Form Wv/raf-3 - Annual, Limited And State Fair Raffle Financial Report Page 4

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WV/RAF-3
ANNUAL, LIMITED & STATE FAIR RAFFLE FINANCIAL REPORT
rtL179 v 10-Web
PLEASE USE BLUE OR BLACK INK ON ALL FORMS
THIS SCHEDULE MUST BE FILED WITH ALL RAFFLE FINANCIAL REPORTS
SCHEDULE 1
LIST ALL WINNERS
OVER $100.00 AT EACH RAFFLE OCCASION
SOCIAL
DOLLAR
DATE
NAME
ADDRESS
SECURITY
AMOUNT
WON
NUMBER
WON
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Page 4 of 4

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