08-23-1989 Council Agenda - Laserfiche WebLink

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CG220 (Rev. 3,,99} Minnesota Charitable Gambling Application for Exemption from Charitable Gambling License For Office Use Only Fill in the unshaded portions of this application for exemption and send it in at least 45 days before your gambling activity for processing. Name and Address of Organization Organization currenVprev ous license number St. John's Church of Little Canada Street City State 380 E. Little Canada Road St. Paul Mn. Chief executive officer Phone Manager Rev. Robert J. Fitzpatrifck)(612) 484 -7708 Type of Non-profit Organization Zip code 55117 Tom- Chapp -le currentprevious exempt number X- 62005 -82 County Ramsay Phone 611 483 -2875 Years in existence 130 +. Attach proof of three -years or more of existence. ❑ Fraternal %I Religious ❑ Veterans Number of active members 1.850 families 0 Other non- profita Member of St.Paul /Mpls. Archdiocese (on charter in ff you checked box for other nonprofit, check one of the following and attach proof of nonprofit statusyour off ice ❑ IRS designation ❑ Incorporated with Secretary of State ❑ Affiliate of parent nonprofit organization (charter) Gambling Site Name of site where activity will take place Street 380 Little Canada Road Date(s) of activity er ccheo-1 City State Zip code Little Canada Mn. 55117 t September 24, 1989 Types of Games County y Financial Report Gams Yss No Gross rscelpts Expenses, Including Cost of Prizes Net profit Market Value of Prizes Bingo 58 ❑ Rattles IM ❑ Paddlewheels ❑ Ei) Tipboards ® ❑ Pull -tabs Iffl ❑ How will profit be used: for general parish programs Distributor from whom gambling equipment purchased Distributors license number I declare all information submitted to the Department of Revenue is.rue accurate, and � pieta t hit exec Local Go st. nature I declare all information submitted to the Department of Revenue is tore, accurate, and complete Date Chief executive officers signature Date nt Acknowledgement I have received a copy of this application, This application will be reviewed by the Department of Revenue and will become effective 30 days from the date of receipt by the city or county, unless the local government passes a resolution to specifically prohibit the activity. A copy of that resolution must be received by the Department of Revenue within 30 days of the date filled in below. City or County Township City or county name Township name ignature of person receiving application gnature of person receiving application Title Date received Tile Date received WNW —Board our- ag.neaae, Y.dow — Board rearm. m Pg.nruron to compete noted won Gold —CAB or county Mali this application to: Department of Revenue — Gaming Division Mail Station 3315 St. Paul, MN 55146 -3315 Page 80