Agenda - Council - 06/08/2010 - Laserfiche WebLink

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~E~'p ~1~~ ~ ~ ~~ Minnesota Laurfrrl [~amhlinn Page 1 of 2 2/10 LG220 Application for Exempt Permit Application fee for each event If a licati n ostmarked or received: An exempt permit may be issued to a nonprofit organization that: less than 30 days more than 30 days - conducts lawful gambling on five or fewer days, and before the event before the event - awards less than $50,000 in prizes during a calendar year. $100 $50 ORGANIZATION INFORMATION Check # '1i5~ $ Organization name Previous gambling permit number Greyhound Pets of America -Minnesota Type of nonprofit organization. Check one. Fraternal ~ Religious Veterans OX Other nonprofit organization Mailing address City State Zip Code County 808 W. 28th St. Minneapolis MN 55408 Hennepin Name of chief executive officer (CEO) Daytime phone number Email address Lisa Quast 612-743-8968 Iquast@memsi.com Attach a copy of Q~~ of the following for proof of nonprofit status. Check one. Do 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 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, have an organization officer contact the IRS at 877-829-5500. IRS -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 nonprofit 501(c) organization with a group ruling, and b. the charter or letter from your parent organization recognizing your organization as a subordinate. IRS -proof previously submitted to Gambling Control Board If you previously submitted proof of nonprofit status from the IRS, 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) King's Ranch Address (do not use PO box) City Zip Code County 17151 Baugh St. NW Ramsey 55303 Anoka Date(s) of activity (for raffles, indicate the date of the drawing) June 26, 2010 heck the box or boxes that indicate the type of gambling activity your organization will conduct: Bingo* ®Raffles ~Paddlewheels* ~ Pull-Tabs* ~Tipboards* * Gambling equipment for pull-tabs, bingo paper, tipboards, and Also complete paddlewheels must be obtained from a distributor licensed by the 6~a~licig Control Board. EXCEPTION: Bingo hard cards and bingo Page 2 of this form. number selection devices may be borrowed from another organization authorized to conduct bingo. Print Form To find a licensed distributor, go to www.gcb.state.mn.us and click on List Reset F orm of Licensed Distributors, or call 651-639-4076.