-40-16, <br />Be sure to complete page 2 <br />