MIME-Version: 1.0 Content-Location: file:///C:/0C4BB24E/business-chance-application.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Games of Chance and Skill Permit

Games of Chance and Skill Permit

Application for Use

Organization  ­­­­­­= ;­­­­­­­­­­­­­­­= ;­­­­________________________________________________= _

 

Person in Charge  _____________________________  Phone __________

 

Address  _____________________________________________________

 

Type of Use: &nbs= p; Raffle ___  =   Lottery ___  O= ther ____________________<= /span>

          For Raffle/Lottery: Number of tickets to be printed _______________

 

Outline of Event (location of event/place of sales, date of drawi= ng, who will sell tickets, etc)

_____________________= _________________________________________________________________

 

_____________________= _________________________________________________________________

 

_____________________= _________________________________________________________________

 

Revenue will be used for (specific use):

_____________________= ________________________________________

_____________________= ________________________________________

 

Dates revenue will be used: _______________________________________

 

Account number that all funds will be deposited to and= all expenses will be paid from:

_ _ _ _ _ - X X X X - _ _ _ _ _ _ (All revenue will be deposited to object code 9871)=

 

Department account number to cover any deficit: _ _ _ = _ _ - X X X X - _ _ _ _ _ _

 

Tentative Budget: = ;            &n= bsp;     Expenses        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;           Income

   &nbs= p;        Advertising     _________________= _____    Sales             =    __________________

   &nbs= p;        Printing  &n= bsp;        _____________________= _    Admission       ___________= _______

   &nbs= p;        Prizes        &= nbsp;      ______________________    Other            =    __________________

   &nbs= p;        Postage        &= nbsp;   ______________________        &= nbsp;           &nbs= p;       __________________

   &nbs= p;        Other        &= nbsp;      ______________________        &= nbsp;           &nbs= p;       __________________

   &nbs= p;            &= nbsp;           &nbs= p;       ______________________        &= nbsp;           &nbs= p;       __________________

   &nbs= p;        TOTAL          __________= ____________    TOTAL   &= nbsp;      __________________

 

   &nbs= p;            &= nbsp;       Projected NET _______________________= ____

 

Prizes to be awarded (may be submitted as attachment): __________________________

 

______________________________________________________= __________________

 

______________________________________________________= __________________

 

Signature of Person in Charge:  ________________= _______________  Date: _________­­­<= /b>