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CG220 <br />03.0.0m9) <br />Minnesota Lawful Gambling <br />Application for Exemption from <br />Lawful Gambling License <br />For Office Use Only <br />Fill in the unshaded portions of this application for exemption and send it in at least 45 days before your gambling activity for processing. <br />Name and Address of Organization <br />Organization <br />St. John's Church of Little Canada <br />Street city <br />380 E. Little Canada Road St. Paul <br />Chet executive officer Phone <br />Rev. Robert Fitzpatrick (614 484 -2708 <br />Type of Non-profit Organization <br />currentlprevioua license number <br />State <br />Mn. <br />Manager <br />Tom Chapple <br />Zip code <br />55117 <br />current/previous exempt number <br />X- 62005 -82 <br />County <br />Ramsey <br />Phone <br />651Z 483 -2875 <br />Years in existence <br />Attach proof of three -years or more of exist <br />❑ Fraternal a Religious ❑ Veterans <br />If you checked box for other nonprofit, check one of the following <br />❑ IRS designation ❑ Incorporated with Secretary of State <br />Gamblina Site <br />ence. Number of active members b, nn; families <br />❑ Other non - profit A��member of St. Paul /Mpls. <br />Archdiocese <br />and attachproolofnonprofrchdiocese (on charter in <br />your office) <br />❑ Affiliate of parent nonprofit organization (charter) <br />Name of site where activity will take place <br />on the Church grounds and in the lower school <br />City State <br />St Paul Mn <br />Street <br />380 Little Canada Road <br />Date(s) of activity <br />Zip code <br />55117 <br />September 30, 1990 <br />County <br />Ramsey <br />Tuves of Games <br />nancial Ytep <br />Raffles <br />Paddlewheels <br />Pull -tabs <br />How will profit be used: <br />fnr genaral parish prn• <br />I declare all infomtation submitted to the Department of Gaming <br />is t__accurate, and c• ,] :te <br />afkui submttted to dta Deparmt <br />8 -8 -90 <br />Ch <br />?uhva nNteru'� emnahtra.•.: >. <br />Local Government Acknowledgement <br />I have received a copy of this application. This application will be reviewed by the Department of Gaming and will become effective 30 days <br />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 <br />resolution must be received by the Department of Gaming within 30 days of the date filled in below. Cities of the first class have 60 days in <br />which to disallow the activity. <br />City or County <br />City or aunty <br />Signet' <br />receiving a. • ..n <br />X. <br />Dar eceived <br />Township <br />Township name <br />Signature of person receiving application <br />r/Gf ✓1c C& Wit. — S,' -9D <br />Title <br />Date received <br />NNW- Bose <br />w.- aymn..m Mall this application and fee of $25 (chec( made out to Commissioner of Revenue) to: <br />Yellow Bowel r.,m.dedNeu na Department of Gaming - Gambling Control Division <br />ant** xn.»Orrw <br />04W-"" °coon' Mail Station 3315 <br />St. Paul, MN 5514¢ -3315 <br />Page 4U <br />