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11) <br />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 less than $50,000 in prizes during a calendar year. <br />ORGANIZATION INFORMATION <br />Organization name <br />CAA.06\ E \`v R-S <br />Type of nonprofit organization. Check one. <br />Fraternal <br />Mailing address <br />Religious 1 lVeterans <br />/ 7/z/ 31oss , vd <br />Name of chief executive officer (CEO) <br />Page 1 of 2 2l10 <br />Application fee for each event <br />If application oos. marked or received: <br />less than 30 days more than 30 days <br />before the event before the event <br />$100 $50 <br />Check # $ <br />0tC1C' <br />Previous gambling permit number <br />Other nonprofit organization <br />City State Zip Code County <br />. s o ni I `Y\ h 551CA b <br />Daytime phone number Email address <br />D n n O'\ 1106 - *PI- 7I 7 3 C s.?xist taarWI-NA rya • C' a <br />Attach a copy of ONE of the following for proof of nonprofit status. Check one. <br />they <br />Do not attach a sales tax exempt status or federal ID employer numbers as 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 />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 />IRS - proof previously submitted to Gambling Control Board <br />If you previously submitted proof of nonprofit status from the IRS, no attachment is required. <br />GAMBLING PREMISES INFORMATION <br />Name of premises where gambling activity will be conducted (for raffles, list the site where the drawing will take place) <br />�y11v tvrwv 1.1C <br />d <br />dress (do not use P box) <br />SWr�I ICI <br />City <br />�'OV.-1-. 111-}-9 <br />RIOms€ / <br />Zip Code County <br />6363 <br />Date(s) of activity (for raffles, indicate the date of the drawing) <br />1.` tAsT 1d --1 i -1 ��- i`1-1s '`� G�,''�-�\ ci 0h Y'IIQ/f <br />C eck t 'e box or boxes that indicate the type of gambling activity your organization will conduct: <br />0 Bingo* l Raffles E] Paddlewheels* LJ Pull -Tabs* U 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 bingo <br />number selection devices may be borrowed from another organization <br />authorized to conduct bingo. <br />To find a licensed distributor, go to www.gcb.state.mn.us and click on List <br />of Licensed Distributors, or call 651-639-4076. <br />Also complete <br />Page 2 of this form. <br />Print Form <br />IReset Form I <br />