Application For A Raffles License Form
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4Application for a Raffles License
Application No. RA _________________
Identification No. __________________
Submit four (4) copies of this application to the Municipal Clerk’s office in the municipality where the games will be conducted.
Please print clearly.
Name of municipality: ____________________________________________________________________________________
Part A - General
1. Name of applying organization: _________________________________________________________________________
2a. Street address of headquarters: __________________________________________________________________________
b. Mailing address (if different):
3. A license is requested to conduct raffles of the kind stated on the date, or on each of the dates, and during the hours listed
(use a separate application for each type of raffle).
Date
Hours
Date
Hours
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4a. Address of place where raffles will be played:
b. Does the applicant own the premises or regularly occupy them for its general purposes?
Yes
No
5. If raffles equipment is to be rented, attach a statement by the raffles equipment lessor to this application on Form 13.
Part B - Schedule of Expenses
The items of expense intended to be incurred or paid in connection with the games listed in this application, the names and
addresses of the persons to whom each item is to be paid, and the purpose for which each item is to be paid, are:
Item of Expense
Name and address of supplier
Purpose
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