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Minnesota Lawful Gambling Page 1 of 2 1/11 Application fee for each event LG220 Application for Exempt Permit If application postmarked or received. An exempt permit may be issued to a nonprofit organization that: less than 30 days more than 30 days -conducts lawful gambling on five or fewer days, and before the event before the event -awards less than$50,000 in prizes during a calendar year. $100 $50 ORGANIZATION INFORMATION Check# $ Organization name Previous gambling permit number St. John the Baptist Catholic Church 62159 Type of nonprofit organization. Check one. Fraternal X Religious Veterans Other nonprofit organization Mailing address City State Zip Code County 835 2nd Avenue NW New Brighton MN 55112 Ramsey Name of chief executive officer(CEO) Daytime phone number Email address (Rev.) Michael Skluzacek 651-633-8333 stjohnsnb@pclink.com Attach a copy of ONE of the following for proof of nonprofit status. Check one. 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 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. IRS-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. GAMBLING PREMISES INFORMATION Name of premises where gambling activity will be conducted(for raffles, list the site where the drawing will take place) St. John the Baptist Catholic Church Address(do not use PO box) City Zip Code County 835 2nd Avenue NW New Brighton 55112 Ramsey Date(s)of activity(for raffles, indicate the date of the drawing) April 9, 2011 Check the box or boxes that indicate the type of gambling activity your organization will conduct: Bingo* Raffles ['Paddlewheels* Pull-Tabs* Tipboards* *Gambling equipment for pull-tabs,bingo paper,tipboards,and paddlewheels must be obtained from a distributor licensed by the Also complete Gambling Control Board. EXCEPTION; Bingo hard cards and bingo Page 2 of this form. number selection devices may be borrowed from another organization authorized to conduct bingo. Print Form l To find a licensed distributor,go to www.gcb.state.mn.us and click on List Reset Form of Licensed Distributors, or call 651-639-4000.