j. Bingo & raffle permits - Laserfiche WebLink

OFFICE OF ATTORNEY GENERAL SFN 9338 (02-2002) Application for: [] Local Permit * [] Charity Local Permit (one event per year) Name of Non-profit Organization I Date(s) of Activity Perso-n Responsible ~r the Gaming Operation, Including Disbursement of Net Income r Tit~ Business Phone Number Bus, ess Add[es~TM Mailing Address (if different) 'F/c 7 State Zip Code Name of Site Where Game(s) will be Conducted ! Che~ the Game(s) to be Condu~: ~ Bingo ~ Raffie¢ City J State Zip Code C~y ~ite Address State Zip Code Cou~ [] Paddlewheels * * Poker, Twenty-one, and Paddlewheels ma, ~ be Conducted only by a Charity Local Permit. I-]Calendar Raffle [] Sports Pool [] Poker * [] Twenty-one * DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED Retail Value of Game Type Description of Prize Prize Retail Value of Game Type Description of Prize Prize $ (Limit $6,000 per year) Total: $ Intended uses of gaming proceeds: "'~' ~'~ t~ 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 cell 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 I through June 30? ~' 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 [] Yes - If"Yes," indicate the total value of all prizes previously awarded: $ . This amount is part of the total pdze limit of $6,0OO~per year. Business Phone Number / (over)