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Minnesota Lawful Gambling <br />LG220 Application for Exempt <br /> An exempt permit may b~': ssued to h6npr°fit organizations <br /> conducting lawful gamb ~g activity on five Or fewer days, and <br /> awarding less than $50,000 in prizes during a calendar year. <br /> Organization Information :]:sar~t± cour~ty chapter <br />Organization legal name <br /> Minnesota Deer Hunters Association <br /> <br />Street <br /> 205 1st Ave East <br /> <br /> City <br />cambridge <br /> <br />Name of chief executive officer (CEO) <br /> First name <br /> John <br /> <br />Last name <br /> Erlandson <br /> <br />Page 1 of 2 11/04 <br /> <br />For Board Use Only <br />FeePaid_ ___ <br />Check No. <br /> <br />Previous license or exemption number, if any <br /> <br /> I State and zip code I County <br /> <br /> MN 55008 ' Isanti <br /> I Daytime phone number <br /> 763-689-4992. <br /> <br />Type of nonprofit organization (check. one) <br /> [] Fraternal [] Religious <br /> [] Veteran. [] Other nonprofit organization <br /> Type of proof of nonprofit - attach a copy (see instructions) [] Nonprofit Articles of Incorporation or Certificate of Good Standing - Minnesota Secretary of State's Office <br /> [] Internal Revenue Service <br /> [] Affiliate of parent nonprofit organization (charter) <br /> <br />Gambling Premises InformatiOn <br /> <br />Name of premises where gambling activity will be conducted (for raffles, list the site where the drawing will take place) <br /> <br /> Armstrong Ranch-Game Fair <br /> <br />Address(donotuse PO box) I City <br /> 8404 161st Ave ~ 'I Ramsay <br />Oate(s) ofactivity(~rraffies, indicatethedateof~edmwing) <br /> August 21, 2005 <br /> <br />Zipcode I County <br /> 55303 Anoka <br /> <br />Check the box or boxes that indicate the type of gambling actiVity your organization will be conducting: <br /> []"Bingo [] Raffles [] *Paddlewheels [] mu!l-Tabs [] *Tipboards <br />*Gambling equipment for pull-tabs, tipb°ards, paddlewheels, and bingo (bingo paper, hard cards, and bingo ball <br />selection device) must be obtained froma distributor licensed by the Gambling Control Board. To find a licensed <br />distributor, go to www. gcb.state.mn.us and click o/1 ~ist Of Licensed Distributors. Or call 651-639-4000. <br /> <br />This form will be made available in alternative <br />format (i.e. large print, Braille) upon request. <br />The information requested on this form (and <br />any attachments) will be used by the Gambling <br />Control Board (Board) to determine your <br />qualifications to be involved in lawfu! gambling <br />activities in Minnesota. You have the dght to <br />refuse to supply the information requested; <br />however, if you refuse to supply this <br />information, the Board may not be able to <br />determine your qualifications and, as a <br />consequehce, may refuse to issue you a <br />permit. If you supply the information <br />requested, the Board will be able to process <br />your application. <br /> <br />Your name and and you~ organization's name <br />and addresswill be public information when <br />received by the Bpard. All the other information <br />that you provide will be pdvate data about you <br />until the Board issuesyour permit. When the <br />BOard issuesyour permit, all of the information <br />thor you have' provided to the Board in the <br />process of app!ying for your permit will become <br />pu, blic. If the Board does not issue you a <br />permit, all the information you have provided <br />in the proces~ of applying for a permit remains <br />pdvate, with the exception of you r name and <br />your organization's name and address which <br />wiJl remain public. <br />Private data aboutyou are available only to <br /> <br />the following: Board members, staff of the <br />Board whose work assignment requires that <br />they have access to the information; the <br />Minnesota Department of Public Safety; the <br />MinnesotaAttorney General; the Minnesota <br />Commissioners of Administration, Finance, <br />and Revenue; the Minnesota Legislative. <br />Auditor, national and international gambling <br />regulatory agencies; anyone pursuant to court <br />order; other individuals and agencies that are <br />specifically authorized by state or federal law <br />to have access to the information; individuals <br />and agencies for which law or legal order <br />authorizes a new use or. sharing of information <br />after this Notice was given; and anyone with <br />your consent. <br /> <br /> <br />