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Minnesota Lawful Gambling Page 1 of 2 6/08 <br />LG220 Application for Exempt Permit <br />@ t <br />An exempt permit may be issued to a nonprofit organization that: Fee IS .pJO 1 Or <br />• <br />ranouauusevmy <br />Check# <br />conducts lawful gambling on five or fewer days, and <br />• awards less than $50,000 in prizes during a calendar year. each event <br />$ <br />ORGANIZATION INFORMATION <br />Organization name <br />Previous gambling permit number <br />St. John the Baptist Catholic Church <br />62159-07-02 <br />Type of nonprofit organization. Check (�) one. <br />❑ Fraternal ❑ Religious ❑ Veterans ® Other nonprofit organization <br />Mailing address <br />City <br />State/Zip Code <br />County <br />835 2nd Avenue NW <br />New Brighton <br />MN/55112 <br />Ramsey <br />Name of chief executive officer (CEO) <br />Daytime phone number <br />(Rev.) Michael Skluzacek <br />(651) 633-8333 ext.1213 <br />ATTACH A COPY OF ONE OF THE FOLLOWING FOR PROOF OF NQNPROFI7 STATUS <br />* Do not attach a sales tax exempt status or federal ID employer numbers as they are not proof of nonprofit status. <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 />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, have an organization officer <br />contact the IRS at 877-829-5500. <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 />a. IRS letter showing your parent organization is a nonprofit 501(c) organization with a group ruling, and <br />b. the charter or letter from your parent organization recognizing -your organization as a subordinate. <br />X Internal Revenue Service -proof previously submitted to Gambling Control Board <br />If you previously submitted proof of nonprofit status from the Internal Revenue Service, no attachment is required. <br />GAMBLING PREMISES INFORMATION <br />Name of premises where gambling activity will be conducted (for raffles, list the site where the drawing will take place) <br />St John The Baptist Church— West Parking Lot <br />Address (do not use PO box) <br />Cit <br />p <br />Z551�12 <br />County <br />835 2nd Avenue NW <br />New Brighton <br />Ramsey <br />Date(s) of activity (for raffles, indicate the date of the drawing) <br />September 13-14, 2008 <br />Check the box or boxes that indicate the type of gambling activity your organization will conduct: <br />® 'Bingo X❑ Raffles ❑ 'Paddlewheels ® 'Pull -Tabs ❑ 'Tipboards <br />* Gambling equipment for pull -tabs, bingo paper, tipboards, and paddlewheels must <br />be obtained from a distributor licensed by the Gambling Control Board. <br />EXCEPTION: Bingo hard cards and bingo number selection devices may be borrowed <br />from another organization authorized to conduct bingo. <br />To find a licensed distributor, go to www.gcb.state.mn.us and click on List of Licensed <br />Distributors, or call 651-639-4076. <br />