Application For Annual, Limited, State Fair Or Super Bingo License Page 2
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3APPLICATION FOR ANNUAL, LIMITED, STATE FAIR OR SUPER BINGO LICENSE
WV/BGO-1
rtL175 v.2-web
SECTION 4 - DATES AND TIMES OF ANNUAL AND SENIOR BINGO OCCASIONS
Please indicate the day(s) of the week your Bingo occasion(s) will be conducted and give the actual playing time:
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY SUNDAY (Circle Days Played)
Date of your first Bingo Occasion:
Hour(s) Bingo will be held:
SECTION 5 - DATES AND TIMES OF LIMITED BINGO OCCASIONS
A limited occasion license entitles an organization to hold a Bingo occasion once every 24 hours for a period not to exceed 2
weeks. An occasion may not exceed 12 hours duration. No more than three (3) Limited Licenses may be granted in one year.
List the actual dates and playing times Bingo will be conducted.
HOLDERS OF ANNUAL LICENSES MAY BE GRANTED NO MORE THAN ONE LIMITED LICENSE PER YEAR.
Date of Bingo:
Date of Bingo:
Time of Bingo(s):
SECTION 6 - DATES AND TIMES OF STATE FAIR BINGO OCCASIONS
STATE FAIR: AN APPLICATION FOR A STATE FAIR LICENSE MUST INCLUDE A COPY OF ANY LEASE
AGREEMENT ENTERED INTO BETWEEN THE STATE FAIR BOARD AND THE PERSONS WHO ARE TO
CONDUCT THE BINGO OCCASIONS.
Has the operator of the Bingo occasions conducted Bingo at the State Fair for at least 2 years prior to the filing of this
application?
YES
NO
(Circle One)
Date of your first Bingo Occasion:
Hour(s) Bingo will be held:
SECTION 7 - DATES AND TIMES OF SUPER BINGO OCCASIONS
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SECTION 8 - PROOF OF EXISTENCE (NOT REQUIRED FOR RENEWAL APPLICANTS)
HAS YOUR ORGANIZATION BEEN IN EXISTENCE IN WEST VIRGINIA TWO YEARS PRIOR TO FILING THIS APPLICATION:
YES
NO
(Circle One)
IF YES, YOU MUST ATTACH DOCUMENTARY PROOF. THIS DOCUMENT IS NECESSARY TO QUALIFY FOR A BINGO LICENSE.
SECTION 9 - CONCESSIONS
WILL A CONCESSION BE OPERATED?
YES
NO
(Circle One)
WILL THE LICENSEE OPERATE THE CONCESSION?
YES
NO
(Circle One)
PLEASE NOTE: IF THE CONCESSIONS ARE TO BE OPERATED BY SOMEONE OTHER THAN THE LICENSEE, A COPY OF ANY AGREEMENT OR AN
EXPLANATION OF ANY ORAL AGREEMENT PROVIDING OF ANY TYPE OF COMPENSATION OF THE CONCESSION MUST BE ATTACHED.
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