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• <br />• <br />Minnesota Lawful Gambling <br />LG220 Application for Exempt Permit <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 />ORGANIZATION INFORMATION <br />Organization name <br />du n n _:s- d e_ <br />Type of nq profit organization. Check one. <br />13 Fraternal 0 Religious Veterans <br />Mailing address City <br />Name of chief executive <br />V ,p <br />Page 1 of 2 9/08 <br />Fee is $50 for each event <br />For Board Use Only <br />Check # _- .. $ <br />Previous gambling permit number <br />J I Other nonprofit organization <br />ice" State Zip Code <br />ki ewtri' YID <br />Daytime phone number En <br />WAY MIMI M <br />Attach a cdpy of t n bf Ithe following fad proof of nonprofit sft us. UTFOCK one. <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 />L J 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 />aIRS income tax exemption [601(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 />aIRS - Affiliate of national, statewide, or international parent nonprofit organization (charier) <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 />10 IRS - proof previously submitted to Gambling Control Board <br />If you previously submitted proof of nonprofit status from the IRS, no attachment is required. <br />GAMBLING PREMISES INFORMATION <br />Name of premises where <br />h <br />use PO box) <br />activity will be conducted (for raffles, list the site where the drawing will take place) <br />Date(s) of activity (for raffles, indicatelhe date of the <br />3 [ f -)Q Aa <br />',heck the bokZrb xes that indicate the type of gan <br />Bingo" VRaffles ❑ Paddlewheels" <br />City <br />ng activity your organization will <br />[Pull -Tabs' ❑Tipboards" <br />* Gambling equipment for pull -tabs, bingo paper, tipboards, and <br />paddlewheels must be obtained from a distributor licensed by the <br />Gambling Control Board. EXCEPTION: Bingo hard cards and bingo <br />number selection devices may be borrowed from another organization <br />authorized to conduct bingo. <br />To find a licensed distributor, go to www.gcb.state.mn.us and click on List <br />of Licensed Distributors, or call 651-639-4076. <br />Zip Code County <br />Wild <br />Also compiete <br />Page 2 of this form. <br />;Print• rrra;, . <br />