Form Ksu 8-45a - Raffle Policy And Guidelines - Kansas Dept.of Revenue (Page 2 of 4) in pdf

Form Ksu 8-45a - Raffle Policy And Guidelines - Kansas Dept.of Revenue Page 2

Raffle Application

Date application received in the Extension office: _________________

Staff Initials: ____________

Name of Extension group/groups conducting the raffle:

Date of the raffle:

Cost of the raffle ticket:

Number of pre-printed tickets to be printed:

Primary Contact Name for Raffle Coordinator:

Mailing address:

Town, Zip

Phone:

Work Phone:

E-mail:

Proposed date raffle ticket selling is to begin: _________________________ (Note, all raffles must be

approved by the ___________________________ prior to the sale of tickets, or the raffle will be cancelled by

the board and the ticket money refunded).

List of specific prizes to be awarded:

Primary purpose of the raffle:

How the money raised from the raffle will be

Approval:

________________________________________

_______________________

Signature of Board Chair/Designate

Date

________________________________________

_______________________

Signature of Board Secretary

Date

________________________________________

_______________________

Signature of Board Treasurer

Date

KSU 8-45a

February 2016

Form Ksu 8-45a - Raffle Policy And Guidelines - Kansas Dept.of Revenue Page 2