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Minnesota Lawful Gambling <br />LG220 Application for Exempt Permit <br />An exempt permit may be issued to a nonprofit organization that; <br />conducts lawful gambling on five or fewer days, and <br />- awards Tess than $50,000 In prizes during a calendar year. <br />If application oos <br />less than 30 days <br />before the event <br />$100 <br />Page 1 of 2 5/11 <br />Application fee <br />marked or received: <br />Wore than 30 days <br />before the event <br />$50 <br />ORGANIZATION INFORMATION <br />Organization name <br />The church of St. Katharine Drexel <br />Check# $ <br />Previous gambling permit number <br />36302 <br />Minnesota tax ID number, If any Federal employer ID number, if any <br />8702087 20-2429058 <br />Type of nonprofit organization. Check one, <br />Fraternal VII Religious I Veterans <br />Mailing address City <br />7101 143rd Ave NW - Suite G Ramsey <br />Name of chief executive officer (CFO) Daytime phone number <br />Fr. Paul Jaroszeski 763-323-4424 pjaooszeski@stkdcc.org <br />Attach a copy ofOP4E of the following for proof of nonprofit status, <br />other nonprofit organization <br />State zip Code County <br />MN 55303 Anoka <br />Email address <br />Do not attach a sales tax exempt status or federal employer ID number as they are not proof of nonprofit status, <br />if <br />Vonprofit 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 />IRS income tax exemption [501(c)] 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 />IRS - Affiliate of national, statewide, or international parent nonprofit organization (charter) <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, and <br />b, the charter or letter from your parent organization recognizing your organization as a subordinate, <br />GAMBLING PREMISES INFORMATION <br />Name of premises where the gambling event will be conducted. For raffles, list the site where the drawing will take place, <br />The church of St. Katharine Drexel <br />Address (do not use Po box) City or township Zip Code County <br />7101 143rd Ave NW Ramsey <br />55303 Anoka <br />Date(s) of activity (for raffles, indicate the date of the drawing) <br />October 1, 1011 <br />Check the box or boxes that Indicate the type of gambling activity your organization will conduct; <br />Bingo* ✓ Raffles Paddlewheels* Pull -Tabs* <br />* Gambling equipment for pull -tabs, bingo paper, tlpboards, 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 />Tlpboards* <br />