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MINNESOTA LAWFUL GAMBLING LG220 Application for Exempt Permit 1/13 Page 1 of 2 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 Benedictine Care Centers 92044 Minnesota tax ID number, if any Federal employer ID number (FEIN), If any Type of nonprofit organization. Check one. Fraternal Religious Veterans .1 —Other nonprofit organization Mailing address City State Zip code County 1995 E Rum River Dr. S Cambridge MN 55008 Isanti Name of chief executive officer [CEO] Daytime phone number E-mail address 763- 689 -1162 .reeky-chapin @bhsheafh.org Rocklon Chapin NONPROFIT STATUS Attach a copy of ONE of the following for 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., 60 Empire Drive, Suite 100, St. Paul, MN 55103 Phone: 651- 296 -2803 X 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. St. John the Baptist Catholic Church Address [do not use PO box] City or township Zip code County 835 2nd Ave NW New Brighton 55112 Ramsey Date[s] of activity. For raffles, Indicate the date of the drawing. Friday, May 2nd, 2014 Check each type of gambling activity that your organization will conduct. Bingo* X Raffle Paddlewheels* Pull -tabs* Tppboards* *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.geb.state.mn.us and click on Distributors under the WHO'S WHO? LIST OF LICENSEES, or call 651 - 539 -1900.