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Minnesota Lawful Gambling <br />Page 1 of 2 3/11 <br />LU12U Application for Exempt Permit <br />Application <br />If application pos-marked <br />fee <br />or received,;_ <br />An exempt permit may issued to a nonprofit organization that: <br />- conducts lawful gambling on five or fewer days, and <br />- awards less than $50,000 in prizes during a calendar year, <br />less than 30 days <br />before the event <br />$ ,pp <br />more than 30 days <br />before the event <br />$50 <br />ORGANIZATION INFORMATION ;check# <br />1 <br />Organization name <br />Greyhound Pets of America Minnesota <br />Previous gambling permit number <br />X-92430 <br />Minnesota tax ID number, if any <br />9147961 . <br />Federal employer ID number, if any <br />41-1847511 <br />Type <br />} of nonprofit <br />Ij Fraternal <br />organization. <br />1 Religious <br />Check one. <br />[1 Veterans ✓i Other nonprofit organization <br />Mailing address City State Zip Code County <br />6553 Meadowlark Lane N. Maple Grove MN 55369 Hennepin <br />Name of chief executive officer (CEO) Daytime phone number Email address <br />Lisa Quest 1 - 34 � 2 74 89.58 iquast@rnemsi.com q memsicam <br />Attach a copy of 1111E Of the following for proof of nonprofit status. <br />Do not <br />1:31+onprofit <br />DIAS <br />attach a sales tax exempt status or federal employer ID number as they are not proof of nonprofit status, <br />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 <br />Phone: 651.296-2803 <br />income talc exemption (501(e)j 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 />ARS- Affiliate of national, statewide, or International parent nonprofit organization (charter) <br />If your organization fails 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 />GA LING PREMISES INFORMATION <br />Name of premises where gambling activity will be conducted. For raffles, list the -site where the drawing will take place. <br />King's Ranch <br />Address (do not. use PO box) City or township Zip Code County <br />17151 Baugh St. NW Ramsey 55303 Anoka <br />Date(s) of activity (for raffles, Indicate the date of the drawing) <br />May 21, 2011 <br />Check the box or boxes that indicate the type of gambling activity your organization -will conduct: <br />Bingo* i f Raffles Paddlewheels* Pull»Tabs4' Tipboards* <br />Gambling equipment for pull -tabs, bingo paper, tipboards, and <br />paddlewheels must be obtained from a distributor licensed by the <br />Gambling Control Board, EXCEPTION: 'Bingo hard cards and <br />bingo number selection devices may be borrowed from another <br />organization authorized to conduct bingo, <br />To find a licensed distributor, go to www.gcb,state,mn,us and click <br />on List of Licensed Distributors, or call 651-639-4000, <br />