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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 />Saint John's Church of Little Canada <br />Previous lawful gambling exemption number <br />X-62005--96-004 <br />Street City S <br />380 Little Canada Road St. Paul Minnesota <br />ate Zip Code County <br />55117 Ramsey <br />Name of Chief Executive Officer <br />First Name <br />Robert <br />of organization (CEO) <br />Last Name <br />Fitzpatrick <br />Daytime Phone number of CEO <br />(12) 484 -2708 <br />Name of Organization Treasurer <br />First Name <br />SAME AS ABOVE <br />Last Name <br />Daytime Phone Number of Treasurer <br />Type of Nonprofit Organization <br />Check the box below which best <br />your organization <br />describes <br />Check the box that indicates <br />by your organization: <br />the type of proof attached to this application <br />income tax exempt status <br />standing from the Minnesota Secretary <br />you're an affiliate of a parent <br />submitted and on file with the Gambling Control <br />(• IRS letter indicating <br />OCertificate of good <br />of State's office <br />Fratemal <br />Veterans <br />!!A charter showing <br />i!7 Religious <br />nonprofit organization <br />croof previously <br />Board <br />Other nonprofit <br />Gambling Premises Information <br />Name of Establishment where gambling activity will be conducted <br />The Venetian Inn <br />Street City State Zip Code County <br />2814 Rice Street St. Paul Mn 55117 Ramsey <br />Date(s) of activity (for raffles, indicate the date of the drawing) <br />Saturday, February 8, 1997 <br />Check the box or boxes which indicate the type <br />of gambling activity your <br />En Pull -tabs <br />organization <br />will be conducting <br />gross Bingo ® Raffles Paddlewheels <br />In Tipboards <br />Be sure the Local Unit of Government and the <br />the reverse side of this application. <br />CEO of your organization <br />sign <br />For Board Use Only <br />Date & Initials of Specialist <br />/ / <br />