Laserfiche WebLink
<br /> <br />'- JI~I' "ì ¡VI IJnn¡ ¡ YâU,,'1,(,} Þ-J;) Û71 ~,',' :"J"lO;] _"I <br />,~ l LA) l).,14' {lj..{ftl ¡ ( -ICV'J/-:itl) j¿ ;'¡ <br /> <br />APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT(hs~~ èYua1J.f :OJJie¡,fo/ <br /> <br />OFFICE OF A TIORNEY GENERAL <br />SFN 9338 (07-2003) <br /> <br />* 0 Charity Local Permit <br /> <br />NameÑONr~nOrg~OXì (hurcR Dafs~ 0~AJ~ty()4 <br /> <br />Person Re~T\~ th~ m¿'tJ~ration, Including Disbursement of Net Income TItle <br /> <br /> <br />Busin\~7ö3 Vd-rJ Ç} r£-, City }(Jr1lreJ <br />Mailing Ad{~ lffelLt ~ \J'~ (PD~)( L1 (p )~'nclfci ) <br />Name of I~ T]1å~ml~~ðå(trhU[æ <br />City~ì Y\t1 ( fJ <br /> <br />Application for: <br /> <br />QlLocal Permit <br /> <br />(one event per year) <br /> <br />to ¥~ J;)-O4 <br />Bt1ð'JP4"5J~~ Y ~ <br />S1j() ljp~ 5 ì <br />City ~YlJj ëJ S1\J 0 ljp ~ 5/ <br />SiteA'&1óJ f)Jrd £+ S~ <br />smV IZJP~6~ ì I CounbM <br /> <br />Check the Game(s) to be Conducted: * Pokero Twenty-one, and Paddlewheels may be Conducted only by a Charity LoCal Permit <br />0 Bingo C&l Raffle 0 Calendar Raffle 0 Sports Pool 0 Poker * 0 Twenty-one * <br /> <br />0 Paddlewheels. <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 />~tf\t <br /> <br />1\ <br /> <br />II <br /> <br />;-my ~Ii/Ì ~\-cduft $ dC15 -- <br />& Ufð1 Ç' í U ~~ Lt ;){j) -- <br />~} Per61 btJ ~O -- <br /> <br />$ <br /> <br />(Umit $12,000 per year) <br />Total: $ 535. dO <br /> <br />Inteoded uses of gaming p<Oœeds, 1'Y1D flQI J tor b mefJ t1: i arb J ertt V icj¡ m Îtlh ya. Bu ç h <br /> <br />Does the organization presently have a state gaming license? ~o 0 Yes - 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 1-800-326-9240. <br /> <br />Has :he 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? f29,No 0 Yes - If "Yes, . <br />indicate the total value of all prizes previously awarded: $ . This amount is pari of the total prize limit of $12,000 per year. <br /> <br />kf~.:æt~~d" <br /> <br />~~ <br /> <br /> Tltle <br /> <br />I Brøe~ ÿ¡ - 3J~~ I <br />