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~Il1i9L'SOfS I..aIN~R,IO ~2f91E73eT,(7~' Page 1 oft 7/09 Application tee L~~~® Ap~~~~~~i®r~ f®r ~~~r~a~~ ~err~a~~ Ifa lication ostmarkedorreceived: An exempt permit may be issued to a nonproft organization that: less than 30 days more than 30 days - conducts lawful gambling on five or fewer days, and before the event before the event -awards less than $50,000 in prizes during a calendar year. $100 $50 ®R~ANi~A~iOCV i~~®R~/L.~i®~ Check# $ Organization name Previous gambling permit number Saint John's Church of Little Canada X-62005-08-002 l"ype of nonprofit organization. Check one. Fraternal Religious Veterans ~ Other nonproft organization Mailing address City State Zip Code County 380 Little Canada Road Little Canada Mn. 55117 Ramse Name of chief executive officer (CEO) Daytime phone number Email address Rev. David ICohner 651 484-2708 dwkohner@comcast.net Attach a copy of ®N~ of the following for proof of nonprofit status. Check one. Do not attach a sales tax exempt status or federal ID employer numbers as they are not 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 Sen~ices Div., 180 State Office Building, St. Paul, MN 55155 Phone: 651-298-2803 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. IRS -proof previously submitted to Gambling Control Board ARCHDIOCESE OF ST. PAUL/MPLS If you previously submitted proof of nonprofit status from the IRS, no attachment is required. GAIVIBLIh!(ti PREYJIISES INFORMATION Name of premises where gambling activity will be conducted (for raffles, list the site where the drawing will take place) School Gymnasium Address (do not use PO box) City Zip Code County 380 Littler Canada Road Little Canada 55117 Ramse Date(s) of activity (for raffles, indicate the date of the drawing) Sunday, November 22, 2009 Check the box or boxes that indicate the type of gambling activity your organization will conduct: ® Bingo" Raffles ~Paddlewheels* ~Puil-Tabs* ~Tipboards* * Gambling equipment for pull-tabs, bingo paper, tipboards, and Also complete paddlewheels must be obtained from a distributor licensed by the Gambling Control Board. CXCEPTION: Bingo hard cards and bingo Page 2 ofthis farm. number selection devices may be borrowed from another organization authorized to conduct bingo. Print Form To find a licensed distributor, go to www.gcb.state.mn.usond clicl: on List Reset Form of Licensed Distributors, or call 651-639-4076.