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Feb. 2I. 2006 8:29AM No. 3855 <br /> <br />Minnesota Lawful Gambling <br />LG220 Application for Exempt Permit <br /> <br />Fee $50 <br /> <br />An exempt perm{t may be issued to nonprofit organizations <br />conducting lawful gambling activity on five or fewer days, and <br />awarding less then $50,000 in prizes during a calendar year, <br /> <br />Page 1 of-"' .11/04 <br /> <br />Il:or goard Use Only <br /> <br />Organization Information <br />Organizatic~3 legal name ^ ---,-;-. Prev~9~s I,[c~nse pr~e~emptJon Dumber, ~t~Y._ <br /> p /'m4 <br /> <br />Name at chiet executive officer (CEO) <br /> First name ~* ,, ) ./ Lest name <br /> m <br /> <br />Type of nonprofit oq~anizefion (~eck one) <br /> [] Fraternal [] Religious <br /> [] Veteran rc~ Other nonprofit organization <br /> Type el proof of nonprofit - attach a copy (see instructions) <br /> .,~__..[>kSnprofit Articles of Incorporation or Certificate of Goc~ Standing - Minnesota Sec4'etary o1 State's Office <br /> ~ Internal Revenue Service ' <br /> []"Affiliate of parent nonprofit organiTatJon (charter) <br /> <br /> Gambling Premises Infon~ation <br />Name f r i w re arab '~g achy_th/will be conducted for raffles. J~t ~a site ~/nere~e dmv4ng will t3ke ~ace) <br /> <br /> Date(s) o f actJvib/[for ~/~l~.lJs, indiC'ate ~e <br /> <br /> Check the box or boxes that ~ndicate t~e ~pe of gambling activity your ozganizadon will be conducting: <br /> <br /> · Gamblin~ equipment for pull4~bs, ~pboa~s, paddlewheel~ and bingo (bingo paper, herd cards, and bingo ball <br /> selection devic.) must be chained from a dls~lbutor licensed by the Gambling Control 8card. To find a licensu-~ <br /> distributor, go ~o www.gcb.statmmn.us and cirri[ on List ~ [Jcens~ Ois~burors. Or c=ll ~51~$4ooO. <br />ll~isl~rmw~bemadeava~ableinalt~matk'e Yournamaendam:ly°ur°~anlzat~n'sneme thetoflowi~g: Boa~memb.m, st~ffofth- <br />Iormat (i.e. large ~lnt, Orallle) upon reque~, and address will be public Intormation when Boa~ whor~e wo~ assignment requires that <br /> <br />your applica§on. <br /> <br />process ct applying for yo~ permit w~l beco me <br /> <br />permit, all the information you have provided <br />I;1 the proce~ or a pplyincj fl3r a perm t females <br />private, v.4th the exception of your name and <br /> <br />Minnesota Attorney General; the Minne~3ta <br /> <br />regule~ age,es; ~e ~amto ~ud <br />~e~l~y au~r~ ~ s~te or ~eml law <br /> <br />-36- <br /> <br /> <br />