b. Permit for raffle - Laserfiche WebLink

if ?f?1 5 L\.l1rnif 4110- OD (l{JpliC'ftifIJYl{el-" [,fj.':;., APPLlCA liON FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT~h'.' CJ~~ J'. .J.' :{~~l} OFFICE OF ATTORNEY GENERAL W/r (:ornp;d"e' (App I~ 11')'1 ';~ ":.<- ~ i SFN 9338 (07-2003) . ~ 0, Jlroa't't' 0" Application for: ~ Local Permit * 0 Charity Local Permit (one event per year) Date(s) of Activity . ~ Name of Non-profit Organization Mailing Address (if different) ~v-e Name of Site Where Game(s) will be Conducted . I City . 'JOb 5 Business Phone Number d 9<6 ..g ~ City State Site Address Check the Game(s) to be onducted: "Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity LoCal Permit. o Bingo ~affle OCalendar Raffle 0 Sports Pool 0 Poker' 0 Twenty-one' DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED Game Type Description of Prize Retail Value of Prize o Paddlewheels' Game Type Description of Prize Retail Value of Prize $ ~ Total: ;Um~o2~tmr) Intended uses of gaming proceeds:\o ~tl...l-4, 11 t~ ~u(\C P fS an J C D\j.pr C.OS+ o-C-fow- W 0 uJ Does the organization presently have a state gaming licenSe?~ 0 Yes - If "Yes," the organization is not ~ligible 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 city or county for the fiscal year July 1 through June 30? ~ D Yes - If'Y es,' the organization does not qualify for a local permit or chari~l,ocal permit. Has the organization received a local permit from this'~r aliOt!1er city or county for the fiseal year July 1 through June 30? ~o' Dyes - If "Yes," indicate the total value of all prizes previously awarded:;; . .' This amount is part of the total prize limit of $12,000 per year. Ii Ii