Raffle Report Of Operations Form - New Jersey Department Of Law And Public Safety

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O
A
G
FFICE OF THE
TTORNEY
ENERAL
D
L
P
S
EPARTMENT OF
AW AND
UBLIC
AFETY
D
C
A
IVISION OF
ONSUMER
FFAIRS
L
G
C
C
C
EGALIZED
AMES OF
HANCE
ONTROL
OMMISSION
PO B
46000 N
, NJ 07101
OX
EWARK
973-273-8000
Raffle Report of Operations
Please print or type.
I.D. Number _________________________
Municipality _______________________________________________________
License number ______________________
Name of Licensee______________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
Street Address
City
State
Zip Code
Location of Games _____________________________________________________________________________________________________________
This report, as required by N.J.S.A. 5:8-37 and N.J.A.C. 13:47-9, must be filed with the Legalized Games of Chance Control Commission
no later than the 15th day of the month following the conduct of the games(s) of chance.
Occasion 1
Date _______________________________
Time _______________________________
Type of raffle ________________________
No. of tickets sold _____________________
Ticket price $_________________________
Gross receipts $_______________________
Cost of prizes $________________________
Rental $_____________________________
Equipment costs $ _____________________
Other $_____________________________
Total Expenses $______________________
Type of prize __________________________________________________________________
Net Proceeds $________________________
Occasion 2
Date _______________________________
Time _______________________________
Type of raffle ________________________
No. of tickets sold _____________________
Ticket price $_________________________
Gross receipts $_______________________
Cost of prizes $________________________
Rental $_____________________________
Equipment costs $ _____________________
Other $______________________________
Total Expenses $______________________
Type of prize ___________________________________________________________________
Net Proceeds $________________________
Occasion 3
Date _______________________________
Time _______________________________
Type of raffle _________________________
No. of tickets sold _____________________
Ticket price $_________________________
Gross receipts $________________________
Cost of prizes $________________________
Rental $_____________________________
Equipment costs $ ______________________
Other $______________________________
Total Expenses $_______________________
Type of prize ___________________________________________________________________
Net Proceeds $_________________________
Occasion 4
Date _______________________________
Time ________________________________
Type of raffle _________________________
No. of tickets sold _____________________
Ticket price $__________________________
Gross receipts $________________________
Cost of prizes $_______________________
Rental $______________________________
Equipment costs $ _____________________
Other $_______________________________
Total Expenses $_______________________
Type of prize ____________________________________________________________________
Net Proceeds $_________________________
Occasion 5
Date ________________________________
Time ________________________________
Type of raffle _________________________
No. of tickets sold ______________________
Ticket price $__________________________
Gross receipts $________________________
Cost of prizes $________________________
Rental $______________________________
Equipment costs $ ______________________
Other $_______________________________
Total Expenses $_______________________
Type of prize ____________________________________________________________________
Net Proceeds $_________________________
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