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<br />Minnesota Lawful Gambling <br /> <br />LG220 Application for Exempt Permit <br /> <br />An exempt permit may be issued to a nonprofit organization that: <br />· conducts lawful gambling on five or fewer days, and <br />. awards less than $50,000 in prizes during a calendar year. <br /> <br />REe~e JUL i g ~08? <br /> <br />Fee is $50 for <br />each event <br /> <br />Page 1 of 2 6/07 <br />For Board Use Only <br />Check # <br /> <br />$ <br /> <br /> <br />ORGANIZATION INFORMATION <br />Organization name <br />/ i C '. e--S ./VJi111\ CfuUYJ heJ::L <br />Type of nonprofit organization. Check C-V) one. <br />D Fraternal D Religious D Veterans Other nonprofit organization <br />Mailing address . ~ 0 City ... State/Zip Code <br />. f.dal/lVldJ. Dr. ID' (V1()/rdJ View M,IV 6"r/r turde. . <br />Name of chief executive officer (CEO) Daytime phone number <br />8v(/cc.. Ni/5' J (f/3.~'5-7/-17gl <br />ATTACH A COpy OF ONE OF THE FOllOWING FOR PROOF OF NONPROFIT STATUS <br /> <br />Previous gambling permit number <br />02S-73 <br /> <br /> <br /> <br />* Do not attach a sales tax exempt status or federal ID employer numbers as they are not proof of nonprofit status. <br /> <br />- Nonprofit Articles of Incorporation OR a current Certificate of Good Standing. <br />Don't have a copy? This certificate must be obtained each year from: <br />Secretary of State, Business Services Div., 180 State Office Building, St. Paul, MN 55155 Phone: 651-296-2803 <br /> <br />- Internal Revenue Service - IRS income tax exemption [501 (c)) letter in your organization's name. <br />Don't have a copy? To obtain a copy of your federal income tax exempt letter, send your federal ID number and <br />the date your organization initially applied for tax exempt status to: <br />IRS, P.O. Box 2508, Room 4010, Cincinnati,OH 45201 <br /> <br />_Internal Revenue Service - Affiliate of national, statewide, or international parent nonprofit organization (charter) <br />If your organization falls under a parent organization, attach copies of both of the following: <br /> <br />a. IRS letter showing your parent organization is a registered nonprofit 501 (c) organization with a group ruling <br />b. the charter or letter from your parent organization recognizing your organization as a subordinate. <br />. <br /> <br /> <br />~nternal Revenue Service - proof previously submitted to Gambling Control Board <br />If you previously submitted proof of nonprofit status from the Intemal Revenue Service, no attachment is required. <br /> <br />GAMBLING PREMISES INFORMATION <br /> <br /> <br />Check the box or boxes that i t1icate the type of gambling activity your organization will conduct: <br />D *Bingo ~ Raffles D *Paddlewheels D *Pull-Tabs 0 *Tipboards <br /> <br />* Gambling equipment for pull-tabs, tipboards, paddlewheels, and bingo (bingo paper, <br />hard cards, and bingo number selection device) must be obtained from a distributor <br />licensed by the Gambling Control Board. To find a licensed distributor, go to <br />www.gcb.state.mn.us and click on List of Licensed Distributors, or call 651-639-4076. <br /> <br />-12- <br />