Form Gc-2 - Application For Games Of Chance License
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1
2Division of Charitable Gaming
GC-2 Application for Games of Chance License
Check the type of license(s) you are applying for:
Bell Jar ______ Casino Nights ______ Raffles
(net profits over $30,000 in calendar year) _______
PART A. GENERAL
1. Name of Organization: __________________________________________________________________________
2. Street Address of Organization:
_____________________________________________________________________________________________
Street Address
City/Town/Village
Zip Code
3. Has applicant ever been denied a games of chance license? _____ Yes _____ No If “yes”, why?
_____________________________________________________________________________________________
4. Check type of organization and, if applicable, give the State and date of incorporation.
Corporation
______
Incorporated Association
______
State Incorporated _____________________
Date ______________
Unincorporated Association ______
Individual
______
State Incorporated _____________________
Date ______________
5. Did your corporate status change since your identification number was assigned? _____ Yes ______ No
If “yes”, under what name? __________________
6. Are you doing business under a trade name? ____ Yes ____ No
PART B. LOCATION OF GAMES
7. Address where games, bell jar, or raffle drawing(s) are to be conducted.
_____________________________________________________________________________________________
Street Address
City/Town/Village
Zip Code
8. Name and address of authorized games of chance lessor renting premises to applicant:
______________________________________________________________________________________
Name
Street Address
City/Town/Village
Zip Code
9. Does the applicant own the premises? _______ Yes
_______ No
10. Capacity for public assembly of premises presently owned or occupied. ____________________________
11. Have premises been regularly used? ___ Yes ____ No If “yes”, how long? ______________________
Have games of chance ever been played on these premises? _____ Yes _____ No
Page 1 of 2
GC-2 (Rev. 2/2014)
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