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REC91) <br />, MAR 1 6 <br />Minnesota Lawful Gambling -------- - -­- Page 1 of 2 1/09 <br />Application fee <br />LG220 Application for Exempt Permit If application postmarked or received� <br />An exempt permit may be issued to a nonprofit organization that: less than 30 days more than 30 clays <br />conducts lawful gambling on five or fewer days, and before the event before the event <br />awards less than $50,000 in prizes during a calendar year. $100 $50 <br />ORGANIZATION INFORMATION Check # $ S <br />Organization name Previous gambling permit number <br />Isanti Chapter of MN. Deer Hunters -4/,o <br />Type of nonprofit organization. Check one. <br />Fraternal [1-11 Religious L1 Veterans FRI Other nonprofit organization <br />RE <br />Mailing address City State Zip Code County <br />205 -1 st Ave. East Cambridge MN 55008 Isanti <br />Name of chief executive officer (CEO) Daytime phone number Email address <br />John Erlandson (P RS°c - ?/t � - s eo 763-689-4992 <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 />0 7 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 />F ill 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 />F E1 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 your organization as a subordinate. <br />IN 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 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) City Zip Code County <br />8404 -161st Ave. NW Anoka 55303 Anoka <br />Date(s) of activity (for raffles, indicate the date of the drawing) <br />A ugust 15, 2010 <br />Check the box or boxes that indicate the type of gambling activity your organization will conduct: <br />Bingo* Z Raffles 7 Paddlewheels* oPull-Tabs* 7Tipboards* <br />* Gambling equipment for pull-tabs, bingo paper, tipboards, and Also complete <br />paddlewheels must be obtained from a distributor licensed by the <br />Gambling Control Board. EXCEPTION: Bingo hard cards and bingo Page 2 of this form.1 <br />number selection devices may be borrowed from another organization <br />authorized to conduct bingo. Fill-in & Print Form <br />To find a licensed distributor, go to www.gcb.state.mn.us and click on List Reset Form <br />of Licensed Distributors, or call 651-639-4076. <br />