Laserfiche WebLink
,-~ ~ SFN 9338 (02-2002) <br />~~ Application for: .j~ Local Permit { ~Charity Local Permit (one event per year) <br /> <br />Nam_.e pf Non-j:~,fit Qrganizat~on <br />Pers~or~Responsible for t[~Gaming Operation, Including Disbursement of Net Income Business Phone Number <br />Busifi~s's¥,~'~ress City O State Zip Code <br />N~.~ecf Sit~he/e_GaFte(s) ?ill be/Cpnducted Site Address <br /> <br />Che~ ~e Game(s) [o be Condu~: * Poker, Twen~ne, and Paddlewheels may be ConduCed only by a Cha~ Lo~l Pe~. <br />Bingo ~Raffie ~Ca~ndar Raffle ~ Spo~ Pool ~ Poker * ~ T~n~ne * ~ Paddlewh~ls <br /> <br />DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> <br />Game Type Description of Prize Retail Value of <br /> Pdze <br /> <br /> Retail Value of <br />Game Type Description of Prize Prize <br /> $ <br /> <br /> (Limit $6,000 per year) <br /> Total: $ ~P~-~'~. (~C) <br /> <br />I t_~j~_d uses of, gaming procCelds: ~'h~//fC-x~ ~t/~/~ ~~~~ ~ <br /> <br />Does the organization presently have a state gaming li~nse?~No ~ Yes - tf "Yes," the organization is not eligible for a Io~1 permit or chari~ <br />pe~it and should ~11 the O~ of A~orney General at 1-800-326-9240. <br /> <br />Has the organization re~ived a chari~ Io~1 permit from this or another ci~ or coun~ for the ~s~l year July 1 through June 30? ~ No ~ Yes - If <br />"Yes," the organization does not quali~ for a Io~1 pe~it or charity Io~1 pe~it. <br /> <br /> ~ Yes - If "Yes," <br />Has the organization re~ived a Io~l permit from this or aqother c~ or ~un~ for the fis~l year July 1 through June 30?" , No ~ ~' <br />indicatethetotalvalueofallprizespreviouslyawarded:$~,00 . This amount is pa~ of the total pdze limit of $6,0Od ~er yean <br /> <br />kJ~sin~ss Phone Number J <br /> <br /> ( o uz,'d <br /> <br /> <br />