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MINNESOTA LAWFUL GAMBLING <br />LG240B Application to Conduct Excluded Bingo <br />ORGANIZATION INFORMATION <br />Organization name Previous gambling permit number <br />gr1()/<0 0/V ? v ' //q / )3 - r� 1i&(a <br />Minnesota tax ID number, if any Federal ployer ID number (FEIN), if any <br />7405140 41-1410087 <br />Type of nonprofit organization. Check one. <br />Fraternal Religious Veterans X Other nonprofit organization <br />Mailing address <br />PO Box 564 <br />Anoka <br />Name of chief executive officer [CEO] <br />Patricia Ludens <br />City <br />State Zip code <br />MN 55303 <br />Daytime phone number <br />(651) 310-6303 <br />6/13 Page 1 of 2 <br />No Fee <br />County <br />Anoka <br />E-mail address <br />PLUDENStravelers.com <br />NONPROFIT STATUS <br />Attach a copy of ONE of the following for proof of nonprofit status. <br />X 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., 60 Empire Drive, Suite 100, St. Paul, MN 55103 <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 <br />officer 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 />EXCLUDED BINGO ACTIVITY <br />1. X No Yes Has your organization held a bingo event in the current calendar year? <br />If yes, list the dates when bingo was conducted. <br />2. The proposed bingo event will be: <br />X one of four or fewer bingo events held this year. Dates 09/07/2013 <br />3. <br />4. <br />5. <br />OR <br />conducted on up to 12 consecutive days in connection with a: <br />county fair. Dates <br />civic celebration. Dates <br />Minnesota state fair. Dates lv 9%y2'i/ <br />Person in charge of bingo event Julie Hammel Daytime phone 763-370-6400 <br />Name of premises where bingo will be conducted Ramsey Town Center <br />Premises street address 7550 Sunwood Drive NW <br />6. city Ramsey <br />If township, township name <br />County Anoka <br />Bingo hard cards and bingo number selection devices may be borrowed from another organization authorized <br />to conduct bingo. Otherwise, bingo hard cards, bingo paper, and bingo number selection devices must be obtained <br />from a distributor licensed by the Minnesota Gambling Control Board. To find a licensed distributor, go to <br />www.gcb.state.mn.us and click on Distributors under the WHO'S WHO? LIST OF LICENSEES, or call <br />651-639-4000. Be sure to complete page 2 <br />