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MINNESOTA LAWFUL GAMBLING LZZ© AiWkatbn for Ex arript Pennit 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 poatmarkod or received 30 days or lf 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 INFORMATWN organization name Previous gambling permit number Retrieve a Golden of Minnesota, INC. Minnesota tax ID number, if any Federal employer ID number (FEIN), if any ES 37548 41- 1856124 Type of nonprofit organization. Check one. FPratemal 0_Religious ,Veterans 2-0ther nonprofit organization Mailing address City State Zip code County 5500 Baker Road, Suite 120 Minnetonka MN 55345 Hennepin Name of chief executive officer [CEO] Daytlme Dhone number E =mail address IMary M McGowan 651 - 341 -611 mary.mcgowan @ragom.org NONPROFIT STATUS AUAI;h a copy of ONE of the following for proof of nonprofit status. LLNonprofit Articles of Incorporation Olt a current Certificate of Good Standing, Dont 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 IRS income tax exemption [501(c)) iletter 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. FIRS - Affiliate of national, statewide, or internatkmal parent nonprofit organization [charb. w] 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 Nam,of premises where the gambling event will be conducted. for raffles, list the site where the drawing will take place, Long Lake R ional Park Address [do not use PO box] City or township Zip code County 1500 Old Hwy 8 New Bri hton 55112 Ramse Date[s] of activity. For raffles, indicate the dabs of the drawing. September 14, 2014 Check each type of ambling activity that your organization will conduct. Raffle Paddlewheels* F-1 Pull- tabs* Tipboards* Bingo* ti- -4 =f *Gambling equipment for bingo paper, paddlewheels, pull -tabs, and tipboards must be obtained from a distributer � 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.Vcb.statenw.us and click on DlsWbutom under the WHO'S WHO? LIST OF LICENSEES, or call 651 - 639 -4000.