09-25-1996 Council Agenda - Laserfiche WebLink

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LG220 Rev06/95 Minnesota Lawful Gamb ling Application for Authorization for an Exemption from Lawful Gambling License For Board Use Only Fee Paid Check # Initais Date Recd Organization Information Organization Name Saint John's Church of Little Canada Previous lawful gambling exemption number X- 62005 -96 -002 Street City S 380 Little Canada Road St. Paul Mn ate Zip Code County 55117 Ramsey Name of Chief Executive Officer First Name Rev. Robert of organization (CEO) Last Name Fitzpatrick Daytime Phone number of CEO (61) 484 -2708 Name of Organization Treasurer First Name same Last Name same Daytime Phone Number of Treasurer ( ) Type of Nonprofit Organization Check the box below which best your organization describes Check the box that indicates by your organization: the type of proof attached to this application income tax exempt status standing from the Minnesota Secretary you're an affiliate of a parent submitted and on the with the Gambling Control IRS letter indicating Epertificate of good of State's office Fratemal Veterans A charter showing ra Religious nonprofit organization proof previously Board Other nonprofit Gambling Premises Information • Name of Establishment where gambling activity will be conducted St. John's School (Gym) Street City State Zip Code County 2621 McMenemy St. Paul Mn. 55117 Ramsey Date(s) of activity (for raffles, indicate the date of the drawing) Sunday, October 27, 1996 Check the box or boxes which indicate the type of gambling activity your organization will be conducting re Bingo mg Raffles Paddlewheels • Pull -tabs Tipboards Be sure the Local Unit of Government and the CEO of your organization sign the reverse side of this application. r,. . . fnn For Board Use Only Date & Initials of Specialist