Form Ador 71-1007 - Bingo License Application Packet printable pdf download

ARIZONA DEPARTMENT OF REVENUE

BINGO SECTION

Bingo License Application Packet

Enclosed is your bingo application packet including: 1) Application for Bingo License; 2) Afﬁ davit; 3) Endorsement by Local Governing Body.

All forms must be complete and legible. Please type or print using black ink only. Also, be sure to indicate on your application a telephone

number where you (or another party responsible for the games) can be reached during the day. If you need additional forms or have any

questions, please call the Bingo Section in Phoenix at (602) 716-7801.

The bingo license package for NEW license and appropriate fees must be forwarded to and approved by the local governing body, (the city

council for incorporated cities or the county board of supervisors for unincorporated areas) prior to submission to the Bingo section.

As part of the review of your application for a bingo license, this Section shall conduct an analysis of any purchase agreement for either

equipment and/or real property to determine that such agreement is bona ﬁ de. This analysis is conducted pursuant to ARS 5-406.F. The

Bingo Section does not “approve” these agreements as to content or other legal ramiﬁ cations. You are strongly advised to consult with

independent legal counsel to determine your rights and obligations under these agreements.

It is advisable that you obtain and review a copy of the Arizona Revised Statutes on “Games of Bingo” and the Administrative Rules prior

to initiating an application. These documents outline qualiﬁ cations and requirements for obtaining a bingo license and may be purchased

from:

Endorsement By Local Governing Body

Fill in lines 2, 3 and 4 on the Endorsement By Local Governing Body form and

submit it to your local governing body. Upon their approval, they will return the

form to the Bingo Section. A bingo license cannot be issued until we receive this form.

CHECKLIST

Send copies of all documents listed below unless otherwise noted.

Before mailing, check to make sure that you have included the following:

Completed application. (original)

Complete afﬁ davits. Class B and Class C applicants must include a completed afﬁ davit for each person participating in the conduct of

your games. Class A applicants shall include a complete afﬁ davit for each person participating as a manager, proceeds coordinator

and supervisors. (originals)

Rental agreement if more than one licensee is using the same rented premises in which to hold bingo.

Application for Special Bonus Game. If you do not conduct special bonus games do not complete the application.

The license fee shall be payable to the Arizona Department of Revenue.

Class A: $ 10.00

Class B: $ 50.00

Class C: $200.00

ADOR 71-1007 (4/06)

Form Ador 71-1007 - Bingo License Application Packet