Form L-2058 - Application For Bingo License Non Profit Organization (Page 2 of 4) in pdf

7. State the specific purpose(s) for which the bingo net proceeds will be used. _________________________________

_____________________________________________________________________________________________

8. List the name, home address, social security number and telephone number of your designated promoter as defined

by Section 12-21-3940.

S.S. # or F.E.I. #

Home Address

Name

Phone Number

Attach a copy of the contract between the organization and promoter.

9. Is the organization leasing or renting equipment, furniture, fixtures, or buildings from the promoter?

Yes

If yes, attach a copy of lease or rental agreements stating the lease or rental amount and a copy of your

labeled floor plan.

10. Is the organization leasing or renting equipment, furniture, fixtures, or building from anyone other than promoter?

Yes

If yes, attach a copy of lease or rental agreements stating the lease or rental amount.

11. If the answer to number nine is yes, is the lessor related to the promoter in any way by blood, marriage, or business

affiliations?

Yes

If yes, state relationship/affiliation. _________________________________________________________________

_____________________________________________________________________________________________

12. Do you currently have a bond on file with the Department of Revenue?

Yes

If yes, what is the value of that bond? $_________________ If no, you must submit a bond per Section 12-21-4230

South Carolina Code.

13. Your books and records are in care of ______________________________________________________________

Name

_____________________________________ _______________________________ _______________________

Physical Location Address

City

State

______________________________________________ _________________________________________

Zip Code

Phone Number

14. Enter month the annual accounting period ends. ______________________________________________________

15. Will there be any retail sales of tangible personal property, e.g. snacks, t-shirts, etc., made for the convenience of

your customers?

Yes

If yes, enter Sales Tax License _________________________________.

16. Are there other business activities being conducted at the bingo location, other than those referenced to in number

fifteen e.g. coin-operated devices?

Yes

If yes, state nature of business activities and attach a copy of any and all contract(s) and/or agreement(s).

41372020

Form L-2058 - Application For Bingo License Non Profit Organization Page 2