Loading...
HomeMy WebLinkAboutGambling Application - MN Darkhouse & Angling Association 01/14/2008 11:46 7639723446 JOYCE FARNICK PAGE 02 ."",..,. uwtul Gambllnf1 LG220 A IlcatIon for Exem Pennlt M ~ J*mIt",.Y be IIaIH 10 a notlpr'Oftt OfVaMta1lon tMt . concU* I8wt'ul ~ "" .. or fwMr MY'. .ncl . 8WlII'." thin $SO,oaD kt prtae clfrtng . ~, 'fMr. 'OROANI%ATION Itft=.OAMA...,oH Fee Ie or eKh event ..... , of 2 8J(ff For.... u.. ontr CIlIdt" . Pr8Y~ ~ permit number . ~ &4/ -D3-ocl Tn- of nonpraftt orpnlull',", CNdc ( ) one. o Fraternal 0 Rellc;oul 0 V""M QD oa.r nonproftt orpllzalion M~ eddreea Stat./Zip Code 'PO 1 a.. NaIM of chief executive omcer (ceo) Daytime pIIone num~ *.~ '.*1 o (' · c.L 7GJ3 -Q1Q.- ~c.p ATTACH ACOPV 0'. me. OF THE,:FOLLOWING'FOR PROOF 'OF' ~OFiT'srATU8 . . . ,. . . . . " '. ',\,' '". " ..... DO not. aaach '8 S8IeI .. ~ ... or feden1I ID employer ~ ., tney are not proof or ~If)ftlftt -.s. _ NonprafttArtIdn of................. OR. DUfI'IIIt~DfGeOlS--. Don't tww a 0fJIVt1 nw ~ mu8t aa. oblHwd MCh ,.., from: s.a...., of StatI...... StrvIcet DIY., 180 S1IIt8 Otftee BuIldInG, st hul, UN 55155 Pho"..: a51.2M-2803 _ 1nIwII" blMlMM s.rvtM ..MIMomI tu ...,,... (101(0))...... In ""' ~lIIlzllon'.tt"'" Don't h8w . COV/1 To abtlIIn . copy or yoW''''''' lnoomf tIIX exempt....... Mnd your ...,.,110 nurnIi*' Ind h cr.t. your Ot~ lnltaIIy.pd fortn ~.~ 1D: IRS, P.O. Bole 25D8. Room AOiO. CInclnMtI. OH -45201 -,,*",11 Rew."....... .AtIIO* of' AIIIIoNI. ........ild.. 01 ~ ptIfWIttnOftprcl8t...nIaUft (eIIarW) If your orpnIt.don .... U1dtre ~ o'lI"'.,ldon. etlRh oopIH of mIIb orb foIIowff'g: .. IRS....... mDwtng ycU .-tnt o~ '- . ~~ ncmproIt !iD1(o) 0I'gInIzat0n wllh . p-oup n.JIing b. the atww or Ie8Il' from your penN1t Ofga.~ recognlzlng ,our ~... ...... .:LftdttIMj ~.8IrVI~-"",IIf'8VkMl,,,.u~ toClambflnt ConttoIBoMI If yOU prNoue!y IUbmIttId proof of nonprvfIt .-au from .,. In1lmll RfWrMJ Servtoe, I'ICl ....mn.nt Ie .-qulred. . ,.1, ,', '.. ZS~31q . ........... ....,...It !'or ~-abs, lfpboards, ~, and blngo (bingo papl'r, hard c:aIds, and bfngo runber selectIOn device) muse be obtalned ti'om a dlsI1butOr ' b'ad by the ~ control Soard. To ftnd a IIcenIed dlltrtbulL'r, go to www.p.state.l1Y1.u1 and dlck on Usr or lJcmIed DlstrtbUlln, or alii 651~39-4076. 01/14/2008 11:46 7639723446 JOYCE FARNICK PAGE 03 LG220 Application tor Exempt Permit Pllp2 of2 eIOT LOCAL UMT'OF ~rteff ACKNOWLEDGMENT :. '. .':' .. . . ". . . ~ It IocaIId In ...._ bOth " the .-bllna ......... .. WIIh~ city 11m.... ::- ~~ ~IAI.. RIUSt ... .:. _~ the city mutt ... this ",Iof" . --.., CIIeoII (..J).............II ... Oft CItMtt (~IM........ aauatyll.... on ..... ~..... . .....".,..... IDWtIdpd ....... __ .-.... The ~lIon II ~..N.1.dgtd . no WIlltIng pertod. The ---. a-. ...... no .....-.. _-. - - -,.....-....... . The ~;. ~ --..30 clay WIlIr1g 11>>1IppIic:don Is ~ "'" . 30 _ WlItlnQ - period .nd aIIowa" SoMt tD ... It ,.,mt...... 30 - pwIod. end .aa- .. BoeftI" .... . pennIt.. 30 cII~ ' _(eodl~for1ll1."'dly). _The aJlfIIicdon Is~ ...-The ~ Ia denltd. PrInt dtr nil".. on NMHoftM air, , ~... thIII~. stg,..u. of clty peIW)I'lnel rteeIYIn9 appb1lon . Prirtt CCM1ly ".". On "."., M tM coun1y. , ~.wdgII tin ,.".". Signnn of ~ ~...., ~ Appllcallon TItle Date-'~_ TtIIe DD-!--1_ '7OWH8H1': Otll>>Wtiltht towf1MIp, J ~"'1h<<1ht otpnlZlfl1n lI.pplyIng tor..""".,.",." HM1 WItNrt fir. tDWMNpJlmltl. [A1IWmINp hHno ......,ry~ tolppnwt or_."~pA.""la "'M1.213..ubd. 2>) p"nt 1DWMhlp name SIgna1u,. of townthlp ofIIciIl ~ .~n TI1Ie 0.. --1--1- CH1!FJ~XlCUTIVE'~~':'IGNATUE. ...... '. n. Infonnelion ptDVidH in thIa .ppl/clltltJn Ia oompJMe end .<<IUr_ to u,. bNt t)f my kn~. I ~ #hit tJr. InMlcMl ,.""", wI1I ". ~, 1d twtumMJ ~ BtMnJ within ~ ~ of 1M da of our fIImbIIng MiJdy. ChIef~ofIIcef'8~ ( .f\tJ U -:;'ttJ1 f)U ("'11 Date 61 1..1!:LJ~ ~..~forMch dvity; .. onedlyof~~ \ .. two or more con-=utM ~ of gembIIng aetlvity .. nc:h eM)' . r1lih dfft1ng II held e.ncf ~ with: · . ecpy of YOU' I'f'DOf of 11Or'IJ/~1""" and .. S60 *PI*aton.... for Nc:tt .".,., .....dwck pe)'81* 1D... of ~.H To: G.riIIIrv CantrvlSoard 1711 w.t County AGed 8, 8. 3QO South R~, MN 55113 FIftMOllJ report _d reoonIu.plnl requ''''' A lInancleI ftlPOrt 101m .nd 1nItructIo,. w1B be .m wllh yw' ptrmlt. WtHn 30 day. at h dvlty dett, (lOI'.... and -.n ... fInInclIll rtpOft form to ... GarnbI/ng ContloI Boerd. ChI ..If'''-? e.I .. LlcInIlng lSdon of.,. ~ ContR:lI Board at 86'~. c-......,. ThII Mn'-' be "-* IMIIIIlII ~...",..lbnNI (1...11111 .. ...., "*' ftqUHt .". ..M.....1'IqUIlIIlId Ol''' JllIm (lInd Mi *If .._aJ) WI tit ....IIV .. GMMlI ConnIIIeMt~1ll diIeImW )"IV qwIII..A..1I1ll be IrMMct In ~ ,.,.........11'1 """""* "'" flM fit IlgN lIP .... t:t IUPPtIh InfomwIoII NqIIIIIlId; ~. 1t)'OCl .... " .... lhlI WonJllllaj~" a-at mIY,.1III ** to .....,. ""'~.~_.. QOIU I OlJI/IClI. !NY IlIfuM fit __ ""'. ~ ttyau~'" 'A'>n._~~. lie BoenlWlIll 1tllI1D JlIlaII ,.out ~.YN_endMd~ OIII~ ,.,.". IIit .....Wltle pdlIcl UI...""",Io..**,NllIMdllyh IN.. /II the .""",,~)tU ~ IMI.,... .. unIlI lie BoInf __ )'M '*'* WleII ..1IoIrd __ )'OCI' pemt. .. of the '''...Ilol, pmo4cIId III .. 8clInf.... ~ ""*' r.. SllIId... not 1Mue. permt. II '4.,,~ Pf'I\'ldId IIIn'IIInI pMtI, ~ '" .~ ofytM",,", -)'1M' ~lbIlIod. - and ...... ~.... rtmIln pubIo. ~ dlIIII_ awIIIbIt to: loaM I7lImIln. Bout IlIIJ lIlofIOM MIlt ,... ac:llM to hWDm.,; ......... ~of PuIIID 8Il'ItY. .-..,. o.r.IIII: c......,... *- ofMIIU.IICin. RIMot,.nd RIwfu: ~AuAw. '-"!.'''',..A..J gmMno ~.,..1n)Cnt JUI&IInt ., cout ordr. oe. hMlIIlI Md ~ It-' _ ~ IIdhorbcf bJ.... or ,..,., IIw tl t.w ~.., .. ~"'.l~ ~"1IId ~ "rMi:tl1lw or" <<dtt ~. ,.", UN or thImg Qf WdmltL. 6r" HelIce _ ~n: llnd ~ .,.." you'~.