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LG220 <br />Rev06/95 <br />Minnesota Lawful Gambling <br />Application for Authorization for an <br />Exemption from Lawful Gambling License <br />For Board Use Only <br />Fee Paid <br />Check # <br />Initals <br />Date Recd <br />...'%x !N� } �,''i* ° yy��.;ti <br />.. � � b yf �q 1� '%�`9� <br />ff.: . ' '$di'7 a4 �'P �vTM�4 j x eF £.. <br />� .. �� i '�' � �� <br />1 <br />x .gar zit � k fa,� <br />:'..��..:�i r� '2r�s :. .. .1-....w�. .,..:..:�..,, <br />_.. a Hiw �'u��.'r� <br />F' Kf M '.4 �r� <br />�p h`e' .y. y 9 <br />:���� �.}��.��� <br />sma.R:`:'�r''�tiw .��,�. .^k- ..4�!q�x1":Eas.. .Ri� x.z... "'. .�k�,.. �',! ce: <br />Organization Name Previous lawful garrdbling exemption number <br />St. Joseph Church X-98004 <br />Street City S ate Zip Code County <br />171 Elm Street Lino Lakes MN 55014 Anoka <br />Name of Chief Executive Officer <br />First Name <br />Timothy <br />of organization (CEO) <br />1 Last Name <br />Morin <br />Daytime Phone number of CEO <br />( 61) 784-3015 <br />Name of Organization Treasurer <br />First Name <br />Ronald <br />Last Name <br />1 Bausch <br />Daytime Phone Number of Treasurer <br />(612) 780-2128 <br />-: � ��� :�i � '. '� <br />r <br />,;.�� <br />.... ..... <br />1 4 . � � � <br />T7ype of'on • afi Organ�zatcor� �-a �� <br />- k 3 ^ { R4, yrse� �$3 <br />'Uk' h$6YTV BMUw+v-�'r,,' ,ak n; s4:.E , u�FF11..,,,,,,�' L- <br />� .. .+.. :. � .q. .: .. .....:.. '4� .. '� :"-.:'" ;CR4 v� .... <br />Check the box below which best describes <br />your organization <br />Fratemal <br />Veterans <br />Religious <br />g <br />Other nonprofit <br />Check the box that indicates the type of proof attached to this application <br />by your organization: <br />0 IRS letter indicating income tax exempt status <br />OCertificate of good standing from the Minnesota Secretary <br />of State's office <br />DA charter showing you're an affiliate of a parent <br />nonprofit organization <br />&Proof previously submitted and on file with the Gambling Control <br />Board <br />$ Ak' aauP r� <br />,j$ may } • R • 2 a e"aL' s or s a ` on a b $ N ,V <br />9Pf Bi �J � ,++tR{aW.�B {r �� I '�f 'M "TR'� c� 4'.e *�.ij}�j}� +J'v�Sf N ui ��4: <br />y e, `^ �, <br />�v{�' kPI <br />g -"•`: <br />j ��_` <br />dN; ;!:P� <br />Name of Establishment where gambling activity will be conducted <br />St. Joseph Parish Hall <br />_ <br />Street City State Zip Code County <br />7 161, Elm Street Lino Lakes MN 55014 Anoka <br />Datc;s) of activity (for raffles, indicate the date of the drawing) <br />March 31, 1996 <br />Check the box or boxes which indicate the type of gambling activity your organization will be conducting <br />Bingo 0 Raffles J Paddlewheels J Pull -tabs D Tipboards <br />Be sure the Local Unit of Govemment and the CEO of your organization sign <br />the reverse side of this application. <br />For Board Use Only <br />Date & Initials of Specialist <br />