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R� ods 95 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 />. 'ks. :a �"%.v.:fi4dy4t:44 •T': e` - <br />.�l^ 'y <br />,!�... $ ,^:i'1znaAr'•.1 �, >. �: 4} a, z;,::.. 4 <br />!.ivrt.. •. � .. �4, � �� . 4 .�:::in �M.' ,� }�,��"N�' i <br />I�r. aniz� •� �nfor afo� �:.. #....�k ,:4�.�. ,,,:: �� � �- - � � t <br />.:::....... <br />...:k. k; k 4 z : .q"^w"`",!;.,''k' �.ij,k <br />s4k:.:. ..,g!' A b .. .. .. :.. . ;;..fr. ... :..:. :.. ..r? :4Y 3.' ...:,r. ..:. �-...._..:: ::X.: 'k" _.�:. <br /><.. :L _ S�.'.�w :F:�^::::4:`!i �u"'1. ;' i} ^J:e' . R�+. '.'�. ..s. <br />.. .... , .:... ...:. :1 ", �. swJ �.ke ,..�":..;.::.:4..: ....><:..::.:. ... �;....u..:-... ..a .,,::..a:,.:..:::." �. �........�..�4;;t,;;irM....:... i....a. .. .a....,a.?:�!:<;., :i:. !a..:� .:... .,�4..'.'�.4...�r:�a.'.�e. <br />� 4+ � w'i' :1'�.N::..:.:."...:�.: r .:°'��.... ,. _ . �'.......:"., kl....'4:'�4...:�xs:�,a.. ...:..... ...:kr.::. :..:...... ............... ............... ........ .... ....... .:....... ..... <br />Organization Name Previous lawful gambling exemption number <br />St. Joseph Catholic Church X-98004-96-001 <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 />Last Name <br />Morin <br />Daytime Phone number of CEO <br />012 )84-3015 <br />Name of Organization Treasurer <br />First Name <br />Ronald <br />Last Name <br />1 Rausch <br />Daytime Phone Number of Treasurer <br />(612) 780-2128 <br />' �' �� .. � � � 3`s. �4 � ��� � � "t C aMg1!s�� o- <br />Ype:.•f • •fi Or�•anizatlot� £J <br />`' az.:..4 �.;'?'' ... .:.:.�w iC'` 3 �' ,.+; .. .�, <br />Check <br />your <br />t r. <br />0 <br />the box below which best describes <br />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 />IRS letter indicating income tax exempt status <br />ECertificate of good standing from the Minnesota Secretary <br />of State's office <br />�A charter showing you're an affiliate of a parent <br />nonprofit organization <br />♦goof previously submitted and on file with the Gambling Control <br />Board <br />A/y,'�■})(k <br />A4 • • ' • � � Y•:: a <br />q1�y y fat' �, i+n i� " <br />��`5 ��, to 1Y} i��D Fi � '{.J <br />Name of Establishment where gambling activity will be conducted <br />:St. Joseph Parking area <br />Street City State Zip Code County <br />171 Elm Street Lino Lakes MN 55014 Anoka <br />Date(s) of activity (for raffles, indicate the date of the drawing) <br />August 10 & 11 <br />Check <br />to <br />the box or boxes <br />Bingo <br />G! <br />which indicate <br />Raffles <br />the <br />E! <br />type of gambling <br />Paddlewheels <br />activity <br />.. <br />your organization <br />Pull -tabs <br />EA <br />will be conducting <br />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 />