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<br /> <br />fTlrw LL{lf I ~ ~ yYi-t« ffY{~~ ~¿ : <br />\ APPLJCA TION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT(lì)b'l1JUr1:tLj UiJ.d¡TõY <br />~ OFFICE OF ATTORNEY GENERAL <br />SFN 9338 (07-2003) <br /> <br />Application for: <br /> <br />\ <br />eO Local Permit <br /> <br />* 0 Charity Local Permit (one event per year) <br /> <br />Date(s) of Activity SfP+ I L1 <br />St¡:¡t. --l to 'Z('k) <br />TItle c" '^ \. . Business Phone Number <br />~ '.l ~I'\.+ C( 8 .- t. K2- <br />City State Zip Code <br />\~O(CÀt e.... N t> -<5~ D r¡ <br />City State Zip Code <br /> <br /> <br />Name of Non-profit Organization <br /> <br />~. ßeAtchJ- ~ It. Lhw- <br /> <br />Person Responsible for the Gaming Operation, Induding Disbursement of Net Income <br /> <br /> <br />l'~ <br />Business Address <br /> <br />tr <br /> <br />æ:!!\. <br /> <br />Mailing Address (if different) <br /> <br /> <br />s1. So . <br /> <br />Name of Site Where Game(s) will be Conducted <br />Sf ell&- Q ~ e.h <br />City <br /> <br />Site Address <br /> <br />Check the Game(s) to be Conducted: <br />0 Bingo % P.affle <br /> <br />~, ~lh <br />CouRty <br />Lt\./>,y <br />* Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Loeal Permit <br />0 Calendar Raffle 0 Sports Pool 0 Poker ~ 0 Twenty-one * <br /> <br /> <br />~~~ <br /> <br />0 Paddlewneels' <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 />Game Type <br /> <br />Description of Prize <br /> <br />Retail Value of <br />Prize <br /> <br /> <br />II <br /> <br />II <br /> <br />$ 300 <br />~ . 0 <br />ti( DO <br />!í.1 00 <br />., 6{) <br />~6V <br />, <br /> <br /> <br />;It <br /> <br />~~ <br />S"ô <br /> <br />III <br /> <br />u <br /> <br />I' <br /> <br />I' <br /> <br /> <br />~ <br /> <br />$ 2> <br /> <br />I' <br /> <br />,¡ <br /> <br />¡, <br /> <br />.1 <br /> <br />". <br /> <br />,¡ <br /> <br />I' <br /> <br />(Umi! $12,000 ;:er year) <br />Total: $ tðS-tJ. ()(!) <br /> <br /> <br />Does the organization presently have a state gaming license? No Dyes - If ~es,. the organization is not eligible fOr a local permit or d1arity focal <br />permit and should call the Office of Attorney General at 1-800-32 9240. <br /> <br />Has the organization received a d1arity local permit from this or another city or county for the fiscal year July 1 through June 3D? r.4'No D Yes - If ~ es,. <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 3D? MNO 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 per year. <br /> <br /> <br /> <br />1i~\ ~ <br /> <br />