Form Ksu 8-45a - Raffle Policy And Guidelines - Kansas Dept.of Revenue Page 3

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Raffle Final Report
This report is due within 10 days after the drawing of the raffle prizes.
Date final report received in the Extension office: _________________
Staff Initials: ____________
Name of Extension group/groups conducting the raffle:
Name of raffle coordinator submitting report:
Mailing address:
Town, Zip
Phone:
Work Phone:
E-mail:
Number of raffle tickets sold:
Number of tickets returned to raffle coordinator:
(Total should match the total number of tickets printed).
Total amount of money collected:
Who collected and counted the money?
Where and when was the raffle money deposited?
Describe any problems, inconsistencies or issues with this raffle:
________________________________________
_______________________
Signature of Raffle Coordinator
Date
Final Board Acceptance:
________________________________________
_______________________
Signature of Board Chair/Designate
Date
________________________________________
_______________________
Signature of Board Secretary
Date
________________________________________
_______________________
Signature of Board Treasurer
Date
KSU 8-45b
February 2016

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