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<br />biJ?mJ+ i IO~OO ttwrM,on fa- <br />P(t(jt1~ Ii +v Cats tJ)L~n 11j t1u& 10( <br />APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT 'vJ i}}1 CP(yJ{) letc?J. <br />OFFICE OF ATIORNEYGENERAL yYA},J/,jlr.j..',o^ <br />SFN 9338 (10-2007) _vf( ) v..(;/' (.1T I <br />Application for: * D Charity Local Permit (one event per year) <br /> <br /> <br />(0 <br /> <br />Conductej1--. Lf' / <br />r~ (r 0-/0(,/ J1P 5' <br /> <br />Check the Game(s) to b onducted: <br />D Bingo Raffle <br /> <br />DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> <br />Game Type <br /> <br />Description of Prize <br /> <br />Retail Value of <br />Prize <br /> <br /> <br />.$' <br /> <br />nv;;-ct a;:MJ <br /> <br />Business Phone Number <br /> <br />'V I) 83tl - 4t/f <br />State Zip Code <br />;U;;J 5PICl 7 <br />Zip Code <br /> <br />D Paddlewheels * <br /> <br />Game Type Description of Prize Retail Value of <br />Prize <br /> (Limit $12,000 per year) <br /> Total: $> /5'aJ.-o.oo <br /> <br />Intended uses of gaming proceeds: <br /> <br />j/.fvc,6j4' YI; <br /> <br />>q;:-/l/J ~A~"l/ <br /> <br />( <br /> <br />/-1v~ <br /> <br />Does the organization presently have a state gaming license? (s;;I No DYes - If "Yes," the organization is not eligible for a local permit or charity local <br />permit and should call the Office of Attomey General at 1-800-326-9240. <br /> <br />Has the organization received a charity local permit from this or another city or county for the fiscal year July 1 through June 30? ~ No .lII Yes - If "Yes," <br />the organization does not qualify for a local permit or charity local permit <br /> <br />Has the organization received a local permit from this or anothf1r ci~r or county for the fiscal year July 1 through June 3D? 0 No ~ Yes - If "Yes," <br />indicate the total value of all prizes previously awarded: $=.fE'()()1J . This amount is part of the total prize limit of $12,000 per year. <br /> <br /> <br />Executive Official <br /> <br /> <br />Business Phone Number <br /> <br />It/I-;:? I' f'9 {f <br />