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MINNE S OTA LAWFUL GAMBLING <br />LG220 Application for Exempt Permit <br />An exempt permit may be issued to a nonprofit organization that: <br />- conducts lawful gambling an five or fewer days, and <br />- awards less than $50,000 in prizes during a calendar year, <br />If.tatal prize value for the year will be $1,500 or less, contact the licensing <br />specialist assigned to your county. <br />ORGANIZATION INFORMATION <br />organization name <br />Wounded Warriors Guido Service <br />Minnesota tax ID number, If any Federal employer ID number (FEIN), if any <br />1/13 Page 1 of 2 <br />Application fee (non refundable) <br />If application is postmarked or received 30 days or <br />more before the event $50; otherwise $100, <br />Type of nonprofit organization. Checkrcone, <br />L Fraternal El Religious I $ i Veterans <br />Mailing address <br />5028 Bemidji Ave N <br />Name of chief executive officer [CEO] <br />Brian Dean Ophus <br />NONPROFIT STATUS <br />JAttach a copy of ONE of the following for proof of nonprofit status. <br />1 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 />il. IRS income tax exemption (SQ1(c)] letter in your organlzation's name. <br />Don't have a copy? To obtain a copy of your federal Income tax exempt letter, have an organization officer contact <br />� `" the IRS at 877-829-5500. <br />l 1 , IRS - Affiliate of national, statewide, or r 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(0 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 piece, <br />Armstrong Ranch Kennels <br />Address [do not use PO box] City or township Zip code 'County <br />8404 161 st Ave NW ,,.-0A-` -y 55303 <br />Date[s] of activity. For raffles, indicate the date of the drawing, �f <br />August 9-18 <br />Check each type of rambling activity thatyourorganization will conduct. <br />J l Bingo* © Raffle 1 1 Paddlewheels* fl Pull -tabs* I I_ Tipboards* <br />Previous gambling permit number <br />City <br />Bemidji <br />_•other nonprofit organization <br />State Zip code County <br />MN 56601 Beltrami <br />Daytime phone number i=-mall address <br />(218) 209-1230 brian@wwgsmn.org <br />*Gambling equipment for bingo paper, paddlewheels, pull -tabs, and tlpboards 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 />