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RECD JUL 0 ~ 201C <br />Page i of 2 2/10 <br />/Iinnesota Lawful Gamplfng Application fee for each event <br />n for Exempt Permit <br />ti <br />li <br />A Ifa lication ostmarked or received <br />o <br />ca <br />pp <br />_G220 0 d than 30 da <br />s <br />An exempt permit may be issued to a nonprofit organization that: ays <br />less than 3 <br />before the event y <br />more <br />before the event <br />-conducts lawful gambling on five or fewer days, and $100 $50 <br />-.awards less than $50,000 in prizes during a calendar year. - <br />ORGANIZATION INFORMATION Check# {~1 ` S Se <br />Organization name Previous gambling permit number <br />Elk River Royal Chapter RMEF <br />Type of nonprofit organization. Check one. <br />Fraternal ~ Religious ~ Veterans ~ Other nonprofit organization <br />Mailing address City State Zip Code County <br />17328 166th St. SE Big Lake MN 55309 Sherburne <br />Name of chief executive officer (CEO) Daytime phone number Email address <br />Kent Johnson 763-2635071 kjohnson@pmanetwork.com <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 federel 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 certifcate must be obtained each year from: <br />Secretary of State, Business Services Div., 180 State OfficeBuilding, St. Paul, MN 55155 Phone: 651-296-2803 <br />IRS income tax exemption [501(c)] letter in your organization's name. <br />have an organization officer <br />r federal income tax exempt letter <br />o <br />f <br />' <br />, <br />u <br />y <br />t have a copy? To obtain a copy o <br />Don <br />contact the IRS at 877-829-5500. <br />IRS -Affiliate of national, statewide, or international parent nonprofit organization (charter) <br />i <br />ng: <br />If your organization falls under a parent organization, attach copies of both of the follow <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 />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 />Game Fair <br />Address (do not use PO box) City Zip Code County <br />8404161st Ave. NW Anoka 55303 Anoka <br />Date(s) of activity (for raffles, indicate the date of the drawing) <br />August 15, 2010 <br />heck the box or boxes that indicate the type of gambling activity your organization will conduct: <br />Bingo' ®RafflesPaddlewheels` Pull-Tabs` ~Tipboards` <br />* Gambling equipment for pull-tabs, bingo paper, tipboards, and Also complete <br />paddlewheels must be obtained from a distributor licensed by the page 2 of this form. <br />Gambling Contrcl Board. IXCEPTION: Bingo hard cards and bingo <br />number selection devices may be bonowed from another organization <br />PrinY:FOrm <br />b <br />ingo. <br />authorized to conduR <br />To find a licensed distributor, go to www.gcbstate.mn.us and dick.on List Reset Form. <br />,.f i ;~e..~e.~ nichdhutnrc. nr tall 651-639-4076. <br />