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6107 <br />Minnesota Lawful Gambling Page 1 of 2 <br />1 C..7dnR Application to Conduct Excluded Bingo No fee <br />Be sure to complete page 2 <br />1 <br />Org' ation name <br />Previous gambling permit number <br />e <br />Type of nonprofit a ganization. Check (4) one. <br />❑ Fraternal ❑ Religious ❑ Veterans [Other nonprofit organization <br />Mailing address <br />Ci <br />State/Zip Code <br />County <br />01 <br />_ 3o <br />. <br />:.......::.::::::....::::.... ..:-:::::::::.........................:.::.:::::::..:::::::::::::::.:...:::::::,..,........ <br />ATTACM A C-riPY J'F QNB: ; :7 t oL�OINl i> . t pE Q P°:NE <br />* Do not attach a sales tax exempt status or federal ID employer number as they are not proof of nonprofit status. <br />XNonprofit 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 />_ Internal Revenue Service - IRS income tax exemption 1501 (c)] letter in your organization's name. <br />Dont 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 4010, Cincinnati, OH 45201 <br />Revenue Service - Affiliate of national, statewide, or International parent nonprofit organization (charter) <br />_internal <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 <br />b. the charter or letter from your parent organization recognizing your organization as a subordinate. <br />Internal Revenue Service - proof previously submitted to Gambing Control Board <br />If you previously submitted proof of nonprofit status from the Internal Revenue Service, no attachment is required. <br />.:..::.::•:..:::::.::::.::::•:::::..:-:::.:.:.........::.::::.. ...:.: .:....:......:.......:...... ..- .:.... ............. <br />CGLUQED BIa.�4CT1VI:Ti(:: :::..:.... .. :...: ..:. .::.... <br />1. 4No Yes Has your organization held a bingo event in the current calendar 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 />conducted up to 12 consecutive days in connection with a: <br />_county fair. Dates _ <br />civic celebration. Dates <br />_Minnesota state fair. Dates <br />5o Daytime �2 <br />3. Person in charge of bingo event phone�3���- <br />4. Name of premises where bingo will be conducted r <br />5. Premises street address ss� o� - 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 651-639-4076. <br />Be sure to complete page 2 <br />1 <br />