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LG24OB <br /> <br /> Minnesota Lawful Garmbling <br /> Application for Authorization to Conduct Excluded Bingo <br /> Part 1 of 2 <br /> (if your organization has been licensed or exempted in the <br /> current calendar year, you are not eligible to apply for excluded bingo) <br /> Fill in the unshaded areas of this application and send it to the <br /> Gambling Control Board at least 30 days prior to the activity. <br />Org,,~nization..' ~ ,~ /, _...- .,4 / / <br /> <br />State Zip code <br />Type of nonprofit organization (check ond: ';:;;~i!i ¢!i !iii;.i ii ii !i ii! ! ii!i!iii;¢ <br />[] Fraternal Veteran <br /> <br /> Type of proof of nonprofit status attached (check one): <br />,~ Certificate of Good Standing - Minnesota Secretary of State's Office <br /> Internal Revenue Service <br /> [] Affiliate of Parent nonprofit organization (charter) <br /> <br /> I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />Has your organization held a bingo event in the current calendar year?, No ~ Yes <br />If yes, list the dates that bingo was conducted <br />Check one: <br />F3The bingo event will be one of fo_ur or Iewer t?ingo events your organization will hold this year. <br /> Date(s) of bingo event: ~'¢'f7C. YY} ~C/¢_ .J~, ~'~ ~..~ <br /> / <br /> <br />[] The bingo event will be conducted (up to 12 consecutive days) in connection with a: <br /> County Fair - Date(s) of bingo event <br /> State Fair - Date(s) of bingo event <br /> Civic Celebration - Date(s) of bingo event <br /> <br />I <br />I <br />I <br />I <br />I <br /> <br />Print the name of the person,in charge of the bingo event Daytime Phone <br /> <br />Street Address... /~/¢~.~, <br />?~ r.~,m~ / <br />Wh~e - <br /> <br />OR County and Township <br /> <br />(Be sure to complete Part 2) <br /> <br />I <br />I <br />I <br />I <br /> <br /> <br />