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<br />f;?~, APPUCA nON FOR A LOCAL PERMIT OR CHARITY LOCAL PERMlli..il&ì LlJUf'L!j UU:,ü '(/~
<br />!t~~) OFFICE OF .ATTORNï=Y GENERAL
<br />~thr:k::ll~ SFN 9~3a (07-2003)
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<br />- Application for: Local Pennít .. 0 Charity Local PeiTllit (one event per year)
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<br />Nar~e of NOn-prCf',t, Ot~a:liZéiticn /) I Date(sì of Ac1i\IÌty
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<br />Person ResponSible for the Gamin¡;; Operation, Including Disburseme.'1t of Net !nCO:Tie ! n~e ' 6 S;/less Phone Number
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<br />Name of Site Where Game(s) will be Condr.:cted, , ' Site Address ,
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<br />I Cit} En i txic h ..I sÅ' b ] Zi5c~:; 7? Ey ék 5£
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<br />R.rlt:C¡, !hE; Game($} to be Conducted: * Poker. Twenty-one. al'd Padd!ewheèls may be Conducted on!y by a Charity i..cé:a¡ Perrnit
<br />L_~ C 8in~1Raffle 0 Cale:Jdar Raffle 0 Spans Pool 0 Poker' 0 Twe:1ty-one .
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<br />DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED
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<br />r Game Typ¿ . -/ Descri¡:tion of Prize " Retail \:,alue of !
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<br />Game T~,.pe Description of Pñze Retail Value of
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<br />I Does::he :rganiz¡;boli present:y !1"ve a~tate ~a!1'!jng license? ~ No 0 Yes - If 'Yes,' the t'rga!1iz.:ation Is not eligib;e for a local permit or charity [c,ca!
<br />perm:t cano Sh::;Lld call the Office of Attorney Geneœ/ at 1-800-316.9240. ,
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<br />H. as ti1e o..¡;;anizalÍü:: re,_(;18iveC a chanty iocal perrn¡: from tin; or another CIty or county fer the 1Ïscal year July 1 through Jur.e :30? VlNO Dyes - If"Yes,'
<br />':he org:¡¡¡¡jzation does '1(;t qualIfy for ¡¡ local perm¡~ or ctarity focal permi:. f'i
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<br />!" Ha~,- the orga:1lzatJon reœiVP.o,' a ;°, ca, pe~l1¡:" frorr tr¡is or ar.cther city or county for the fi~ca, ,I year ",'UIY 1 th ro",hJ~. "" III'í N" Dy~ . '"Y~,' ¡
<br />; indica:e the ¡ú:al v¡¡;¡;e ci ail priz.es prevícllsly awarded: $ , This arn:;¡W1I is "art of the total pl'izl1/fmìt of $12,Oðt'Per year,
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