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Minnesota Lawful Gambling <br />LG240B Application to Conduct Excluded Bingo <br />ORGANIZATION INFORMATION <br />3/11 <br />Page 1 of 2 <br />No fee <br />Organization name Previous gambling permit number <br />Ramsey Women of Today XB-05229-06-001 <br />Minnesota tax ID number, if any Federal employer ID number, if any <br />1905764 41-1796712 <br />Type of nonprofit oraanization. Check (41_ one. <br />IFraternal F . Religious I Veterans f � `Other nonprofit organization <br />1 <br />Mailing address <br />14672 Junkite St NW <br />City <br />Ramsey <br />State Zip Code <br />MN 55303 <br />County <br />Anoka <br />ATTACH A COPY OF ONE OF THE FOLLOWING FOR PROOF OF NONPROFIT STATUS <br />* Do not attach a sales tax exempt status or federal ID employer number 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 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 [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 />I '_Internal Revenue Service -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 />EXCLUDED BINGO ACTIVITY <br />1.1 i,No Yes Has your organization held a bingo event in the current calendar year? <br />If yes, list the dates when bingo was conducted 9/18/10 <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 9/16/11 9/17/11 <br />OR <br />Iconducted up to 12 consecutive days in connection with a: <br />county fair. Dates <br />civic celebration. Dates <br />Minnesota state fair. Dates <br />3. Person in charge of bingo event Julie Hammel <br />4. Name of premises where bingo will be conducted <br />Ramsey Town Center <br />5. Premises street address 7550 Sunwood Drive NW <br />6. City Ramsey If township, name of township <br />Daytime phone <br />763-433-0407 <br />County Anoka <br />Bingo hard cards and bingo number selection devices may be borrowed from another organization <br />authorized to conduct bingo. Otherwise, bingo hard cards, bingo p aper, and bingo number selection <br />devices must be purchased from a distributor licensed by the Gambling Control Board. To find a licensed <br />distributor, go to www.gcb.state.mn.us and click on List of Licensed Distributors. Or call 651-639-4000. <br />Be sure to complete page 2 <br />J <br />