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Charity Gaming Qualification Application Instructions - Indiana Department Of Revenue Page 2

Line 9 - Enter information about the parent organization.

If your organization does not have a parent organization,

check "No" and continue to Line 10. If your organization is

affiliated with a parent organization, complete Lines 9b and

9c.

b) List the name of the parent organization, their street address,

city, state, zip code, county, daytime telephone number, and

their federal identification number.

c) Enter the number of years the parent organization has been

in active, continuous existence. Note: If your organization

has not been in existence for five years, your parent

organization must have been. If this is the case, attach

verification of continuous existence information (detailed

in the line 7 instructions) for the parent organization.

Line 10 - If you answered yes, attach a copy of the favorable

tax-exempt status letter from the Internal Revenue Service. If

this letter has been applied for but not yet received, attach a

copy of the application plus a copy of the check used to pay the

application fee.

If you answered no, your organization is not

eligible to conduct charity gaming activities in Indiana.

Note: You must send a copy of the favorable tax-exempt status

letter once it is received. Failure to do so will result in the delay

of additional charity gaming licenses.

Line 11 - You should list all potential operators who might

manage your gaming events. The operators may not have been

convicted of a felony within the last ten years. The names provided

on this form will be cross-checked against felony records.

Your operators must be at least 18 years old and be a member in

good standing with your organization for at least one year before

managing your gaming event. In addition, operators must not

have managed a gaming event for any other organization in the

same calendar month your event is scheduled to be held.

Line 13 - Carefully read Line 12. Make sure that you agree

with the information on Line 12 before you sign the application.

*Note: Once a year a qualified organization holding an annual

convention of its (or its affiliates) membership may hold a charity

gaming event in an Indiana county other than the county of its

principal office. A note to this effect must be attached to the

particular gaming event license application. Read Publication 2,

Charity Gaming Information, for more details.

Charity Gaming Qualification Application Instructions - Indiana Department Of Revenue Page 2