Fillable Application For A Raffles License Form (Page 4 of 4) in pdf

Part I - Statement of Applicant and member(s) in charge

State of New Jersey

} ss.

County of __________________________________

We do hereby each make the following statement, under oath, with respect to the foregoing application:

1. The applicant (is) (is not) limited in its activities to the

5. For each occasion for which a license is sought, one or more of

furtherance of one or more authorized purposes as defined

the members listed who are familiar with the Raffles Licensing

in the Raffles Licensing Law.

Law and the Rules and Regulations, will be in full charge of,

and primarily responsible for, the conduct of the games.

2. Prior to the issuance of any license to it to conduct games

of chance, the applicant was actively engaged in serving

6. No commission, salary, compensation, reward or recompense

one or more “authorized purposes.”

will be paid to any person for holding, operating or conducting

or assisting in the holding, operation or conducting, of the

3. The applicant has received and used, and in good faith

games, except to bookkeepers or accountants for professional

expects to continue to receive and use, to further one or

services not exceeding the amounts fixed by the Schedule

more authorized purposes, funds from sources other than

of Fees, as well as the compensation for the Licensed

games of chance.

Compensated Workers pursuant to N.J.A.C. 13:47-6A. No

4. The conduct of the games on the occasion or occasions for

prize may be offered and given in cash, except as otherwise

which this application is made will be to raise and devote

provided by the Raffles Licensing Law (N.J.S.A. 5:8-50 et seq.).

the entire net proceeds to the authorized purpose described

If a cash prize under certain circumstances is permitted by the

in the application.

law, the amount of the cash prize may not exceed the limits

prescribed by the Raffles Licensing Law.

7. All statements in the foregoing application are true.

____________________________________________________

Sworn and subscribed to before me this

Signature of Officer and Title

______ day of ________________ , 20 ___.

____________________________________________________

Signature of Member-in-Charge

____________________________________

____________________________________________________

Notary Public (Print name)

Signature of Member-in-Charge

____________________________________

____________________________________________________

Signature of Notary Public

Signature of Member-in-Charge

____________________________________________________

Signature of Member-in-Charge

ffix seAl here

If more space is needed in any section of this application, insert extra sheets of paper.

Applicant’s registration slip from the Legalized Games of Chance Control Commission

must be presented to the Municipal Clerk with this application.

Application For A Raffles License Form Page 4

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