02/08/1999 Council Packet - Laserfiche WebLink

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LG240B (Rev. 1/21/93) Minnesota Lawful Gambling Application for Authorization to Conduct Excluded Bingo Part 1 of 2 (If your organization has been licensed or exempted in the current calendar year, you are not eligible to apply for excluded bingo) Fill in the unshaded areas of this application and send it to the Gambling Control Board at least 30 days prior to the activity. Organization Information Organization -Tetk\Er Centennial Middle School Parent/Association Street 399 Elm Street •FOR BOARD USE ONLY Proof • a S : ❑ c ❑ 013 N ❑ NA ❑ : Other Activity City Lino Lakes State Zip code MN 55014 Type of nonprofit organization (check one): ❑ Fraternal Veteran ❑ Religious ® Other nonprofit organization Type of proof of nonprofit status attached (check one): ❑ Certificate of Good Standing - Minnesota Secretary of State's Office ❑ Internal Revenue Service .n(' Affiliate of Parent nonprofit organization (charter) Excluded Bingo Activity Igformation Has your organization held a bingo event in the current calendar year? No Q If yes, list the dates that bingo was conducted Check one: ® The bingo event will be one of four or fewer bingo events your organization will hold this year. Date(s) of bingo event: _ - ' ' ' _ - - - \C\ kC\CIA ❑ OR ❑ The bingo event will be conducted (up to 12 consecutive days) in connection with a: County Fair - Date(s) of bingo event State Fair - Date(s) of bingo event Civic Celebration - Date(s) of bingo event Print the name of the person in charge of the bingo event Barbara R. Regnier Premises where excluded bingo will be conducted Daytime Phone ( 612) 340 -7586 Name of premises Centennial Middle School Street Address 399 Elm Street City Lino Lakes OR County and Township (Be sure to complete Part 2) WNW - Original Ydow -Board