12-17-1997 Council Agenda - Laserfiche WebLink

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" ■`.1 Rev06 /96 Minnesota Lawful Gambling Application for Authorization for an Exemption from Lawful Gambling License For Board Use Only y Fee Paid Check # I nitals Date Recd Organization Information Organization Name - _. . .___ .. _ . ._... - , .._....Previousiawfui Saint John's Church of Little Canada gambling exemption number X62005 -97 -004 Street City State Zip Code County 380 Little Canada Road St. Paul Minnesota 55117 Ramsey Name of Chief Executive Officer First Name Robert of organization (CEO) Last Name Fitzpatrick Daytime Phone number of CEO (612) 484 -2708 Name of Organization t reasu First Name SAME AS ABOVE er Last Name Daytime Phone Number of Treasurer y ) SAME AS ABOVE Type of Nonprofit Organization . Check the box below which best describes your organization Q Fratemal Q Veterans ln Religious Q Other nonprofit Check the box that indicates the type of proof attached to this application by your organization: Q IRS letter indicating income tax exempt status Q Certificate of good standing from the Minnesota Secretary of State's office ® A charter showing you're an affiliate of a parent nonprofit organization Q Proof previously submitted and on file with the Gambling Control Board Gambling Premises Information Name of Establishment where gambling activity will be conducted Venetian Inn Street City State Zip Code County 2814 Rice Street St. Paul Minnesota 55117 Ramsey Date(s) of activity (for raffles, indicate the date of the drawing) Saturday, February 21, 1997 Check the box or boxes which indicate the type of gambling activity your organization will be conducting *Bingo ms, Raffles Q *Paddlewheels C *Pull -tabs Q *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 Page 42