Form L-2060 - Application For A Class D Bingo License - 2008
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1STATE OF SOUTH CAROLINA
1350
1350
DEPARTMENT OF REVENUE
L-2060
APPLICATION FOR A CLASS D BINGO LICENSE
(Rev. 9/24/08)
4139
FOR THE YEAR OF ______
Do Not Write in This
TO OPERATE AT A RECOGNIZED STATE OR COUNTY FAIR
Space
General fund $ _____________
Cash-M.O.-Check
Games are to be played 10 days or less
- $100.00 Fee
File#
Exp. Date
Games are to be played more than 10 days
- $200.00 Fee
Audit by
Date
The remittance for your license fee will be deposited by the Department of Revenue immediately upon receipt. This is not to be
interpreted as approval of the application. If the application is not approved the fee will be refunded.
Mail application and make check payable to the South Carolina Department of Revenue, Regulatory Division, Bingo Enforcement,
Columbia, SC 29214-0140. Telephone (803) 898-5393.
1. Name of Fair
Mailing Address
City
State
Zip
Location
2. Dates games to be played: From __________________________________________ Thru
3. Has fair been recognized by the governing body of county in which it is to be held (County Fair) or by the South Carolina
Agricultural and Mechanical Society (State Fair)?
Yes or No
4. Name of person responsible for operating the Bingo Games:
5. How many locations will be used for Bingo Games:
Maximum fair market value of merchandise offered as prizes for each game must not exceed $50.00.
**********
I, ____________________________________, certify that the information contained in this application is true and correct
(Please print)
and that I have the authority to submit this application. I further certify that the Bingo Games will be conducted in compliance with all applicable
sections of the South Carolina Bingo Act of October 1997 to include but not limited to, Section 12-31-3620 of that Act.
Sworn to and subscribed before me this
Signature
____________________ day of __________________ 19 ______
Title
Notary Public for South Carolina
Date
14-25512
41391020
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