Bingo Licensee'S Report Of Change In Officers, Directors, Officials Or Persons Employed On Bingo Premises Page 2

ADVERTISEMENT

DELETIONS
Title or Position
Full Name
Home Address
_______________________ _______________________________ ________________________________________________
_______________________ _______________________________ ________________________________________________
_______________________ _______________________________ ________________________________________________
_______________________ _______________________________ ________________________________________________
_______________________ _______________________________ ________________________________________________
_______________________ _______________________________ ________________________________________________
_______________________ _______________________________ ________________________________________________
_______________________ _______________________________ ________________________________________________
4.
Has any of the persons listed above under "Additions" been convicted of, pleaded guilty to or pleaded nolo contendere (no
contest) to violation of any gambling laws of any state or the United States or violation of any felony of this or any other
state, or forfeited bond to appear in court to answer charges for violation of the gambling laws of any state or the United
States? (circle one) No
Yes
If yes, list name of each such person and particulars of conviction or bond forfeiture on a separate page and attach to this
application.
VERIFICATION OF OFFICERS OF ORGANIZATION
STATE OF KANSAS
)
)
ss:
COUNTY OF
)
We the undersigned, of lawful age, being first duly sworn, upon our oaths state:
That we are the presiding officer and secretary, respectively, of the above-named organization; that we have read and know
the contents of the above and foregoing Bingo Licensee's Report of Change in Officers, Directors, Officials or Persons employed
on Bingo Premises; and that all of the answers and information provided therein are true, correct and complete.
__________________________________________________ ____________________________________________________
Signature of Presiding Officer
Signature of Secretary
__________________________________________________ ____________________________________________________
Typed or Printed Name of Presiding Officer
Typed or Printed Name of Secretary
__________________________________________________
Title
SUBSCRIBED AND SWORN TO before me this ____________ day of ___________________________, 20______.
___________________________________________
Notary Public
My Appointment Expires ___________________

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Employer's Report Of Change Form - Louisiana Department Of Labour Employer's Report Of Change Form - Louisiana Department Of Labour Legal
Employer's Report Of Change Form - Louisiana Department Of Labor Employer's Report Of Change Form - Louisiana Department Of Labor Legal
Form Ui-21 - Report Of Change In Ownership Or Discontinuance Of Business In Whole Or Part - Department Of Employment Services Form Ui-21 - Report Of Change In Ownership Or Discontinuance Of Business In Whole Or Part - Department Of Employment Services Legal
Form Uce-101-s - Employer's Report Of Change Form Uce-101-s - Employer's Report Of Change Legal
Form 3360b - Banking Corporation Tax Report Of Change In Tax Base Made By Internal Revenue Service And/or New York State Department Of Taxation And Finance - 2007 Form 3360b - Banking Corporation Tax Report Of Change In Tax Base Made By Internal Revenue Service And/or New York State Department Of Taxation And Finance - 2007 Financial
Form Nyc-3360 - General Corporation Tax Report Of Change In Tax Base Made By Internal Revenue Service And/or New York State Department Of Taxation And Finance Form Nyc-3360 - General Corporation Tax Report Of Change In Tax Base Made By Internal Revenue Service And/or New York State Department Of Taxation And Finance Financial
Form Nyc-3360 - General Corporation Tax Report Of Change In Tax Base Made By Internal Revenue Service And/or New York State Department Of Taxation And Finance - New York City Department Of Finance Form Nyc-3360 - General Corporation Tax Report Of Change In Tax Base Made By Internal Revenue Service And/or New York State Department Of Taxation And Finance - New York City Department Of Finance Financial
Form Nyc-3360f - Financial Corporation Tax Report Of Change In Tax Base Made By Internal Revenue Service And/or New York State Department Of Taxation And Finance Form Nyc-3360f - Financial Corporation Tax Report Of Change In Tax Base Made By Internal Revenue Service And/or New York State Department Of Taxation And Finance Financial
Form Nyc-115 Draft - Unincorporated Business Tax Report Of Change In Taxable Income Made By Internal Revenue Service And/or New York State Department Of Taxation And Finance - 2015 Form Nyc-115 Draft - Unincorporated Business Tax Report Of Change In Taxable Income Made By Internal Revenue Service And/or New York State Department Of Taxation And Finance - 2015 Financial
Form Nyc-115 - Unincorporated Business Tax Report Of Change In Taxable Income Made By Internal Revenue Service And/or New York State Department Of Taxation And Finance - 2002 Form Nyc-115 - Unincorporated Business Tax Report Of Change In Taxable Income Made By Internal Revenue Service And/or New York State Department Of Taxation And Finance - 2002 Financial

Related Categories

Parent category: Financial
Download
Go
Page of 2