CCP 01-13-2009 (3) - Laserfiche WebLink

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Minnesota Lawful Gambling page 1 of 2 Gros LG220Application for Exempt Permit For Board Use Only An exempt permit may be issued to a nonprofit organization that: Fee IS $50 for Check# conducts lawful gambling on five or fewer days, and awards less than $50 000 in prizes during a calendar year. each event $ ORGgIIZATIOI� MI FOI:IUI�TICN Organization name Previous gambling permit number Church of St. John The Baptist 62159-08-002 Type of nonprofit organization. Check (4) one. ❑ Fraternal [ Religious ❑ Veterans ❑ Other nonprofit organization Mailing address City State/Zip Code ___TCounty 835 2nd Avenue NW New Brighton MN 55112 Ramsey Name of chief executive officer (CEO) Daytime phone number (Rev.) Michael Skluz acek (651) 633-8333 ext. 1213 A"C7ACH; A CU;PY C7I aNE' QF THE Fad LQWINr FOR PIC�C7F QF N'aNPRaFIT SYATUS . 71 Do not attach a sales tax exempt status or federal ID employer numbers as they are not proof of nonprofit status. Nonprofit Articles of Incorporation OR a current Certificate of Good Standing. Don't have a copy? This certificate must be obtained each year from: Secretary of State, Business Services Div., 180 State Office Building, St. Paul, MN 55155 Phone: 651-296-2803 Internal Revenue Service - IRS income tax exemption [501(c)] letter in your organization's name. Don't have a copy? To obtain a copy of your federal income tax exempt letter, have an organization officer contact the IRS at 877-829-5500. _Internal Revenue Service -Affiliate of national, statewide, or international parent nonprofit organization (charter) If your organization falls under a parent organization, attach copies of both of the following: a. IRS letter showing your parent organization is a nonprofit 501(c) organization with a group ruling, and b. the charter or letter from your parent organization recognizing your organization as a subordinate. Xlnternal Revenue Service - proof previously submitted to Gambling Control Board If you previously submitted proof of nonprofit status from the Internal Revenue Service, no attachment is required. GAMBLING, PF E ...Is I IFORM�MTI 7N Name StJan the Baptist stnCacthol.i'c Church Pastoral list of phwhere gambling Y ( where the drawing will take place) P (St- Jose his Hall) Address (do not use PO box) City Zip Code County 835 2nd Avenue NW —iNew-BriqbLon 12 Ramsey Date(s) of activity (for raffles, indicate the date of the drawing) January 31, 2009 Check the box or boxes that indicate the type of gambling activity your organization will conduct: ❑ *Bingo M Raffles ❑ *Paddlewheels ❑ "Pull -Tabs ❑ •Tipboards * Gambling equipment for pull -tabs, bingo paper, tipboards, and paddlewheels must be obtained from a distributor licensed by the Gambling Control Board. EXCEPTION: Bingo hard cards and bingo number selection devices may be borrowed from another organization authorized to conduct bingo. To find a licensed distributor, go to www.gcb.state.mn.us and click on List of Licensed Distributors, or call 651-639-4076.