Instructions For 2013 Alaska Renewal Permittee Check List
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1
2Instructions for 2013
Alaska Renewal Permittee Check List
Failure to complete any portion of this application
Page 2: Permit Applications
will result in the delay of your permit.
Use these
Enter organization’s name and permit number.
instructions to make sure all information has been
completed.
FACILITY-BASED GAMES
Select each game type by checking the applicable
Page 1: Permit Application
box. See Mandatory Attachments for Calcutta Pools
ORGANIZATION INFORMATION
and Special Draw Raffles and page 2 of this Check
You must enter your organization’s Federal Employer
List.
Identification Number (EIN) and gaming permit
number.
Enter your organization’s name and website address,
AREA-BASED GAMES
if applicable.
Under Area, list each city or borough where your
organization will conduct gaming activities. Under
Enter your organization’s mailing address with zip
Game Type, check the specific game type(s) that
code + 4.
your organization will conduct in the designated area.
If your organization will conduct gaming activities
ENTITY TYPE
in more than two areas, attach additional sheets as
Check one box:
Corporation, Partnership, or
necessary.
Association
MANAGER OF GAMES
ORGANIZATION TYPE
Manager Information. Complete all boxes only if your
Check one box. Refer to AS 05.15.690 and AAC
organization has self-directed pull-tabs and/or bingo.
160.995 for definitions of the organization types.
The manager can be the primary or alternate member
Membership Question.
You must check the
in charge or another person appointed to manage the
appropriate box.
games.
MEMBERS IN CHARGE OF GAMES
VENDOR INFORMATION
Primary and Alternate Members in Charge of Games
Complete all information in each box for every bar or
must be members of the permittee. Social security
liquor store listed.
numbers are required.
Attach a 2013 Pull-Tab Vendor Registration form
completed and signed by both parties.
Vendor
compensation can not exceed 30% of the ideal net of
LEGAL QUESTIONS
each pull-tab game.
Answer the questions by checking the appropriate
A $50 registration fee must be enclosed for each
box. If you answer “yes” to either of the questions, you
vendor registration submitted with the application.
must submit, as an attachment, the person’s name,
date of birth, social security number, and position of
responsibility.
OPERATOR INFORMATION
List the operator’s license number, the name of
the operator, the operator’s facility name, physical
SIGNATURES & PAYMENT
address, and the types of games to be conducted and
Four signatures may be required. See cover letter. If
attach a signed operating contract.
the person signing as the primary or alternate member
is also the organization’s president, then another
officer of the organization must sign the application.
Check the applicable box under Permit Fee. You can
MULTIPLE-BENEFICIARY PERMITTEE INFORMATION
List the MBP permit number, the MBP name, facility
pay the fee online at , or you can
name, physical address, and the types of games to
submit a check payable to the State of Alaska with
be conducted. If this is a new MBP, or you are a new
your application.
member of an established MBP, attach a copy of the
MBP agreement
0405-826RC Rev 10/12 - page 1
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