05-28-1996 Council Packet - Laserfiche WebLink

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LG220 Rev06/95 Minnesota Lawful Gambling Application for Authorization for an Exemption from Lawful Gambling License For Board Use Only Fee Paid Check # Initals Date Reed Organization Information Organization Name Minnesota International Center Previous lawful gambling exemption number Street 711 East River Road City Minneapolis State MN Zip Code 55455 County Hennepin Name of Chief Executive Officer of organization (CEO) First Name Last Name BvrneCarol Name of Organization Treasurer First Name Last Name Da>1ime Phone number of CEO ^612^625-8646 John Leavitt Daytime Phone Number of Treasurer 2 ^825-7030^12) Type of Nonprofit Organization Check the box below which best describes your organization Fraternal I I Veterans I I Religious [~^ Other nonprofit Check the box that indicates the type of proof attached to this application by your organization; nn IRS letter indicating income tax exempt status □Certificate of good standing from the Minnesota Secretary of State ’s office I lA charter showing you're an affiliate of a parent nonprofit organization LD^roof previously submitted and on file with the Gambling Control Board Gambling Premises Information Name of Establishment where gambling activity will be conducted Home of Steven and Diane Reynolds - hosts for MIC's Benefit Gala Street 1570 Fox Street City Wayzata State MN Zip Code 55 391 County Hpnnpp*! n Date(s) of activity (for raffles, indicate the date of the drawing) Tickets sold on June 7 and June 8. Drawing nn .limp S Check the box or boxes which indicate the type of gambling activity your organization will be conducting I—I Bingo Raffles □ Paddlewheels □ Pull-tabs □ Tipboards Be sure the Local Unit of Government and the CEO of your organization sign the reverse side of this application. For Board Use Only Date & Initials of Specialist Z