Large Stakes Card Game Tournament Permit Application & Notification Form
Download a blank fillable Large Stakes Card Game Tournament Permit Application & Notification Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Large Stakes Card Game Tournament Permit Application & Notification Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3LARGE STAKES CARD GAME TOURNAMENT
OFFICE USE ONLY
PERMIT APPLICATION & NOTIFICATION FORM
CHECK AMOUNT:
______________
Montana Department of Justice, Gambling Control Division
CHECK NUMBER:
______________
2550 Prospect Ave. ● PO Box 201424 ● Helena, MT 59620-1424
Phone: (406) 444-1971 ●
Fax: (406) 444-9157
NO OF TRNYS:
______________
Email: GCD@mt.gov
NO OF CHARITABLE: ______________
APPROVED:
______________
Please check one of the following:
NOT APPROVED:
______________
ANNUAL PERMIT FEE: $120.00 (for first application)
SECOND AND SUBSEQUENT TOURNAMENT NOTIFICATION(S) NO FEE
_
_
_
GOA
GAMBLING OPERATOR ACCOUNT NUMBER
FEDERAL TAX ID
ESTABLISHMENT NAME
ESTABLISHMENT PHONE NUMBER
MT
LOCATION OF TOURNAMENT (ADDRESS)
CITY
STATE
ZIP
EMAIL ADDRESS
Number of licensed tables
Number of tournament tables
*Date(s) of tournament
Total amount of entry and reentry
$
fees charged (may not exceed
$1,875)
Type of card games to be played
Estimated amount of all prizes
$
including the amount of any cash
prizes or the value of a seat in a
Face value of the chips to be
higher level tournament
used
Is this a Charitable Tournament?
Yes
Is this a Progressive Tournament?
Yes
If yes, please provide in the box below the name(s)
No
If yes, please provide in the box below (attach separate
No
and address of each charitable, educational, or
sheet, if needed) the name(s) and address of each
recreational nonprofit organization(s).
participating location.
NOTE:
At least 50% of all entry and reentry fees
NOTE:
Each location participating in the progressive
must be paid to the nonprofit organization(s)
tournament must obtain a separate tournament permit.
Name:
Address:
1
1
2
2
2
**SUBMIT A COPY OF ANY RULES THAT ARE NOT INCLUDED IN THE POKER TOURNAMENT DIRECTOR’S ASSOCATION
RULES**
*NOTE:
Applications
MUST
be received by the Division at least 5 business days prior to start of tournament
I CERTIFY THAT THIS INFORMATION IS TRUE AND CORRECT
AUTHORIZED SIGNATURE
PRINTED NAME OF PERSON SIGNING
DATE
FORM 14A REV 06/14
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial