Cg-3 State Form 45382 - Single Event License Application - 2005 Page 3
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4Gross Retail Sales Information
14. a. Will you be conducting any type of sales during the licensed event? (Check one)
Yes*
No
(Example: concessions, daubers, snacks, etc.)
*If you answered "Yes" complete the following information. If the seller is required to have a Retail Merchant Certificate, enter that number
in the box provided.
Name of organization offering the sales
Retail Merchant Certificate Number
b. Which of the following will your organization be receiving? (Check one.)
_____ All of the sales income
_____ A flat fee sales payment
_____ A percentage of the sales income
_____ Other (explain) ____________________________________________
Game and Prize Information
Answer the following for all gaming events:
15. Will your organization be conducting a door prize drawing during this event?
Yes
No
16. Will your organization be selling pull tabs, punchboards and/or tip boards at this event?
Yes
No
Note: A Calendar Raffle and Annual Door Prize license does not authorize the sale of pull tabs, punchboards or tip boards.
Answer the following for FESTIVAL EVENTS:
17. Will your organization be conducting card, dice and/or wheel games at this event?
Yes
No
18. Will your organization be conducting a raffle during this event? (one day only) indicate the date ____/____/______ Yes
No
19. You may request special permission to increase certain prize limitations at this festival or special bingo event.
Check this box only if you wish to increase the total bingo prize limitation for the special bingo event(s) at this festival from $6,000 up
to $10,000 for the entire event. Note: You may increase your bingo prize limitation only two (2) times a year for all charity events.
Please list the exact date(s) from those listed on page 1,
line 5, you wish to increase this bingo prize limitation.
Check this box only if you wish to increase the total door prize limitation for this festival license or door prize license from $5,000
up to $20,000 for the entire event. Note: You may increase your door prize limitation only one (1) time a year for all door prize events.
Limitation on door prize drawings at all other events is $1,500.00 and cannot be increased.
Please list the exact date(s) from those listed on page 1,
line 5, you wish to increase this bingo prize limitation.
Answer the following for RAFFLE EVENTS:
20. Check a box below only if you are requesting special permission to:
Hold this raffle at a licensed bingo event
Hold this raffle at a licensed Charity Game Night event.
Answer the following for Charity Game Nights and special bingo events:
Are you going to have a raffle at the event?
Yes
No
If yes, you need to complete an additional CG-3 and pay an applicable fee.
Yes
No
Note: You may hold a raffle event only one time a year at a licensed bingo event, and only one time a year at a licensed Charity Game Night event.
21. Check this box only if you are requesting special permission to:
Increase the total raffle prize limitation for this raffle license up to $25,000.*
*Note: The prize limitation on the raffle drawings when held at either a special bingo or Charity Game Night event is $5,000. With special permis-
sion from the Department, this prize limitation may be increased up to $25,000 one time a year.
Answer the following for CALENDAR RAFFLE EVENTS OR ANNUAL DOOR PRIZE EVENTS:
22. Has your organization attached a calendar list of dates on which you plan to conduct drawings?
Yes
No*
23. The drawing hours listed on Line 5 must be for a period of eight hours or less. Are your drawings
being held during those hours?
Yes
No*
*No license will be issued if you answered No to questions 22 and/or 23.
Note: Your calendar can not exceed a twelve-month period. See Publication 2: Charity Gaming Information for more details.
CG-3 (3)
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