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MINNESOTA LAWFUL GAMBLING <br />LG220 Application for Exempt Permit <br />1/13 Page 1 of 2 <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 />If total prize value for the year will be $1,500 or less, contact the licensing <br />specialist assigned to your county. <br />Application fee (non refundable) <br />If application is postmarked or received 30 days or <br />more before the event $50; otherwise $100. <br />ORGANIZATION INFORMATION <br />Organization name Previous gambling permit number <br />Ramsey Fire Relief Association N/A <br />Minnesota tax ID number, if any Federal employer ID number (FEIN), if any <br />41-1654031 <br />Type of nonprofit organization. Check one. <br />organization <br />,_] Fraternal <br />IIlIReligious .._Veterans ILOther nonprofit <br />Mailing address City State Zip code County <br />7550 Sunwood Dr. Ramsey MN 55303 Anoka <br />Name of chief executive officer [CEO] Daytime phone number E-mail address <br />Adam J. Gordon, President 763-300-6440 agordon@ci.ramsey.mn.us <br />NONPROFIT STATUS <br />Attach a copy of ONE <br />of the following for proof of nonprofit status. <br />of Incorporation OR a current Certificate of Good Standing. <br />copy? This certificate must be obtained each year from: <br />State, Business Services Div., 60 Empire Drive, Suite 100, St. Paul, MN 55103 <br />exemption [501(c)] letter in your organization's name. <br />copy? To obtain a copy of your federal income tax exempt letter, have an organization officer contact <br />of national, statewide, or international parent nonprofit organization [charter] <br />falls under a parent organization, attach copies of both of the following: <br />showing your parent organization is a nonprofit 501(c) organization with a group ruling, and <br />or letter from your parent organization recognizing your organization as a subordinate. <br />FTNonprofit Articles <br />Don't have a <br />Secretary of <br />MI Phone: 651-296-2803 <br />IRS income tax <br />Don't have a <br />the IRS at 877-829-5500. <br />IRS - Affiliate <br />If your organization <br />a. IRS letter <br />b. the charter <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 />Ramsey Fire Station <br />Address [do not use PO box] City or township Zip code County <br />15050 Armstrong Blvd. Ramsey 55303 Anoka <br />Date[s) of activity. For raffles, indicate the date of the drawing. <br />October 12, 2013 <br />Chi, each type of c=^'hling <br />activity that your organization will conduct. <br />T <br />_ <br />*Gambling equipment for bingo paper, paddlewheels, pull -tabs, and tipboards must be obtained from a distributor <br />licensed by the Minnesota Gambling Control Board. EXCEPTION: Bingo hard cards and bingo number selection devices <br />may be borrowed from another organization authorized to conduct bingo. <br />To find a licensed distributor, go to www.gcb.state.mn.us and click on Distributors under <br />the WHO'S WHO? LIST OF LICENSEES, or call 651-639-4000. <br />