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<br />, <br /> <br />5Lt~lt\it "10. ODCl.{Jplitit1rtJtl feL=' <br />/i;;~;\ \. APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT~c,~~ J'H.L' <br />1I(~J OFFICE OF ATTORNEY GENERAL w"n CDllIpd,' o.Pf'r:o.l'IY <br />~, '" .-a i SFN 9338 (07-2003) <br />0;__"1""'0" <br /> <br />'':;," ... <br /> <br />< <br /> <br />~ Local Permit <br /> <br />Application for: <br />Name of Non-profit Organization <br />CI'lS.sCOlAfJT'1 ~5T1J~ICfH_ <br />Person Responsible for the Gaming Operation, Induding Disbursement of Net Income <br />',Yh R.L. <br /> <br /> <br />Business Address <br />~ \~Sl <br /> <br /> <br />w.rn <br />Mailin9 Address 0f different> <br />It:? <br /> <br /> <br /> <br />Name of Site Where Game(s) will be Conducted <br />OVlO\.;r,~H\ <br />City <br />We-S+- ~~'<l. <br /> <br />~ Check the Game(s) to be'Conducted: <br />DSingo ~affle' <br /> <br />. D Charity Local Permit (one evenf per year) <br />Date(s) of Activity Q:I2 . <br />3i-.'~ lf20oC:. to 'De c. !.j) 2..00 b <br />Title <br /> <br />. City <br /> <br />Business Phone Number <br />~.~~ J.' ~ <br />State Zip COde <br />D 5807g <br />Zip Code <br />5'i{D'IR <br /> <br /> <br />Site Address <br />l~S\ <br />State <br />NL> <br /> <br />State <br />1-Jl) <br />'w . V'h 0..:\.... Ave. <br /> <br />Zip Code . <br />S807ls' <br /> <br />County <br />CIhCS <br /> <br />. Poker. Tvienty-<>ne, and Paddlewheels may be Conducted only by' a Charity LoCal PermIt.. <br />0. Calendar Raffie 0. Sports Pooi 0. Poker' ',',' 0. Twenty-<>ne' <br /> <br />0. Paddlewheels.' <br /> <br />DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> <br />Game Type Description of Prize Retail Value of <br />Prize <br />'<'0.. -t'f\-e . $~OOO <br />qUI (t <br /> IJ <br /> . <br /> . <br /> . <br /> , <br /> .\ <br /> --.... <br /> <br />Game Type <br /> <br />; Description of Prize <br /> <br />Re~tail Value of <br />Prize <br /> <br />$ <br /> <br />';"-~. . <br /> <br />) <br /> <br />....~ . <br /> <br /> <br />(Umit $12.000 per year) <br />Total: $ 04000 <br /> <br />Intended uses of gaming proceeds: I V\ "::, f\ ~ --\; O,^....J. <br /> <br />. <br />S IA-,\? pO 'IT <br /> <br />Does the organ}zation presently have a state gaming license? 'trf No Dyes - If "Yes: the organization is not eligible for a local pennit or charity local <br />permit and should call the Office of Attorney General at 1-80o.-S:9240. . <br /> <br />Has the organization received a charity local pennitfrom this or another city or ~unty for the fiscal year July 1 through June 30? let N9 DYes _ If"Yes,. <br />the organization does not qualify for a local pennit or charity local permit Jt' <br /> <br />Has the organization received a local permit from this or another city or C9unty for the fiscal year July, 1 through June 3D? MNO Dyes _ If "Yes,. <br />indicate the total value of all prizes previously awarded: S . This amount is part of the total prize jirr:it of $12. oti)<per year. . <br /> <br /> <br />Date <br />5~ 1- -z.OcJ (p <br /> <br />TItle "&.> oc..-cl <Ib <br />?yeS'\deJ Di yretJws <br /> <br />