Laserfiche WebLink
<br />(,~lft~t.~\ <br /> <br />11.." . "'1:i :~l 'I <br /> <br />;~\~~a~~~ll <br /> <br />b~m)+ i IV. 00 awrtaf,.on 1ft, <br /> <br />APR 28 2DDB fCUja,bJi..(o WSCl>Unfy 'ffu&ir;t <br />APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT IN i}}t CP/Yl{) le.tr?J. <br />OFFICE OF AITORNEYGENERAL Y:tiN!.jI"j..,o^ <br />SFN 9338 (10-2007) _vff ) v.t//I (l71 <br />Application for: ~ Local Permit (one event p'eryew)l:j..-t <br />Date(s) of Activity I <br />JiL l~ f" '2 ('4 to ~. f' 20 () ? <br />Title Business Phone Number <br />O\Lt V'-~ ,9,J)J ~ ~~ d-}- <br />lip Code <br />5t07t <br />lip Code <br />5"f:'D 7 Y <br /> <br />RECEIVED <br /> <br />Name of Non-profit Organization <br />CtA S S. C Ou.. 1-"; .\+) 'S TIvYI (c:~ ~ 0 u e <br />Person Responsible for the Gaming Operation. Including Disbursement 0 <br />\Z\ \ '<\. "~\. ~CD <br />Business Address <br /> <br /> <br /> <br />" 2> S \ \;J EsT /\/\A1 ~ <br />Mailing Address (if different) <br />\00 ~ -II?) <br /> <br />City <br />ll/(ST Pr-h2 6. 0 <br /> <br />State <br /> <br />AJO <br /> <br /> <br />Name of Site Where Game(s) will be Conducted <br />c.......5\ \ <br /> <br />City <br />AJ f:-s T P fh'2.01 0 <br />Site Address <br /> <br />State <br /> <br />Cihl <br /> <br />bJ e;;..".+ i=c, '(2 <br /> <br />Check the Game(s) to be Conducted: . Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Local Permit. <br />o Bingo ~Raffle DCalendar Raffle 0 Sports Pool D Poker' D Twenty-one' \ D Paddlewheels' <br /> <br /> <br />.)J l) <br /> <br />DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> <br />Game Type Description of Prize Retail Value of <br />Prize <br />r {(-(~ l--e.. I~t( eh ~ (t $20l)() <br /> --c::' <br /> <br />Game Type Description of Prize Retail Value of <br />Prize <br /> (Limit $12,000 per year) <br /> Total: $;1 00 0 0.00 <br /> <br />Intended uses of gaming proceeds: D?e.l{"@ ~ <br /> <br />s l^.J\? pO vT <br /> <br />Does the organization presently have a state gaming license? ~ No DYes - If "Yes," the organization is not eligible for a local permit or charity local <br />permit and should call the Office of Attorney General at 1-800-~-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 0 Yes - If "Yes," <br />the 9rganization does not qualify for a local permit or charity local permit. <br /> <br />Has the organization received a local permit from this or another ci~ or county for the fiscal year July 1 through June 30? 0 No ~ Yes - If "Yes," <br />indicate the total value of all prizes previously awarded: $ 2-- CO' . -- . This amount is part of the total prize limit of $12, 000 per year. 2- I:) 0 7 <br />'D2.~ <br /> <br /> <br />Date <br />g..1-0~ <br /> <br /> <br />{,{.--D,'ve.- ~1Y eCD..V <br /> <br />