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LG220 For Board Use Only <br /> Rev06r95 Minnesota Lawful Gambling <br /> Application for Authorization for an Pee Paid <br /> • PP Check# <br /> Exemption from Lawful Gambling License Initals <br /> Date Recd <br /> Drganlzat!on Information k �_- <br /> Organization Name Previous lawful gambling exemption number <br /> New Brighton Eagles Auxiliary #3718 X-03930-96-001 <br /> Street City State Zip Code County <br /> 563-8th Avenue N.W. New Brighton MN 55112 Ramsey <br /> Name of Chief Executive Officer of organization (CEO) Daytime Phone number of CEO <br /> First Name Last Name <br /> Penny - Eggan (612) 636-9525 <br /> Name of Organization Treasurer First Name Last Name Daytime Phone Number of Treasurer <br /> Dorothy McCallum 228-1234 <br /> ) <br /> Type of Nonprofit Organizati on <br /> x <br /> 'heck the box below which best describes Check the box that indicates the type of proof attached to this application <br /> our organization by your organization: <br /> 0 IRS letter indicating income tax exempt status <br /> Fraternal [,Certificate of good standing from the Minnesota Secretary <br /> [] Veterans of State's office <br /> DA charter showing you're an affiliate of a parent <br /> 0 Religious nonprofit organization <br /> El Other nonprofit MProof previously submitted and on file with the Gambling Control <br /> Board <br /> Gambling Premises Information e , <br /> a�x�f v: r is <br /> Name of Establishment where gambling activity will be conducted <br /> New Brighton Eagles ##3718 <br /> Street City State Zip Code County <br /> 563-8th AVenue N.W. New Brighton MN 55112 Ramsey <br /> Date(s) of activity(for raffles, indicate the date of the drawing) <br /> September 14, 1996 <br /> Check the box or boxes which indicate the type of gambling activity your organization will be conducting <br /> El Bingo © Raffles El Paddlewheels CD Pull-tabs El Tipboards <br /> Be sure the Local Unit of Government and the CEO of your organization sign For Board Use Only <br /> the reverse side of this appli�:ation. Date & Initials of Specialist <br /> / / <br />