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MINNESOTA LAWFUL GAMBLING <br />LG220 Application for Exempt Permit <br />1/13 Page 1 of 2 <br />An exempt permit may be issued to a nonprofit organization that: <br />- conducts lawful gambling on five or fewer days, and <br />- awards less than $50,000 in prizes during a calendar year. <br />If total prize value for the year will be $1,500 or less, contact the licensing <br />specialist assigned to your county. <br />Application fee (non refundable) <br />0 application is postmarked or received 30 days or <br />more before the event $50; otherwise $100. <br />ORGANIZATION INFORMATION <br />Organization name Previous gambling permit number <br />Church of St. Odilia X-62107 <br />Minnesota tax ID number, if any Federal employer ID number (FEIN), if any <br />24942 41-0837655 <br />Type of nonprofit organization. Check one. <br />Fraternal X Religious Veterans Other nonprofit <br />organization <br />_ <br />Mailing address City State Zip code County <br />3495 Victoria St. N Shoreview MN 55126 Ramsey <br />Name of chief executive officer [CEO] Daytime phone number E-mail address <br />Fr. Phillip J. Rask 651-484-6681 rask@stodilia.org <br />NONPROFIT STATUS <br />Attach a copy of ONE of the following for proof of nonprofit status. <br />Nonprofit Articles of Incorporation OR a current Certificate of <br />Good Standing. <br />100, St. Paul, MN 55103 <br />name. <br />letter, have an organization officer contact <br />nonprofit organization [charter] <br />of both of the following: <br />organization with a group ruling, and <br />your organization as a subordinate. <br />Dont have a copy? This certificate must be obtained each year from: <br />Secretary of State, Business Services Div., 60 Empire Drive, Suite <br />Phone: 651-296-2803 <br />IRS income tax exemption [501(c)] letter in your organization's <br />Don't have a copy? To obtain a copy of your federal income tax exempt <br />the IRS at 877-829-5500. <br />X IRS - Affiliate of national, statewide, or international parent <br />If your organization falls under a parent organization, attach copies <br />a. IRS letter showing your parent organization is a nonprofit 501(c) <br />b. the charter or letter from your parent organization recognizing <br />GAMBLING PREMISES INFORMATION <br />Name of premises where the gambling event will be conducted. For raffles, list the site where the drawing will take place. <br />Little Venetian <br />Address (do not use PO box] City or township Zip code County <br />2900 Rice St. Little Canada 55117 Ramsey <br />Dates) of activity. For raffles, indicate the date of the drawing. <br />2/9/15 <br />Check each type of gambling activity that your organization will conduct. <br />X Bingo* X Raffle Pull -tabs* Tipboards* <br />_Paddlewheels* <br />*Gambling equipment for bingo paper, paddlewheels, pull -tabs, and tipboards must be obtained from a distributor <br />licensed by the Minnesota Gambling Control Board. EXCEPTION: Bingo hard cards and bingo number selection devices <br />may be borrowed from another organization authorized to conduct bingo. <br />To find a licensed distributor, go to www.gcb.state.mn.us and click on Distributors under <br />the WHO'S WHO? LIST OF LICENSEES, or call 651-639-4000. <br />3 <br />