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II;TRLCTIONS: <br /> <br />Minnesota Charitable Gambling Control Board <br />904 Summit State Bank Building <br />310 4th Avenue South <br />Minneapolis, MN 55415 <br />{612) 341-7676 <br /> <br />REGISTRATION OF EXEMPT BINGO <br /> <br />1, Submi~ to above address at least 30 days prior to bingo occasion. <br />2. PRINT or TYPE. <br /> <br />- ~rd f~uet~uc <br /> <br />Name of ~r~on m Charge of Bingo Occasion <br /> <br />type of G~;anizataon <br /> <br />-Jlrate.mal r-I Religious [] Veteran <br /> <br />~umber of ~'ears in Existence in Minnesota <br /> <br />~ Other Nonprofit Organization <br /> <br />Number of Active Members <br /> 'Thor+V <br /> <br />Number of Consecutive Days Bingo <br />Will Be Played <br /> <br />)atel'~l of Rngo Occasion <br /> _~ptcrnl~r 3, lq$~ <br /> <br />City, State. Zip <br /> <br />Phone Number <br /> q~l-5b~ <br /> <br />Type of Occasion <br />[] County Fair [:]. Civic Celebration <br />[] State Fair[~ 4 or Less Occasions <br /> <br />Number of Bingo <br />Occasions Conducted <br />by Organization in <br />Present Calendar Year <br /> <br />I /~_~.~_~,~,~,~__.~~_ ~_~,$ig~'~lChief Executive Officerl _ . <br /> <br />:G-~10-01 ~1~85l White m Board Canary ~ Organization <br /> <br />Date of Request <br /> <br />'1 <br /> <br />I <br />I <br /> <br /> <br />