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LG220 <br />Rev06/95 <br />Minnesota Lawful Gambling <br />Application for Authorization for an <br />Exemption from Lawful Gambling License <br />For Board Use Only <br />Fee Paid <br />Check # <br />Initals <br />Date Recd <br />Organization information <br />Organization Name <br />Minnesota Opticians Society <br />Previous lawful gambling exemption number <br />Street City S <br />26 East Exchange Street St. Paul <br />ate Zip Code County <br />MN 55101 Ramsey <br />Name of Chief Executive Officer <br />First Name <br />Scott <br />of organization (CEO) <br />Last Name <br />Franzmeier <br />Daytime Phone number of CEO <br />(612) 290 -6285 <br />Name of Organization Treasurer <br />First Name <br />Dan <br />Last Name <br />Olson <br />Daytime Phone Number of Treasurer <br />(612) 224 -2884 <br />Type of Nonprofit <br />Organization <br />Check the box below which best <br />your organization <br />describes <br />Check the box that indicates the type of proof attached to this application <br />by your organization: <br />Q IRS letter indicating income tax exempt status <br />QCertificate of good standing from the Minnesota Secretary <br />of State's office <br />QA charter showing you're an affiliate of a parent <br />nonprofit organization <br />(roof previously submitted and on file with the Gambling Control <br />Board <br />Fratemal <br />Veterans <br />Q Religious <br />in Other nonprofit <br />Gambling Premises Information <br />Name of Establishment where gambling activity will be conducted <br />Venetian Inn <br />Street City State Zip Code County <br />2814 Rice Street Little Canada MN 55113 Ramsey <br />Date(s) of activity (for raffles, indicate the date of the drawing) <br />Sunday, March 15, 1998 <br />Check the box or boxes which indicate the type <br />of gambling activity your organization <br />Q Pull -tabs Q Tipboards <br />will be conducting <br />Q Bingo pa Raffles <br />a Paddlewheels <br />Be sure the Local Unit of Govemment and the CEO of your organization sign <br />the reverse side of this application. <br />For Board Use Only <br />Date & Initials of Specialist <br />