Looking for a Alaska Tax Forms And Templates? Download it for free!

Form 0405-702 - Permittee/licensee Authorization Of Handling Electronic Bingo Devices

Alaska

702

Permittee/Licensee Authorization of Handling

Electronic Bingo Devices

All electronic bingo devices must adhere to the statutes and regulations set out in AS 05.15.180(a), 15 AAC 160.570(e),

and 15 AAC 160.995(7) prior to being used in the conduct of gaming in the State of Alaska.

The Department of Revenue will approve the use of handheld electronic bingo devices upon representation, under penalty

of unsworn falsification, that the equipment listed below complies with the following requirements:

1) the device must replicate a traditional bingo hard card;

2) it must not be capable of connection to a random number generator;

3) it must not be capable of being played without direct player participation;

4) balls must still be randomly selected by an operator from an appropriate device and the number “called” and

displayed to all players; and

5) the player must key in the precise numbers or separately mark by a touch on the display to play the number

called, correct errors, or catch up on missed numbers.

Description of Device

Manufacturer

Model *

Number of Machines

*Modifications of software or hardware require an updated authorization.

Your signature, under penalty of unsworn falsification, represents to the Department of Revenue that these machines

comply with the requirements listed above.

Misrepresentation or modification of the handheld electronic bingo devices will lead to a notice of violation and/or

suspension of license or permit.

Name and Title

Signature

Date

Operator or Permittee Name

License or Permit Number

Phone Number

Address

This date stamped document must be available where devices are in play.

Phone 907-465-2320

Fax 907-465-3098

702

Mail to: Alaska Department Of Revenue, PO Box 110420, Juneau AK 99811-0420

0405-702 Rev 09/12

Form 0405-702 - Permittee/licensee Authorization Of Handling Electronic Bingo Devices