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<br />,~~{\::: ~r.'." <br /> <br />ir:~~J <br /> <br />'()II'\'! <br /> <br />APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT <br />OFFICE OF ATTORNEY GENERAL <br />SFN 9338 (10-2007) <br />Application for: 0 Local Permit <br /> <br /> <br />'ff <br /> <br />i~.\-. S.t <br />Mailing Address (if different) <br />P.O\ (I ~%'O <br />Name of Site Where Game(s) will be Conducted <br />K~~<.:\(,eV' bCclf"tv" Li' <br /> <br />Title <br /> <br />? <br /> <br />10 <br />State <br />pD <br />State <br />~J'D <br /> <br />City <br /> <br />e;, \(.( <br /> <br />City <br />\2.,; <br />Site Address <br /> <br />\-\1 )(~O_ <br />Check the Game(s) to be Conducted: <br />o Bingo 0 Raffle <br /> <br />41 "::t t'ljU '; v, tAv'( ~'I lJ( t <br />State Zip Code County <br />N \J C;;"60l.f7 C Ct.~ <::. <br />· Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Local Permit. <br />DCalendar Raffle 0 Sports Pool III Poker. 0 Twenty-one. <br /> <br />City <br /> <br /> <br />CC:~ t f' <br /> <br />DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> <br />Game Type <br /> <br />Retail Value of <br />Prize <br /> <br />Description of Prize <br /> <br /> <br />~ 1 tl(J s3 v.. <br /> <br /> <br />:;G '- <br />S~O.+I"'''\' <br /> <br /><:::" ~ . <br /> <br />-\ <br /> <br />v v"-. <br /> <br />C.(HV\ \ +' ... <br /> <br />-t-. <br /> <br /> <br />o Paddlewheels . <br /> <br />Game Type Description of Prize Retail Value of <br />Prize <br /> (urni! $12,000 per year) <br /> Total: $ 0.00 <br /> <br />Intended uses of gaming proceeds: <br /> <br />10 f"'(iy-t+r (}...... t" 12 '" lc" 'j f'e" VA u.f ~ <br /> <br />Does the organization presently have a state gaming license? [;gJ No 0 Yes - If "Yes," the organization is not eligible for a local permit or charity local <br />permit a nd should call the Office of Attomey General aI1-800-326-9240. <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 0 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 another city or county for the fiscal year July 1 through June 30? I&l No 0 Yes - If "Yes," <br />indicate the total value of all prizes previously awarded: $ . This amount is part of the total prize limit of $12,000 per year. <br /> <br />Business Phone Number <br /> <br /> <br />Date <br />i ! . s" olf <br /> <br />7Cl-.l.P7-31<i3 ~ n' <br /> <br />Title <br />vP <br />