Laserfiche WebLink
<br />5lt~tl\it "110.00 Q{JpJiCitifM fet,= <br /> <br />iFi~, \ APPLICATION FOR A LOCAL PERMit OR CHARITY LOCAL PERMIT~h' tJ~'!!' J" ~.I.> <br />l~l OFFICE OF ATTORNEY GENERAL Wi ~Dtltpd,~ ~fPIC()..l11Y <br />'\" a.'"'" i SFN 9338 (07-2003) -#''-1 all <br />0"0''''' Application for: . )(f Local Pennit (one event per year) <br />Name of Non-profit Organization <br />N 0'(0... L lA.. \1'\ ev 1l..\'1 C ~\l).-\C,:..l,\ <br /> <br /> <br />to iO- 1.-{}& <br /> <br />perso~esponSjbJe.fO; the Gaming Operation, Including Disbursement of Net Income <br />\..... " v\ , <br />Business Address City' <br />&O.-1.~JL\'\-.e.-Y- <br />Mailing Address (if different) <br />O'f\Q. [1I't?A'lSb71 1'70;)./ J5 ") r 5 E <br />Name of Site Where Game(s) will be Conducted <br />0..0.- L.k '1\ ov.-. ell u..-yc,k <br />C'ty <br />I G (4& Y\.e.... <br /> <br />Check the Game(s) to be Conducted: <br />D Bingo ~ Raffle <br /> <br />... Poker, Twen'ty-one, and Paddlewheels may be Conducted only by a Charity LoCal Permit. <br />Dj::alendar Raffle : 0 Sports Pool D Poker' D Twenty-one' <br /> <br /> <br />Business Phone Number <br />~r - 5735 <br />State Zip Code / <br />/If 570'.5 10 <br />S\;'le Zip Code <br />JV:V, 5~'O"3~ <br /> <br />D Paddlewheels' <br /> <br />DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> <br />Retail Value of <br />Prize <br /> <br />~,I".' <br /> <br />7 <br /> <br />Game Type Description of Prize Retail Value 01 <br />Prize <br /> $ <br />, ' <br /> " <br />, <br /> (U~,i.;?2.000 per year) <br /> Total: $ , ~100. ~,c <br /> <br />Game Type <br /> <br />Description of Prize <br /> <br /> <br />II <br /> <br />, , <br /> <br />/1 <br /> <br />\\ <br /> <br />--- <br />~--- <br /> <br />Intended uses of gaming proceeds: <br /> <br />Does the organization presently have a state gaming license? fXl 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 1-800-326-9240. <br /> <br />Has tile organization received a charity'local permit from this or another city or county for the fiscal year July 1 through June 3D? ~-No Dyes _ If~Yes," <br />the organization does not qualify for a local permit or charity local permit <br /> <br />Has the organization received a local pennit from this or another city.or county'for the fiscal year July 1 through June 3D? tgfNo Dyes _ If "Yes," <br />indicate the total value of all prizes previously awarded: S . This amount is part of the total prize limit of $12,000 peryear. <br /> <br /> <br />Date <br />{, - ;2(;-tf(., <br /> <br />Title <br />U./'C LC/~ <br /> <br />