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

Form Ksu 8-45a - Raffle Policy And Guidelines - Kansas Dept.of Revenue Page 4

Ticket Sample – Note ticket should be perforated.

Clover County 4-H Council Raffle - $1.00

001

Clover County 4-H Council Raffle - $1.00

001

Raffle Drawing – February 20, 2016

Raffle Drawing – February 20, 2016; at the Clover County 4-H

Carnival, Clover County 4-H Building, Clovertown, KS

Name: ________________________________

Prizes to be awarded:

Mailing Address:__________________________

-Dinner for 2 at Pizza Hut (Valued at $50.00)

-$50 gift certificate to Home Depot

Town: _____________________ Zip:________

-$100 gift certificate to local grocery store, Clovertown, KS

-10 car wash coupons to local car wash (Valued at $120.00)

Cell Phone:___________ Work: _____________

-10 movie passes to local movie (Valued at $100.00)

E-Mail:_________________________________

Need not Be Present to Win!

To be retained for the drawing of prizes.

For a complete listing of prize winners, contact:

Debbie Coupon, iloveraffles@yahoo.com; 785-555-2007 after

February 27, 2016. This ticket is to be given to purchaser.

February 2016

Form Ksu 8-45a - Raffle Policy And Guidelines - Kansas Dept.of Revenue Page 4