Application For Conducting A Raffle Form - Adams County, Illinois (Page 2 of 2) in pdf

Application For Conducting A Raffle Form - Adams County, Illinois Page 2

3. Presiding Officer _____________________________________________________

Address _____________________________________________________________

Phone _______________________________________________________________

Raffle Manager _______________________________________________________

Address _____________________________________________________________

Phone ____________________ Relationship with organization _______________

I certify that this organization is non-for-profit; it has been in existence continuously for at

least the past five years; it has maintained a bona fide membership engaged in carrying out its

objectives; its officers, operators, and workers at the raffle are bona fide members of the

organization and are of good moral character. I further certify that all of the information

provided in this application is true, to the best of my knowledge.

4. All Officers must sign below:

Presiding Officer Signature ____________________________________________

Additional Officer(s)

_____________________________________________

Raffle Manager Signature _____________________________________________

Return application to:

Adams County Clerk

507 Vermont St.

Quincy, IL 62301

Application For Conducting A Raffle Form - Adams County, Illinois Page 2