12-20-1995 Council Agenda - Laserfiche WebLink

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LG220 Rev06/95 Minnesota Lawful Gambling Application for Authorization for an Exemption from Lawful Gambling License For Board Use Only Fee Paid Check # Initals Date Recd Organization Information Organization Name St. John's Church of Little Canada Previous lawful gambling exemption number X- 62005 -95 -004 Street City S 380 E. Little Canada Road St. Paul Mn. ate Zip Code County 55117 Ramsey Name of Chief Executive Officer First Name Robert of organization (CEO) Last Name Fitzpatrick Daytime Phone number of CEO (12) 484 -2708 Name of Organization Treasu First Name SAME AS ABOVE er Last Name 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 / on charter in your office submitted and on file with the Gambling Control J IRS letter indicating ECertificate of good of State's office Fraternal • Veterans Fq Religious PIA charter showing nonprofit organization P 9 proof previously Board Other nonprofit Gambling Premises Information Name of Establishment where gambling activity will be conducted The Venetian Inn Street City State Zip Code County 2814 Rice Street St. Paul Minnesota 55117 Ramsey Date(s) of activity (for raffles, indicate the date of the drawing) Saturday, February 10, 1996 Check the box or boxes which indicate the type of gambling activity your organization will be conducting Ezii Pull -tabs 0 Tipboards =jg Bingo ET Raffles in Paddlewheels Be sure the Local Unit of Government and the CEO of your organization sign the reverse side of this application. on For Board Use Only Date & Initials of Specialist