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LG220 <br />(Rev.11114190) <br />Minnesota Lawful Gambling <br />Application for Exemption from <br />Lawful Gambling License <br />All in the unshaded portions of this application for exemption and send it in at least 45 days before your gambling activity for processing. <br />Namf a»d Address of orgraoizrxttort <br />Organization Name <br />St. John's Church of Little Canada <br />Street Ciry State Zip code <br />380 Little Canada Road St. Paul Minnesota 55117 <br />FOR BOARD USE ONLY <br />FEE <br />INIT <br />CHK <br />DATE <br />Current/previous license number <br />Currenuprevious exempt number <br />62005 -92 -004 <br />County <br />Ramsey <br />Chief executive officer Phone Treasurer <br />Rev. Robert Fitzpatrick ( 612 ) 484 -2708 same <br />Phone <br />c c►, f Nora prat Q, artizat at"t <br />Check the box below which indicates your type of organization <br />❑ Fraternal g Religious ❑ Veterans 0 Other non-profit <br />Gam TXi)tt9 Site° <br />Name of site where activity will take piece <br />The Venetian Inn <br />A member o >the. <br />Paui /Mpls <br />Street City Township <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 />X3 Affiliate of parent nonprofit organization (charter) <br />clidiocege (on charter in your of lice) <br />2814 Rice Street St. Paul Little Canada <br />Date(s) of activity <br />February 13, 1993 <br />Wipes U. f tames 3. <br />Game <br />Bingo <br />Raffles <br />Paddlewheels <br />Tipboards <br />Pull -tabs <br />State <br />MN <br />Zip code <br />55117 <br />County <br />Ramsey <br />Expenses, tncuding <br />::'s' Goat of Prises i:::i <br />Value; <br />Izesii::' <br />I declare all information submitted to the <br />Gambling Control Division is true, accurate, <br />a•. complete. <br />a �..iXi W. _ / l'3 <br />Chief executi s . tgnature Date Chief executtxe officers wgnetute Date: <br />Local itt Acknow ledgentent <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 />Cite o un ame <br />Ds1000o010mvrfomgaml <br />D titbu5 s 30 ns#:00:44e <br />PAM! .en purchased <br />d6clare r�li+ntfe orr+tann sub tlig01GConra/ <br />wuo acra <br />arlo`complcte _ <br />jr <br />Sign.tur: of pe� .on re.y i t application <br />mimaidAst <br />/ Date received <br />White _BOOM Mail with $25 permit fe <br />Pet -- Orgmhaom <br />YSEov -BOOM rOLna to CtganiaM b <br />Mnwele shaded seas <br />Gold ._. City a cdvnry <br />Township name <br />Page 1 <br />Department a <br />Rosewood Plaza South, 3rd Floor <br />1711 W. County Road B <br />1g application <br />uatus to: <br />Date received <br />