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JUL.20.2007 1:55PM FIRESTONE METAL PRODUCIS, LLC Nu y m r n <br />Minnesota Lawful Gambling 6/07 <br />Page 1 of 2 <br />LG240B Application to Conduct Excluded Bingo No fee <br />Orgatation name r-N.— i I Previous gambling permit number <br />Type of nonprofit oiganization. Check (4) one. J <br />❑ Fraternal [l Religious [] Veterans 9coe nonprofit organization <br />Mailing address City State/Zip Code <br />•ATT''AC- 4 "A `COPY b -99E DF TFfP -. FOLLdWING •.i=`L k-PkOOF` 01 - NO11!PROFIT STATUB'• <br />Do riot attach a sales tax exempt status or federal ID employer number as they are not proof of nonprofit status. <br />X 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 />Internal Revenue Service - IRS Income tax exemption (SOi (e)] 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, off 45201 <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 bath of the following: <br />a. IRS letter showing your parent organization is a 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 />_ Internal Revenue Service -Proof previouslysubmittedtoGambing Control Board <br />If you previously submitted proof of nonprofit status from the Internal Revenue Service, no attachment is required <br />ACTIVITY <br />1. &No Yes Has your organization held a bingo event in the current calendar year? <br />If yes, list the dates when bingo was conducted <br />2. The proposed bingo event for which we are applying will be: <br />one of four or fewer bingo events hold this year, Dates <br />OR <br />conducted up to 12 consecutive days in connection with a: <br />` county fair, Dates <br />civic celebration, Dates <br />_Minnesota state fair, Dates <br />3. Person in charge of bingo event r :.L�' �-. Daytime phone? <br />4. Name of premises where bingo will be conducted S <br />5. Premises street address 157 ocs ` <br />6. If township, name of township County <br />Bingo hard cards, bingo paper, and bingo number selection devices must be purchased <br />from a distributor licensed by the Gambling Control Board. To find a licensed distributor, go <br />to www.gcb.state.mmus and click on List of Licensed Distributors. Or call 651- 638 -4076. <br />Be sure to complete page 2 <br />—22— <br />