Form 201 - R - Charitable Gaming Permit Application Renewal Applicants Only Page 6
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12FOR VOLUNTEER FIRE DEPARTMENTS AND RESCUE SQUADS EXEMPT FROM THE
APPLICATION FEE UNDER § 15.2-955 OF THE CODE OF VIRGINIA, 1950, AS AMENDED.
30.
Is the applicant organization currently recognized in accordance with Section 15.2-955 by
an ordinance or resolution by a political subdivision where the organization is located as
being part of the safety program of the political subdivision?
Yes or No
31.
Date the organization was recognized in accordance with Section 15.2-955 by an
ordinance or resolution by a political subdivision where the organization is located as being
part of the safety program of the political subdivision.
Month/Date/Year
32.
Name of political subdivision that has recognized the applicant organization as being part
of its safety program.
County, City or Town
33.
Provide a copy of the dated ordinance or resolution issued by the above referenced
political subdivision that designates the applicant organization as being part of the safety
Copy
program of the political subdivision.
attached?
Yes or No
FOR OCRP USE ONLY
Gaming Locality City/County Code:
Organization Locality City/County Code:
CONTINUE TO NEXT PAGE
Charitable Gaming Permit Application - Renewal Applicants Only
Rev. 07/30/13
Page 6 of 12
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