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APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT ~,~.~/~L~. ~;¥( <br /> Appii~tion foK ~Lo~m Pe~it *~Chad~ Lo~l Pe~it (one e~nt peryear) <br /> <br />L~ o~J £ ~'2-- to <br /> <br />Disbursement of Net Income <br /> <br />C~y <br /> <br />DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> <br /> Retail Value of GameType I Descrip/ionofPrize I Retail Value of <br />Game Type DescflpUon of Prize Pdze Prize <br /> i I <br /> I <br /> <br />Total: <br /> <br />(ntended uses of gaming proceeds: ~l~',l~"~... ;~4)/XT'~-~ <br /> <br /> <br />