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� MINNESOTA LAWFUL GAMBLING 1/13 Page 1 of 2 <br /> LG220 Application for Exempt Permit <br /> An exempt permit may be issued to a nonprofit organization that: AE7p�ICat1011 fE'@ (non refundable) <br /> - conducts lawful gambting on five or fewer days,and � <br /> - awards less than $50,000 in prizes during a calendar year. If application is postmarked or received 30 days or <br /> If totai prize value for the year will be$1,500 or less,contact the licensing more before the event$50; otherwise $100. <br /> specialist assigned to your county. <br /> ORGANIZATION INFORMATION <br /> Organization name Previous gambling permit number <br /> � � <br /> Minnesota tax ID number, if any Federal mployer ID number(FEIN), if any <br /> � <br /> Type of nonprofit organization. Check one. �O� ����� <br /> �Fraternal �Religious J�l�Veterans L1.�Other nonprofit organization <br /> Mailing address State ` Zip code � ^ County <br /> �� �.7� �� �� N c�.L <br /> Nam��;hi�efJexecutive officer [CEO] Daytime phto�.ne numbes _ E-maii address <br /> y T �� <br /> NONPROFIT STATUS , <br /> Attach a copy of ONE of the following for proof of nonprofit status. <br /> �Nonprofit Articles of incorporation OR a current Certificate of Good Standing. ��� c������ <br /> Don't have a copy? This certificate must be obtained each year from: �1 �� <br /> Secretary of State, Business Services Div., 60 Empire Drive, Suite 100, St. Paul, MN 55103 <br /> Phone: 651-296-2803 <br /> ,,�IRS income tax exemption [S01(c)] letter in your organization's name. <br /> Don't have a copy? To obtain a copy of your federal income tax exempt letter, have an organization officer contact <br /> the IRS at 877-829-5500. <br /> �IRS-Affiliate of national, statewide, or international parent nonqrofit organization [charter] <br /> If your organization falls under a parent organization, attach copies of both of the foHowing: <br /> a. IRS letter showing your parent organization is a nonprofit 501(c)organization with a group ruling, and <br /> b. the�charter or letter from your parent organization recognizing your organization as a subordinate. <br /> GAMBLING PREMISES INFORMATION <br /> Name of premises where the gambiing event wil; be conducted. For raffles, list the site where the drawing witl take piace. <br /> �C�l� � <br /> Address [d�not se PO box] City or township Zip code County <br /> `� 6� C�( �� � <br /> Date[s] of activity. For rafFles, indicate the date of the dra g. <br /> � <br /> Check each type of am ' activity that your organization will conduct. <br /> �Singo* �RafFle �.�1Paddlewheels* � Pull-tabs* �Tipboards* <br /> *Gambling equipment for bingo paper, paddlewheels, puli-tabs, and tipboards must be obtained from a distributor <br /> licensed by the Minnesota Gambling Control Board. EXCEPTION: Bingo hard cards and bingo number selection devices <br /> may be bo�rowed from another organization authorized to conduct bingo. <br /> To find a licensed distributor, go to www.gcb.state.mn.us and click on Distributors under <br /> the WHO' S WHOT L I S T OF �.ai�E�6 d�BB3S4000. <br />