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<br /> <br />5!t~ lIlit 4f1 (). OG ~liCi:JJilJYl{eL ~ <br />APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT~h',' c,~,!!, . H~' <br />OFFICE OF ATTORNEY GENERAL wiT (;Drr.pd"e' ~PpJICO-IIH1 <br />SFN 9338 (07-2003) " <br /> <br />Application for: <br />Name of Non-profit Organization <br />Red I Y Y- ,Vrk lie <br />Perso~esponsible,for the Gaming Opera on, Induding Disbursement of Net Income <br />t);-U c e q, OL5o/7 <br />Business Address \. J A A A . / to Ci~ <br />o IfIJ /vllL; () v '-- e 51 <br />Mailin Address,!if different) <br />" 0 VoX 19'7 <br />Name of Site Where Game(s) will be Conducted r <br />Red R: e V' a /1 e r-tL; v <br /> <br />cityltJesT Fa-v- <br /> <br />){ Local Permit <br /> <br />* 0 Charity Local Permit (one event per year) <br />Date(s) of Activity Jllnt--~hj .;We.> <br />--/J4. ff Y /1 ;?rH}!7 to J U N ~6/ ;;;OtJ <br />Title _ ",lsiness Phone Number <br />fl1 y 'lof ,;;ji~-4~OO <br /> <br /> <br />if:5 SO <br /> <br /> <br /> <br />Site Address <br />IAJol <br /> <br />State <br />F"P-. r () N D <br />Ma. 'I r1 <br /> <br />Zip Code <br />5,fo 7R <br />ZiP6go7? <br /> <br /> <br />State <br />^' <br /> <br />County (! a 5 5 <br /> <br />Check the Game(s) to be Con ucted: * Poke'i", Twen'ty-one, and Paddlewheels may be Conducted only by a Charity LoCal Permit. <br />o Bingo ~ Raffle 0 Calendar Raffle 0 Sports Pool 0 Poker. 0 Twenty-one. <br /> <br />o Paddlewl1eels' <br /> <br />DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> <br />Game Type Description of Prize Retail Value of <br /> Prize <br /> $ <br />~ <br />, <br /> (Umit $12,000 per year) <br /> Total: $ <br /> <br />Game Type Description of Prize Retail Value of <br />Prize <br />t1a. r~LP DeL ; L'- $1/00,00 <br /> , <br /> <br />'~'d'" ~ of gam',. p'oceOO" PI.!, .- c h a...5 e <br />u.,i Ld;"'3 <br /> <br />Does the organization presently have a state gaming license? E No 0 (es - If "Yes," the organization is not ~ligible for a local permit or charity local <br />permit and should call the Office of Attorney General at 1-800-326-9240. <br /> <br />New <br /> <br />d I' spllty ea 5 e <br /> <br />hr <br /> <br />f}I!Ts J aaFT.. <br /> <br />Has the organization received a charity local permit from this or another city or county for the fis!;al year July 1 through June 30? KI No Dyes - If "Yes,. <br />the organization does not qualify for a local permit or chari.~ ',<?cal permit <br /> <br />Has the organization received a local permit from this"~r another city or county for the fisCal year July 1 through June 30? ~No" Dyes - If"Yes," <br />indicate the total value of all prizes previously awarded: $"' ". This amount is part of the total prize limit of $12,000 per year. <br /> <br />~ t; <br /> <br /> <br />Title <br />Pres/den I <br /> <br />Business Phone Number <br />10/ :;$~--o <br /> <br />