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MINNESOTA LAWFUL GAMBLING 1/13 Page 1 of 2 LG220 Application for Exempt Permit An exempt permit may be issued to a nonprofit organization that: Application fee (non refundable) -conducts lawful gambling on five or fewer days, and -awards less than$50,000 in prizes during a calendar year. If application is postmarked or received 30 days or If total prize value for the year will be$1,500 or less,contact the licensing more before the event$50; otherwise $100. specialist assigned to your county. ORGANIZATION INFORMATION Organization name Previous gambling permit number Community Partners with Youth X-34576-08-001 Minnesota tax ID number, if any Federal employer ID number(FEIN), if any 41-1952012 Type of nonprofit organization. Check one. --I Fraternal Religious Veterans 1LOther nonprofit organization Mailing address City State Zip code County 1900 7th Street NW New Brighton MN 55112 Ramsey Name of chief e c tive officer[CEO] Daytime phone number E-mail address nf) .I .Ir" (as) -V035-- 7pL/( / tl7arj@ CP ;-nn .00, NON IT STATUS Attach a copy of ONE of the following for proof of nonprofit status. LNonprofit 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., 60 Empire Drive, Suite 100, St. Paul, MN 55103 / Phone: 651-296-2803 V 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 the gambling event will be conducted. For raffles, list the site where the drawing will take place. Brightwood Hills Golf Course Address [do not use PO box] City or township Zip code County 1975 Silver Lake Rd New Brighton 55112 Ramsey Date[s] of activity. For raffles, indicate the date of the drawing. June 1, 2013 C each type of c=^ambling activity that your organization will conduct. M Bingo* Raffle Paddlewheels* n Pull-tabs* Tipboards* *Gambling equipment for bingo paper, paddlewheels, pull-tabs, and tipboards must be obtained from a distributor licensed by the Minnesota 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 Distributors under the WHO'S WHO?LIST OF LICENSEES, or call 651-639-4000.