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11 <br />1�1 <br />• <br />ne:...____a_ 1 _...F..: r+_...i.I <br />Page 1 of 2 7/09 <br />ir++r+++¢.waw +_arr+a++ vwn++++nry <br />Application fee <br />LG220 Application for Exempt Permit <br />If application postmarked or received: <br />less than 30 days <br />before the event <br />more than 30 days <br />before the event <br />An exempt permit may be issued to a nonprofit organization that: <br />- conducts lawful gambling on five or fewer days, and <br />$100 <br />$50 <br />- awards less than $50,000 in prizes during a calendar year. <br />ORWIZI - TION ,INFORIIIIi�iTIdN eru� ac <br />Organization name Previous gambling permit number <br />New Brighton Eagles Auxiliary # 3718 _ 9 3 9 1 <br />Type of nonprofit organization. Check one. <br />IMFraternal Religious [a Veterans Other nonprofit organization <br />Mailing address city State Zip Code County <br />563 Old Highway 8 NW New Brighton, Mn 55112 Ramsey <br />Name of chief executive officer (CEO) Daytime phone number Email address <br />Bev Menk 651 633 7196 <br />ch a copy ofQagof=the followifng nir proof-af.nptiprofit status. Check 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 />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 />❑� IRS 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 />IRS - 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 />IsIRS - 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 gambling activity Will be conducted (for raffles, list"the'site where the drawing will take place) <br />New Brighton Eagles Club <br />- <br />Address (do not use PO box) City Zip Code Co;nty <br />563 Old Highway 8 NW -- - New Brighton 55112 Ramsey <br />Date(s) of activity (for raffles, indicate the date of the drawing) <br />F_ <br />a.. ^-6 4 La = 1 :2 <br />or gambling activity your organization will conduct: <br />Check the box boxes t at ndicate the type of <br />❑ Bingo* ® Raffles ❑ Paddlewheels* ❑ Pull -Tabs` ❑Tipboards* <br />* Gambling equipment for pull -tabs, bingo paper, tipboards, and Also complete <br />paddlewheels must be obtained from a distributor licensed by the page 2 of this form. <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. MEMO <br />To find a licensed distributor, go to www.gcb.state.mn.us and click on List <br />sm <br />of Licensed Distributors, or call 651-639-4076. <br />