c. Permit for raffle - Laserfiche WebLink

APPLiCATiON FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT OFFICE OF A]-FORNEY GENEP, AL SFN 9338 (02-2002) Application for. [] Local Permit Name of Non-profit Organization IPerson Responsible for~the Gaming Operation, ll~cluding Disbursement of l~et Income ~s"~"~i~i~dd ressi ~ b ~, ~ '~ :hadty Local Permit (one event peryear) (s) of Activity -~ Title ~-) Business Phone Number Zip Code State Zip Code !Ma~iling Address (if diff,e3ent) Name of Site Where Game(s) will be Conducted Chec~ the Game(s) to be_Conducted: r"~ Bingo ~affie Site Addre~,s .~ State I Zip Code ~ County Poker, Twen~ne, and Paddlewn~e~ may be ConduCed only by a Cha~ Lo~t Pe~. ~Calendar Ra~e ~ Spo~ Pool ~ Poker * ~ Twen~ne * DESCRIPTION AND RETAIL VALUE OF PRIZE, Game Type J Description of Prize Retail Value Prize i TO BE AWARDED I' Retail Value of Game Type Description of Prize Prize $ I 1 (Limit $6.000 2er year) Total: '~51 5'(-~ Intended uses of gaming proceeds: XO ~f'" Does the organization presently have a state gaming license?bo [] Yes - If "Yes," the organization is not eligible for a local permit or charity local permit and should call the Office of Attorney General at 1-800-326-9240. Has the organization received a charity local permit from this or another c;~'y or county for the fiscal year July 1 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 Icc'al 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 prfze limit of $6,000 per year. Signature of Organization's Tol~E~ecutive Official Business Phone Number