c. Permits for raffle - Laserfiche WebLink

APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT OFFICE OF ATTORNEY GENERAL SFN 9338(07-2009) Application for: 16,Local Permit •❑Charity Local Permit (one event per year)Li -hi Name of Non-profit Organization Date(s)of Activity }� ) �4�11 q_ r'�j to Person Resloonsibl for the aming Operation and he Disbursement of Net Income Title Business Phone N ber -,..... .11' eC an—. _1,.e0A-e c- (-/61) 3tg�1-o Business Address State Zip Code X10 �1S Sk SV.� o�'c�0 D 5�1,0 LP Mailing Address(if different) City State Zip Code Name of Site Where Game(s)will be Conducted Site Address S \ -M- 4 ZiAr.c i�cc 6 t, S 3Cikl-el � city l St�a�t� Zip County r�`�� Check the Game(s)to be Conducted oker,Twenty-one,and Paddlewheels may be Conducted only by a Charity Local Permit. ❑Bingo Raffle ❑Calendar Raffle ❑Sports Pool ❑Poker• ❑Twenty-one• ❑ Paddlewheels" DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED Retail Value of Retail Value of Game Type • Description of Prize Game Type Description of Prize Prize Prize 5o\ 0 Ca.s -L ) 000.0U (Limit$12,000 per year) Total: $ 60o.00 Intended uses of gaming proceeds: 'V ^'Cit, O\X C_Vt\S Se S jS -`cC\\h-k��C, l �tju. Su�Plit �c; zn C1in.SCCOX � *eat\- -4 tr, S Does the organization presently have a state gaming license? No ❑Yes - If"Yes,"the organization is not eligible for a local permit or charity local permit and should call the Office of Attorney 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?10 No ❑ Yes- If"Yes," the organization does not qualify for a local permit or charity local permit. Has the organization received a local permit from this or another city or county for the fiscal year July 1 through June 30? ❑No gg Yes - If"Yes," indicate the total value of all prizes previously awarded:$ 30v) . This amount is part of the total prize limit of$12.000 per year. ' igna - .f i1 ganizati 's Top cu ive Official Date Title Business Phone Number 1. I& 4 act ttt rlo�3q.- kili/0