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<br /> <br />. ,Vfl¡'t') N) n ¡lir..; '.... jLiJ..¡ '.'\;...~{\L Jilt! :fl.. "~I j/.ìJ. 1f1Í1. .1 <br />(II v' lIt/ L"L""1 t ~,\'jA/I,f ': 'J J{.A../ O/'J. /..t-tJ Iv It <br /> <br />APPLICATION FORA LOCAL PE.RMIT OR CHARITY LOCAL PERMI~(j,t~)1lÞüftt1¡IŒu£~'+O{ <br />OFFICE OF A TIORNEY GENERAL <br />SFN 9338 (07-2003) <br /> <br /> <br />r:a Local Permit <br /> <br />(;) <br />Check the Game(s) to be Conducted: * Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity LoCal Permit <br />D Bingo !:¥ Raffle DCalendar Raffle D Sports Pool D Poker * D Twenty-one * <br /> <br />~c- <br /> <br />'f!' f S' <br /> <br />Mailing Address (if different) <br /> <br /> <br />DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> <br />Game Type <br /> <br />Retail Value of <br />Prize <br /> <br />Description of Prize <br /> <br /> <br />$ :1.úv <br />BI ~ ~O <br />t .A¿J c) <br /> <br />* D Charity Local Permit (one event per year) <br />Date(s) of Activity <br /> <br /> <br />CityC <br />rt?l.r <br />City <br /> <br />Business Phone Number <br />101- ;l17 ~?t'ç <br />State Zip Code <br />'vLJ 5 i/o1 <br />Zip Code <br /> <br />CJ <br /> <br />State <br /> <br /> <br />uJ~sf <br /> <br />(/-e.. <br /> <br />D Paddlewheels. <br /> <br />Game Type Description of Prize Retail Value of <br /> Prize <br /> $ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> (Umit $12,000 per year) <br /> Total: $ ?~() <br /> <br />Intended uses of gaming proceeds: / n1 ()raCle J14 >t! n-f"'S <br />, <br /> <br />..J.o fÆe 5::r~//',~ .~CÁ"7 <br /> <br />Âr'" <br /> <br />Does the organization presently have a state gaming license? ~ No D Yes - If "Yes,. the organization is not eligible for a local permit or charity local <br />permit and should call the Office of Attomey General at 1-800-326-9240, . <br /> <br />Has the organization received a charity local permit from this or another city or county for the fiscal year July 1 through June 30? œ No <br />the organization does not qualify for a local permit or charity local permit <br /> <br />Has the organization received a local permit from this or another city or county for the fiscal year July 1 through June 3D? ISlJ No Dyes - If "Yes,. <br />indicate the total value of all prizes previously awarded: $ . This amount is part of the total prize limit of $12,OOOper year, <br /> <br />Dyes - If "Yes," <br /> <br /> <br /> <br />Business Phone Number <br /> <br />1tJ!-:l.r,1 '19t;Ç <br />