Agenda - Council - 07/08/2014 - Laserfiche WebLink

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MINNESOTA LAWFUL GAMBLING LG220 Application for Exempt Permit An exempt permit may be issued to a nonprofit organization that: - conducts lawful gambling on five or fewer days, and - awards less than $50,000 in prizes during a calendar year. If total prize value for the year will be $1,500 or less, contact the licensing specialist assigned to your county. 5/14 Page 1 of 2 Application fee (non refundable) If application is postmarked or received 30 days or more before the event $50; otherwise $100. ORGANIZATION INFORMATION Organization name Previous gambling permit number Ruffed Grouse Society - Twin Cities Chapter X82048 Minnesota tax ID number, if any Federal employer ID number (FEIN), if any Type of nonprofit organization. Check one. Fraternal Religious Veterans X Other nonprofit organization Mailing address City State Zip code County 1552 148th Ave NW Andover MN 55304 Anoka Name of chief executive officer [CEO] Terrence L Lydell NONPROFIT STATUS Daytime phone number E-mail address 612-237-6214 terrylydell@qualityci.us Attach a copy of ONE of the following for proof of nonprofit status. Nonprofit Articles of Incorporation OR a current Certificate of Good Standing. Don't have a copy? This certificate must be obtained each year from: Secretary of State, Business Services Div., 60 Empire Drive, Suite 100, St. Paul, MN 55103 Phone: 651-296-2803 IRS income tax exemption [501(c)] letter in your organization's name. Don't have a copy? To obtain a copy of your federal income tax exempt letter, have an organization officer contact the IRS at 877-829-5500. X IRS - Affiliate of national, statewide, or international parent nonprofit organization [charter] If your organization falls under a parent organization, attach copies of both of the following: a. IRS letter showing your parent organization is a nonprofit 501(c) organization with a group ruling, and b. the charter or letter from your parent organization recognizing your organization as a subordinate. GAMBLING PREMISES INFORMATION Name of premises where the gambling event will be conducted. For raffles, list the site where the drawing will take place. Ganje Fair / Armstrong Ranch Address [do not use PO box] City or township Zip code County 8404 162st Ave NW Ramsey 55303 Anoka Date[s] of activity. For raffles, indicate the date of the drawing. August 17, 2014 Check each type of gambling activity that your organization will conduct. _Bingo*X Raffle [total value of raffle prizes awarded for year $ 0 Paddlewheels* Pull -tabs* Tipboards* *Gambling equipment for bingo paper, paddlewheels, pull -tabs, and tipboards must be obtained from a distributor licensed by the Minnesota Gambling Control Board. EXCEPTION: Bingo hard cards and bingo number selection devices may be borrowed from another organization authorized to conduct bingo. To find a licensed distributor, go to www.gcb.state.mn.us and click on Distributors under the WHO'S WHO? LIST OF LICENSEES, or call 651-539-1900.