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•Minnesota Lawful Gambling Page 1 of 2 <br />LG240B - Application to Conduct Excluded Bingo (No fee) 8/00 <br />If your organization has been licensed or exempted in the current calendar year, you are not eligible to apply for excluded bingo. <br />Organization Information Previous authorization number, if any <br />Organization Name (as it appears on documentation filed with Minnesota Secretary of State or Internal Revenue Service) <br />R Ic�k.�- PT 0 <br />icy <br />Street �, , <br />5-1 5 Biv-c., ThPet- <br />City <br />Limo L &ke Q <br />State <br />NA k1 <br />Zip code <br />sc I <br />County <br />(Al -Lb k <br />Type of nonprofit organization (check one): <br />Fraternal Veteran <br />Religious Other nonprofit organization <br />Type of proof of nonprofit - attach a copy (see instructions): <br />MCertificate of Good Standing - Minnesota Secretary of State's Office <br />Intemal Revenue Service <br />Affiliate of parent nonprofit organization (charter) <br />Excluded Bingo Activity Information <br />Has your organization held a bingo event in the current <br />No X Yes If yes, list the <br />year? <br />dates that bingo was conducted <br />bingo events held this year. <br />i,A0-P_-C� 114._ 2 <br />CSI The bingo event will be one of four or fewer <br />Date(s) of bingo event(s) S P. e <br />fir. <br />CC__I <br />-OR - <br />The bingo event will be conducted (up to 12 <br />County Fair Date(s) of bingo event <br />State Fair Date(s) of bingo event <br />Civic Celebration - Date(s) of bingo event <br />Name of person in charge of the bingo event <br />consecutive days) in connection with a: <br />7 ,/ • <br />Su 7_ `-' « +ii fill ue 1 Le't' <br />Daytime Phone ( ) -1541 % _3L1 <br />Premises Where Excluded Bingo Will Be Conducted <br />Name of premises <br />_ Lidc-c_, L.-_--: I c_1-1.---v-e4 vtcu - / <br />Street address _ f <br />111;' 't',�t' 1'7 75 e r k- di 1 S' "f li? c' i- <br />City or township ,. n S� i County <br />L Iii Ci( c-c.4 /111. l iii /cc& <br />Be sure to complete page 2 <br />