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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 />Organization Nam <br />St. Joseph Parish <br />For Board Use Only <br />Fee Paid <br />Check # <br />Initais <br />Date Recd <br />.- Previous iawfu1 gambling exemption number <br />Street <br />171 Elm Street <br />City <br />Lino Lakes <br />State <br />MN <br />Zip Code <br />55014 <br />County <br />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) 784 -3015 <br />Name of Organization Treasurer <br />First Name Last Name <br />Ronald <br />Rausch <br />Daytime Phone Number of Treasurer <br />1612 ) 780 -2128 <br />Type of Nonprofit Organization <br />Check the box below which best describes <br />your organization <br />LI Fraternal <br />Veterans <br />Ea Religious <br />Other nonprofit <br />Check the box that indicates the type of proof attached to this application <br />by your organization: <br />Q IRS letter indicating income tax exempt status <br />ri 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 />EgProof previously submitted and on file with the Gambling Control Board <br />Gambling Premises <br />Information <br />Name of Establishment where gambling activity will be conducted <br />St. Joseph Parish <br />Street <br />171 Elm Street <br />City <br />Lino Lakes MN <br />State Zip Code <br />County <br />55014 Anoka <br />Date(s) of activity (for raffles, indicate the date of the drawing) <br />April 5, 1998 <br />Check the box or boxes which indicate the type of gambling activity your organization will be conducting <br />Et *Bingo Q Raffles Q *Paddlewheels Q *Pull -tabs Q *Tipboards <br />*Equipment 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 />/ <br />