Form Rev-1753 As Application For Small Games Of Chance Page 4

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REV-1753 AS (03-16)

SMALL GAMES OF CHANCE SCHEDULES

SCHEDULE D

List all states wherein business is conducted regarding small games of chance. Attach a seperate sheet if more space is required.

SCHEDULE E

Check all types of games distributed and manufactured:

Daily/Weekly Drawings

Pull-Tabs

Punchboards

Raffles

Race Night

Pools

50/50 Drawings

Dispensing Devices

Check all types of entities that small games of chance will be sold to:

Eligible Organizations

Club Licensees

Taverns

Manufacturers must submit all pull-tab games, punchboards and dispensing machines to be reviewed and approved.

•

For games that the department previously has approved, provide a list of the games to be manufactured for sale in the commonwealth during the reg-

istration term. The list shall include the name of the game and form number.

•

If a manufacturer is discontinuing the sale of previously approved game(s), the manufacturer shall submit a list of the game(s). The list shall contain

the name of the game and form number.

•

For new games that the department has not previously approved, attach a game approval form (REV-915) for each game.

Attach a separate sheet if more space is required.

Form

New or

Form

New or

Name of Game

Discontinued

New

Discontinued