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MINNESOTA LAWFUL GAMBLING LG220 Application for Exempt Permit (ac11 5/15 Page 1 of 2 An exempt permit may be issued to a nonprofit Application Fee (non-refundable) organization that: Applications are processed in the order received. If the application • conducts lawful gambling on five or fewer days, and • awards less than $50,000 in prizes during a calendar is plication fee is received 30 days the more before the event, the year. application fee is $100; otherwise the fee is ¢150. If total raffle prize value for the calendar year will be Due to the high volume of exempt applications, payment of $1,500 or less, contact the Licensing Specialist assigned to additional fees prior to 30 days before your event will not expedite your county by calling 651-539-1900. service, nor are telephone requests for expedited service accepted. ORGANIZATION INFORMATION Organization Previous Gambling Name: American Legion Auxiliary Unit 620 Permit Number: X-00968-15-017 Minnesota Tax IO Federal Employer ID 27 1447354 Number, if any: Number (FEIN), if any: Mailing Address: 5383 140th Street North City: Hugo State: MN zip; 55038 County: Washington Name of Chief Executive Officer (CEO): Rita D. Lorey, President Daytime Phone: 612-371-8512 Email: riorey@foleymansfield.com NONPROFIT STATUS Type of Nonprofit Organization (check one): = Fraternal = Religious E✓ Veterans Other Nonprofit Organization Attach a copy of one of the following showing proof of nonprofit status: (DO NOT attach a sales tax exempt status or federal employer ID number, as they are not proof of nonprofit status.) A current calendar year Certificate of Good Standing Don't have a copy? Obtain this certificate from: MN Secretary of State, Business Services Division Secretary of State website, phone numbers: 60 Empire Drive, Suite 100 www.sos.state.mn.us St. Paul, MN 55103 651-296-2803, or toll free 1-877-551-6767 IRS income tax exemption (501(c)) letter in your organization's name Don't have a copy? To obtain a copy of your federal income tax exempt letter, have an organization officer contact the IRS toll free at 1-877-829-5500. IRS - Affiliate of national, statewide, or international parent nonprofit organization (charter) If your organization falls under a parent organization, attach copies of beth of the following: 1. IRS letter showing your parent organization is a nonprofit 501(c) organization with a group ruling, and 2. the charter or letter from your parent organization recognizing your organization as a subordinate. GAMBLING PREMISES INFORMATION Name of premises where the gambling event will be conducted (for raffles, list the site where the drawing will take place): Hugo American Legion Post 620 Address (do not use P.O, box): 5383 140th Street North City or Township: Hugo, MN zip: 55038 County: Washington Date(s) of activity (for raffles, Indicate the date of the drawing): July 17, 2016 Check each type of gambling activity that your organization will conduct: Bingo* ❑ Paddlewheels* ❑ Pull -Tabs* ❑Tlpboards* Raffle (total value of raffle prizes awarded for the calendar year. $ ] * Gambling equipment for bingo paper, paddlewheels, pull -tabs, and tipboards must be obtained from a distributor licensed by the Minnesota Gambling Control Board. EXCEPTION: Bingo hard cards and bingo number selection devices may be borrowed from another organization authorized to conduct bingo. To find a licensed distributor, go to www.mn.gov/gcb and click on Distributors under List of Licensees, or call 651-539-1900.