2020.03.02 CC Packet - Laserfiche WebLink

Home

6.8 MINNESOTA LAWFUL GAMBLING LG220 Application for Exempt Permit 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 is postmarked or received 30 days or more before the event, the awards less than $50,000 in prizes during a calendar application fee is $100; otherwise the fee is $150. year. 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 / c�L4� Organization � jl f, M �; no V /► i 6A 11E- SPrevious GamblingName: („ r'I L /„ IiirVVV�-1�L /'� Permit Number: I Q Minnesota Tax ID q / ! b q I 1 � A ., r, ■ Federal Employer ID �/ / /_ a 7 8999 Number, if any: ! V(�((j Number FEIN , if any:(I tP ! �f Mailing / �J/ Q Addressj:� ` r?/0 �� //�� rr// City: A i+5 i&u h/' k E State: Zipc S County: Name of Chief Executive Officer (CEO): O N e Z-I<,e L.6u'/'_ - v Daytime Phone: / D q-! Email: NONPROFIT STATUS Type of Nonprofit Organization (check one): = Fraternal = Religious Veterans E�r 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 both 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 „� &idCAA1 � ON (for raffles, list the site where the drawing will take place): ,� p! , f� !"1 J Address (do n t use P.O. box):3 o7� �l . /V _ City G-o ©3 Towhip: Zip: County: Date(s) of activity (for raffles, S Jy A� h ,, 1 L 1 'j/Q Z d indicate the date of the drawing): iJ i/�& (p Z Check each type of gambling activity that your organization will conduct: ❑ Bingo* ❑ Paddlewheels* ❑ Pull -Tabs* ❑Tipboards* 00 FYRaffle (total value of raffle prizes awarded for the calendar year: $ C & ) * 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.