Instructions For 2013 Alaska New Permittee Check List
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1
2Instructions for 2013 Alaska New
Permittee Check List
Failure to complete any portion of this application will
Page 2: Permit Applications
result in the delay of your permit. Use these instructions
Enter organization name. New organizations should
to make sure all information has been completed.
leave the permit number blank.
Page 1: Permit Application
FACILITY-BASED GAMES
Check boxes for all game types your organization
ORGANIZATION INFORMATION
wants permitted.
See Mandatory Attachments for
You must enter your organization’s Federal Employer
Calcutta Pools and Special Draw Raffles on page 2
Identification Number (EIN).
of this checklist. (For bingo and pull-tabs, list facility
Permit Number. New organizations should leave this
names and physical addresses).
space blank.
Name of Organization, telephone number, fax number,
website address, mailing address.
AREA-BASED GAMES
Enter location of all self-directed activities. List all cities
or boroughs where activities will occur.
ENTITY TYPE
Check one box: Corporation, Partnership, or
MANAGER OF GAMES
Association
Manager Information. Complete ONLY if your
organization has self-directed Pull-Tabs and/or Bingo.
The manager can be the primary or alternate member
ORGANIZATION TYPE
in charge or another person appointed to manage the
Check one box.
Refer to AS 05.15.690 and AAC
games.
160.995 for definitions of the organization types listed
on the application.
Membership Question. You must check the applicable
VENDOR INFORMATION
box.
Complete all information in each box for every bar or
liquor store listed.
Attach a completed 2013 Pull-Tab Vendor Registration
MEMBERS IN CHARGE OF GAMES
form, signed by both parties, for each vendor. Vendor
Primary and Alternate Persons in Charge of Games
compensation can not exceed 30% of the ideal net of
must be members of the permittee.
Complete all
each pull-tab game.
applicable boxes for each member in charge. Please
A $50 registration fee must be enclosed for each
note that social security numbers are required.
vendor registration.
LEGAL QUESTIONS
OPERATOR INFORMATION
Answer the questions by checking the appropriate
List the operator’s license number, name of the operator,
box. If you answer “yes” to either of the questions, you
the operator’s facility name, physical address, and the
must submit, as an attachment, the person’s name,
types of games to be conducted and attach a signed
date of birth, social security number, and position of
operating contract.
responsibility.
MULTIPLE-BENEFICIARY PERMITTEE INFORMATION
SIGNATURES & PAYMENT
List the MBP permit number, the MBP name, facility
Four signatures may be required.
If the person
name, physical address, and the types of games to be
signing as the primary or alternate member is also
conducted there.
the organization’s president, then another officer of
the organization must sign the application.
Check
the applicable box under Permit Fee. Submit a check
payable to the State of Alaska for $20 with your
organization’s permit application.
0405-826i - Rev 09/12 • Page 1
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