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<br />'''.'' <br /> <br />':. - <br /> <br />RECEIVED <br /> <br />DEe e 2005. 5~bmif41IO.0()appli(af,Dr1fee,.~ <br /> <br />APPLlCATft1~W8'WAce~ERMlf OR CHARITY LOCAL PERMIT~fh'.' Co~"!fA.. J...J-' <br />OFFICE OF ATTORNEY GENERAL , WI cOIl1pd-i! o.pp 'co-l,r(1 <br />SFN 9338 (07-2003) - ::# 23 q J- <br />. . 0 Charity Local Permit (one event per year) <br />Date(s) of Activity <br /> <br /> <br />City <br /> <br />to '-,;2.' od. <br />Business Phone Number <br />'tJ / til- '13 ,;z <br /> <br />~~g-/a3 <br />Zip Code <br /> <br />CountyCa4...d~.'/ <br /> <br />Check the Game(s) to be Co ducted: <br />o Bingo ~aflle <br /> <br />. Poker, Twen"ty-one, and Paddlewheels may be Conducted only by a Charity LoCal Permit <br />o Calendar Raffle 0 Sports Pool 0 Poker' 0 Twenty-one' <br /> <br />o Paddlewheels' <br /> <br />DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> <br /> <br />Game Type <br /> <br />Description of Prize <br /> <br />Game Type <br /> <br />Description of Prize <br /> <br />Retail Value of <br />Prize <br /> <br />fl <br /> <br /> <br />$ <br />aO . 05!- <br /> <br />0-<> <br />.- <br /> <br />0<> <br /> <br />ot! <br /> <br />00 <br /> <br />00 <br /> <br />(Umit $12,000 per year) <br />Total: $ / 3 SJ'~ 00 <br /> <br />'iPr;r;;;;~~~~~-:;~~~/:ff:g;!f <br /> <br /> <br />Does the organization "presently have a state gaming license? ~o DYes - If "Yes," the organization is not ~ligible for a local permit or charity local <br />permifand should call the Office of Attorney General at 1-800.326-9240. <br /> <br />Has the ~rganjzation received a charity local permit from this or another city or oounty for the fiscal year July 1 through June 3D? !)a"NO Dyes - If ~yes,. <br />the organization does not qualify for a local permit o~.chariY,"I:9.cal permit <br /> <br />Has the organization received a local pennit from this ~r another city or oounty for the fisCal year July 1 through June 30? fS5:fNO" Dyes - If "Yes," <br />indicate the total value of all prizes previously awarded: $ :' :.,- . This amount is part ofthe)otal prize limit of $12,000 per year. <br /> <br />.. " <br /> <br />