Form L-2057 - Application For Bingo Promoter'S License Page 2
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48. Do you currently have a bond on file with the Department of Revenue?
Yes
No
If yes, what is the value of that bond? $
If no, you must submit a bond per Section 12-21-4230 South Carolina Code.
9. Your books and records are in care of
Name
Physical Location Address
City
State
Zip Code
Phone Number
10. Will there be any retail sales of tangible personal property, e.g. snacks, t-shirts, etc., made for the convenience of
your customers?
Yes
No
If yes, enter Sales Tax License Number
11. Are there other business activities being conducted at the bingo location, other than those referenced to in number
ten e.g. coin-operated devices?
Yes
No
If yes, state nature of business activities and attach a copy of any and all contract(s) and/or agreement(s).
12. Provide the following information for all partners, officers of the corporation and stockholders of ten percent or more:
Position Held
Name
Home Address
S.S. #
Phone #
DOB
Attach additional sheet, if necessary.
13.
Provide the following information for each person who will work at the proposed bingo games and who will receive
compensation for the work. Under Section 12-21-4060 of Bingo Tax Act, a person who has been convicted within
the last twenty years of violating a state or federal criminal statute relating to gaming or gambling, or who has been
convicted of any other crime that has a sentence of two or more years, or where applicable, whose promoters
license has been revoked by the department is not permitted to manage or conduct a game or assist in any manner
with the bingo operation.
Work to be
Ever
Name
Home Address
S.S. #
Phone #
DOB
Performed
Convicted?
Attach additional sheet, if necessary.
41362021
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Parent category: Financial