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LG220 <br />Rev06/96 <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 Information <br />Organization Name <br />St. Joseph Church <br />Previous lawful gambling exemption number <br />X-98004-96-002 <br />Street <br />171 Elm Street <br />City <br />Lino Lakes <br />State Zip Code <br />MN 55014 <br />County <br />Anoka <br />Name of Chief Executive Officer of organization (CEO) <br />First Name Last Name <br />Timothy Morin <br />Daytime Phone number of CEO <br />(612) 784-3015 <br />Name of Organization Treasurer <br />First Name Last Name <br />Ronald Rausch <br />Type of ttk0:0" tofit Organization <br />Daytime Phone Number of Treasurer <br />(612) 780-2128 <br />Check the box below which best describes <br />your organization <br />El Fraternal <br />0 Veterans <br />X. E r Religious <br />0 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 />0 Certificate of good standing from the Minnesota Secretary of State's office <br />0 A charter showing you're an affiliate of a parent nonprofit organization <br />® Proof previously submitted and on file with the Gambling Control Board <br />• Gambling Prern!ses.Information <br />Name of Establishment where gambling activity will be conducted <br />St. Joseph Church <br />Street <br />171 Elm sTreet <br />City <br />State Zip Code <br />County <br />Lino Lakes MN 55014 Anoka <br />Date(s) of activity (for raffles, indicate the date of the drawing) <br />November 24, 1996 <br />Check the box or boxes which indicate the type of gambling activity your organization will be conducting <br />tEr *Bingo waffles 0 *Paddlewheels 0 *Pull -tabs 0 *Tipboards <br />Jt 4 4 * ur ment for these activities must be obtained from a licensed distributor <br />Be sure the Local Unit of Government 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 />