Monte Carlo Lottery Licence Application Page 2
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1
2Monte Carlo Lottery Licence Application
Event(s) Date(s)
1) A single event to be held on _______________________________________
2) A series of events to be held during the period ____________________ to ____________________ for a total of __________ events.
Event Information
Monte Carlo Tables & Games
Number of Tables/Games
Admission
per event
Number of Tickets Printed ________________________
Ticket Price $ __________________________________
Roulette
_________________
Is there a door prize or ticket draw associated
Blackjack
_________________
with the purchase of the ticket?
Yes
No
Poker
_________________
If Yes, what is the value of the prize? $ _____________
Horserace
_________________
and describe the prize(s): ____________________________
Other Games & Tables
_________________
___________________________________________________
(please describe below)
Wheel of Fortune
Number of Wheels per event
______________________
_________________
______________________
_________________
Ticket Wheel (cash or merchandise)
_________________
______________________
_________________
Crown and Anchor
_________________
Over and Under
_________________
Other Wheels (please describe below)
_________________
Ticket Raffle
______________________
_________________
(Prize value per raffle cannot exceed $500)
Yes
No
______________________
_________________
Lotteries Trust Account Information
Event(s) Chair/Manager
Name of Bank of Financial Institution:
Person responsible for the event(s):
________________________________________________________
____________________________________________________________
________________________________________________________
Phone (W): ___________________ Phone (H): ______________________
Address: ________________________________________________
Gaming Supplier(s)
________________________________________________________
Name of gaming supplier(s):
City/Town: _______________________________________________
____________________________________________________________
Province: ________________________________________________
____________________________________________________________
Type of account: __________________________________________
Licence
If you would like to pick up your licence please check the appropriate location, otherwise the licence will be mailed to your organizations mailing
address.
Service Centres:
St. John’s
Clarenville
Gander
Corner Brook
729-2660
466-4085
256-1019
637-2445
Reminder
This application is only to be used if applying for a Monte Carlo Table or Monte Carlo game.
The application must be signed by two principal officers of your organization. i.e. president, vice president, treasurer.
Any changes or amendments to the licence shall be requested in writing. A licence is not transferable.
A licence will not be issued for a Monte Carlo lottery event where the location of the event will be a commercial bar or tavern.
Please read the General Rules and the rules for Monte Carlo lottery before submitting your application. See Schedule “F”
Please allow two weeks for the processing of your application.
June 21, 2012
Service NL
Government of Newfoundland & Labrador
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