08-13-1997 Council Agenda - Laserfiche WebLink

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LG220 Rev06 /96 Minnesota Lawful Gambling Application for Authorization for an Exemption from Lawful Gambling License For Board Use Only Fee Paid Check* Initals Date Recd Organization Information Organization Name St. John's Church of Little Canada -Previous 1awfui gambling exemption number X- 62005 -97 -001 Street City S ate Zip Code County 380 East Little Canada Rd. St. Paul Minnesota 55117 Ramsey Name of Chief Executive Officer First Name Rev. Robert of organization (CEO) Last Name Fitzpatrick Daytime Phone number of CEO (612) 484 -2708 Name of Organization i reasu First Name SAME AS ABOVE er Last Name Daytime Phone Number of Treasurer y ( ) Type of Nonprofit Organization Check the box below which best describes your organization Fraternal Veterans Religious 0 Other nonprofit Check the box that indicates the type of proof attached to this application by your organization: IRS letter indicating income tax exempt status Certificate of good standing from the Minnesota Secretary of State's office ® A charter showing you're an affiliate of a parent nonprofit organization O Proof previously submitted and on file with the Gambling Control Board Gambling Prernises Information' Name of Establishment where gambling activity will be conducted St. John's School gym Street City State Zip Code. County 2621 McMenemy Street St. Paul Minnesota 55117 Ramsey Date(s) of activity (for raffles, indicate the date of the drawing) Sunday, October 26, 1997 Check the box or boxes which indicate the type of gambling activity your organization will be conducting ® *Bingo Raffles in *Paddlewheels C *Pull -tabs NI *Tipboards *Equipment for these activities must be obtained from a licensed distributor 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 D.rvo Q9