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LG220 <br />Rev06/96 <br /> <br /> Minnesota Lawful Gambling <br />Application for Authorization for an <br />Exemption from Lawful Gambling License <br /> <br />For Board Use Only <br /> <br />Fee Paid <br />Check # <br />Initals <br />Date Recd <br /> <br />Organkation Name Isanti County Chapter/ <br />Minnesota Deer Hunters Association <br /> <br />Previous lawful gambling exemption number <br /> <br />Street City State Zip Code County <br /> 10491 Hwy 95 Princeton MN 55371 Mille Lacs <br /> <br />Name of Chief Executive Officer of organization (CEO) <br />First Name I Last Name <br /> Charles I Co,nell <br />Name of Organization Treasurer <br />First Name Last Name <br />Joel I Bremer <br /> <br />Daytime Phone number of CEO <br />(612) 389-1696 <br /> <br />Daytime Phone Number of Treasurer <br /> (3'29 679-4668 <br /> <br />Check the box below which best describes <br />your organization <br /> <br />E~ Fraternal <br />~ Veterans <br />r--I Religious <br />~ Other nonprofit <br /> <br />Check the box that indicates the type of proof attached to this application <br />by your organization: <br />F-3 IRS letter indicalJng income tax exempt status <br /> <br />F--I CerlJflcate of good standing from ~he Minnesota Secretan/of State's office <br />r'x"l A charter showing you're an affiliate of a parent nonprofit organization <br /> <br />I"-] Proof previously submitted and on file with the Gambling Control Board <br /> <br />Name of Establishment where gambling activity will be conducted <br /> Game Fair' <br /> <br />Street City State Zip Code County <br /> 8404 161'st Ave NW Anoka MN 55303 Anoka <br /> <br />Date(s) of activity (for raffles, indicate the date of the drawing) <br /> August 20, 2000 <br /> <br />Check the box or boxes which indicate the type of gambling activity your organization will be conducting <br /> [---] *Bingo rxq Raffles ['-] 'Paddlewheels [--I *Pull-tabs [] *Tipboards <br /> <br />*Equipment for these activities must be obtained from a licensed distributor <br /> <br />Be sure the Local Unit of Government and the CEO of your organization sign <br />the reverse side of this application. <br /> <br /> For Board Use Only <br />Date & Initials of Specialist <br /> <br />, / / <br /> <br /> <br />