Form Bc-6 - Application To Amend Bingo License printable pdf download

Form Bc-6 - Application To Amend Bingo License

Division of Charitable Gaming

BC-6 Application to Amend Bingo License

Municipal License Number: _________ Amount of Fee Paid: $__________ Date: ________

ust Be Conspicuously

Displayed Along With

_______________________

License (BC-5)

Bingo Identification Number:

Name of Organization: _______________________________

Present License Number: _______________________

Address: __________________________________________________________________________________________

(Organization)

Street Address

City/Town/Village

Zip Code

Address: _________________________________________________________________________________________

(Where games will be conducted)

Street Address

City/Town/Village

Zip Code

Application is hereby made to amend the above numbered license. The amended information is contained in the schedules

which are checked below and attached, and are to replace the schedules previously filed.

___ Schedule 1.

Officers and Directors

___ Schedule 2.

Members in Charge of Games

___ Schedule 3.

Auxiliary/Affiliate Organizations Assisting at Games

___ Schedule 4.

Assistants to Members in Charge of Games

___ Schedule 5.

Dates, Hours and Rent of All License Periods to be Held

___ Schedule 6.

Expenses

___ Schedule 7.

Types of Games

If any other information furnished on original application is to be changed, show amended data below.

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BC-6 (Rev. 9/2014)

Form Bc-6 - Application To Amend Bingo License