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Application for Exemption from Lawful Gambling License, Form LG220 Instructions .rwposoppmfrpticx utive officer s name tfeec ilx IIT . . :>>:::::»[::>:`>:::;>::'<:;:;::: : ;:a«:<':>::: C he i Organizations that conduct lawful gambling five or fewer days Filln the name of the person who heads the organization and award less than$50,000 in prizes during a calendar year and that person's telephone number. may receive a lawful gambling exemption permit. Treasurer's name The application serves two purposes:it is both an application Fill in the name of the treasurer of your organization who is for a permit and a financial report. responsible for the conduct of gambling and that person's phone number.This person may be the same as the chief Fill in the unshaded areas when applying for the exemption executive officer. permit and send the form to the Department of Gaming— Gamblin Control Division.When the exemption has been 9 P granted, the organization will receive an exemption permit �::....�...::........� -. ..-:�:and a copy of the exemption application for filling out the Check the box that describes the type of organization seeking financial report. the exemption permit.Attach proof of the nonprofit status that Fill out the financial report-the shaded areas-within 30 you check.To obtain a copy of the certificate of good days-of-the-last day of-gambling activity. (Minnesota law standing as a nonprofit incorporation filed with the Minnesota provides for a$250 penalty for organizations that fail to Secretary of State,write or call- file a financial report within the 30-day period.) MN Secretary of State When an organization is granted a permit, it may not obtain Business Services Division a gambling license during the same calendar year. For 180 State Office Bldg. example, if the organization is granted a permit on St. Paul, MN 55155 Jan. 1, 1989, it may not obtain a license for gambling for Phone(612)296-2803 all of 1989. The application must be received by the Gambling Control To obtain a copy of the federal income tax exempt letter, Division office at least 45 days before the gambling event. send your federal ID number and date applied,to: IRS 0A.741. /jfiaifitiypzwitte.kywpmpiiimoamm PN2 2-2 Attn: EO Branch FEE $25.00 per application P.O. Box A-3290 The 1989 session of the Legislature created in statute a Chicago, IL 60690 fee for organizations under Minnesota Statutes 349.214, Subd.2(b)effective July 1, 1989. NOTE:The nonprofit status must be for the organization which is applying for exemption from a lawful gambling I Please submit a check for$25 payable to the license.This may include a copy of the organization's "State of Minnesota"for each application,submitted. certificate of good standing with the Minnesota Secretary of State, a copy of the organization's charter,or an IRS tax [ YE40tfefCITLS3� ; <QT13I2Z. : exemption letter. (A sales tax permit is not acceptable.) Organization nization a Fill in the official name of the organization conducting the activity(for example:Church of St. Mark; Ducks Unlimited, Kandiyohi County Chapter 189; Lions Club of Ely;VFW Post Name of site where activity will occur 666;Fire Department Relief Association of Staples, etc.) Fill in the name of the site where the gambling activity will take place (for example,the Holiday Inn of Mankato,the License or exempt number basement of St. Mary's church). If the organization has previously obtained a gambling license and/or permit,fill in the license or exempt number(s). Address of activity site If the organization has never received a license or exemption, Fill in the full address of the site where the activity will occur, write in"none."If the organization has a license that is still in including the county. Do not use a post office box. effect, it cannot get an exemption.An organization is either licensed or exempt in the same calendar year,not both. If the gambling site is outside city limits-include the township name. Address Fill in the mailing address of the organization and the county Dates of gambling activity in which the organization is located. Fill in the dates of the gambling activity.You must fill out an aoolication for each occasion.An occasion may be either one day of activity or two or more consecutive days of gambling.