c. Permit for raffle-Chaffee Lions; Cowboy Up

�i i, ,It -I. 1 ss ,ii au -J f .ti APPLICATION J v 4J' 4 a ino 1 i i t l ti i CA FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT r 5 OFFICE OF ATTORNEY GENERAL `s SFN 9338 (07 2009) Application for ocal Permit harity Local Permit (one event per year) Narrig of ro Orga tion Date(s) of Activity r i r;�,t,� ~3 3 to l� 3 3 Person nsible for the Gaining Operation and the Disbursement of Net Income Title Business Phone Number 5j z ?O tt/ o n D;P 70 -3‘I-)-155 Business Address City State Zip Code 1 4 5 9 1 s L c 5 �ct. i. Q City A 55 Mailing Address (if different) State Zoe Narne of 'le Where Gam Will be Conducted C ...1 Site Address EN1 U /U FA- rPt tars GL Al 1 0/V 3G/ iLO City State zip Code County I A) /J 45 e °7' c Check the Game(s) to be Conduuczed: Poker, Twenty-one, and Paddlewheels may oe Conducted only by a Charity Local Permit Bingo akftiffle a El Calendar Raffle El Sports Pool Poker' Twenty -one' Paddlewheels' DESCRIPTION AND RETAILS VALUE OF PRIZES TO BE AWARDED Game Type Description of Prize Retail Value of Game Type Description of Prize Retail Value of Retget- Prize Prize a loo 13 50. (Limit $12.000 per year) ,4e,L.� O 50O�, US Total: �,,$b fended of gam L .4i..J L .4_ AL. 44L..:.• Does the organization presently have a stagaming license? EtNo 0 Yes If Yes," the organization is not eligible for a local permit or charity local permit and should call the Office 4Aftomey General at 1- 800 326 -9240. Has the organization received a charity local permit from this or another city or county for the fiscal year July 1 through June 30? No Yes If "Yes," the organization does not qualify k,r a local permit or charity local permit. Has the organization received a ko¢al permit from this or another city or county for the fiscal year July 1 through June 30? OAo 0 Yes If "Yes," indicate the total value of all prizes #previously awarded: S This amount is part of the total prize limit of S12.000 par year. Signs r Organize To p etattive Official Title t Business Phone Number