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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 />Organization Name <br />St. Joseph Parish <br />Previous lawful gambling exemption number <br />X-980014-95-002 <br />Street <br />171 Elm Street <br />City <br />Sate Zip Code <br />County <br />Lino Lakes MN 55014 Anoka <br />Name of Chief Executive Officer of organization (CEO) <br />First Name Last Name <br />Timothy <br />Morin <br />Daytime Phone number of CEO <br />(612) 7814-3015 <br />Name of Organization Treasurer <br />First Name Last Name <br />Ronald <br />Rausch <br />Daytime Phone Number of Treasurer <br />(612) 780-2128 <br />Check the box below which best describes <br />your organization <br />[—] Fratemal <br />[1 Veterans <br />[X Religious <br />(i Other nonprofit <br />Check the box that indicates the type of proof attached to this application <br />by your organization: <br />ri IRS letter indicating income tax exempt status <br />[Certificate of good standing from the Minnesota Secretary <br />of State's office <br />FIA charter showing you're an affiliate of a parent <br />nonprofit organization <br />ElDroof previously submitted and on file with the Gambling Control <br />Board <br />Gambling Premises Information <br />Name of Establishment where gambling activity will be conducted <br />St. Joseph Parish Hall <br />Street <br />161 elm STreet <br />City <br />Lino Lakes <br />State Zip Code <br />MN 55014 <br />County <br />Anoka <br />Date(s) of activity (for raffles, indicate the date of the drawing) <br />November 19, 1995 <br />Check the box or boxes which indicate the type of gambling activity your organization will be conducting <br />® Bingo 0 Raffles ri Paddlewheels 0 Pull -tabs n 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 />