e. Permit for raffle and bingo - Laserfiche WebLink

&~m)f $10.00 appH'ta:t,-on fa" ~~t1b Ii -it> WS(}unty ftu&1o( APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT vJ \}}t ()f\1~ )e;t~ .. OFFICE OF ATTORNEY GENERAL ~JNIf(:a'hf9r1 SFN 9338 (10-2007) -~H Application for: ~~I Permit * 0 Charity Local Permit (one event per year) Date(s) of Activity /-;;..t -or Title //,e. 5 ,'/~ t( ) (1) to / - ;Z h ~ 0 ~ Business Phone Number 70/- dJ?'- ).;L/ City State Zip Code City w~~~fb../l / Site Address State 1Y:lAk. Zip Code SS'o' .tl Check the Game(s) to be Conducted: * Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Local Permit. ~ ~ffle DCalendar 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 ~c .:/ O. #" LJOD. o Paddlewheels * Game Type Description of Prize Retail Value of Prize (Limit $12.000 per year) Total: $ J cf,,"o#' 0.00 / Intended uses of gaming proceeds: /-1 L:vulv /:"f? /.I.. 14.'t /.;,,("1:. ((t,.o'.s/ ~ f) /:,.;4 \ P{e.....':l..o.., ;I R<it,/eCc.9p ( Ht..<..rt 1<eo,.: t?"j:-./......eJ.;C.......... / Does the organization presently have a state gaming license? ~ Yes - If "Yes," the organization is not eligible for a local permit or charity local penmit 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 "Yes," the organization does not qualify for a local permit or charity local penmit. f1, \.- ' Has the organization received a local penmit from this or another city or county for the fiscal year July 1 through June 30? I2j11o ~~ - 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. Title r:. / l'.e 5. Date /;J. -A 0- 0