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RMIT <br />APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PE <br />OFFICE OF A~ORN~ GENE~L <br />SFN 9338 (02-2002) <br /> Application for: ~ Lo~l Pe~it * ~ Char[~ LO~I Pe~it (o.e e~m per year) <br /> <br />Business Address <br /> <br />TiUe ~ Busine~ Phone Numar <br /> <br /> Z~ Code <br /> <br />Name of S~[e Where Game(s) ~/111 be Conducted <br /> <br />hack the Game(s) [o b~ Conducted: * Poker, Twenty.one, and Paddiewheels may be Canducted only by a Chadty Local Permit- <br /> [] Bingo ,J~ Raffle []Calendar Raffle [] Sports Peel [] Poker ' [] Twenty-one * [] Padd~ewheels * <br /> <br />DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> <br /> Retail Value of <br />Game Type Desc~ption of Prize Pdze <br /> J l" TV' $ I00,00 <br /> ~,z~ jr: 1) I00.00 <br /> £D 50,00 <br /> <br /> Retail Value of <br />Game Type Description of Prize Prize <br /> $ <br /> <br /> (LTmit $8,000 per year) <br /> Total: $~ ?~r~.DD <br /> <br /> <br />