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LG220 Minnesota Lawful Gambling <br />Application for Exemption from <br />Lawful Gambling License <br />(Rev.11114/90) <br />FOR BOARD USE ONLY <br />FEE CHK <br />INIT DATE <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 />Narne and Address Qf;"Orgartiza on <br />Organization Name <br />St. John's Church of Little Canada <br />Currenvprevious license number <br />Currenvprevious exempt number <br />62005 -92 -002 <br />County <br />Ramsey <br />Street Ciry State <br />380 E. Little Canada Road St. Paul Mn. <br />Zip code <br />55117 <br />Chief executive officer <br />Phone <br />Treasurer <br />Rev. Robert Fitzpatrick(612 ) 484 -2708 same <br />Phone <br />(612 )484 -2708 <br />Non- profit Organization <br />Check the box below which indicates your type of organization <br />❑ Fraternal IXReligious ❑ Veterans ❑ Other non - profit <br />Name of site where activity will take place <br />on the Church grounds <br />Attach proof of nonprofit status which shows <br />that your organization is nonprofit <br />❑ IRS designation <br />❑ Certification of good standing from the Minnesota <br />Secretary of State's office <br />OS Affiliate of parent nonprofit organization (charter) <br />A memter o£ the St• ixWAiis.;Arehdiaeese <br />(on charter in your office) <br />and in the lower school <br />Street City <br />Township <br />380 Little Canada Road Little Canada <br />State <br />MN <br />Zip code <br />55117 <br />County <br />Ramsey <br />Date(s) of activity <br />September 27, 1992 <br />[ CEtrftes : ' <br />Game <br />Bingo <br />Raffles <br />Paddlewheels <br />Tipboards <br />Pull -tabs <br />❑. <br />s rece niai <br />penses,inctudtn <br />' Cesf ot:Brtzes .' <br />Report <br />t Value <br />et Prizes <br />boor #runt whom garnbltng equipment was punk. <br />I declare all information submitted to the <br />Gambling Control D' ' ion is true, accurate, <br />mplete. <br />4 <br />t3 fit <br />of , xecutive • the : na Date <br />teOai Goner ,; rrowlrie gement,, <br />:tidedar�aNu tormanprtsubmit <br />is true,. accurate, avid complete; <br />Ih <br />ti3 <br />r <br />I have received a copy of this application. This application will be reviewed by the Gambling Control Division 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 Gambling Control Division 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 Township <br />Ci <br />oou na <br />/LY <br />Siena a of p =rson re <br />"/ <br />Township name <br />wing application <br />�/ Date received <br />�yrrryc, l/ .i-- 7-v? %-� <br />Signature of person receiving application <br />Title <br />Date received <br />wab_eaa4 Mall with $25 permit fee and copy of proof of nonprofit status to: <br />FM_- dganhaMm Department of Gaming - Gambling Control Division to dIoN -compete sh`edmenaso",a Rosewood Plaza South, 3rd Floor <br />anstM men <br />Gold —Gaya Cooly 1711 W. County Road B <br />Roseville. MN 55113 <br />Page 2 <br />