Form 04-862 - Calendar Year Answer Sheet Only For New Members In Charge And Bingo And Pull-Tab Gaming Managers - 2013
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142013 Calendar Year Answer Sheet
Only for New Members in Charge
and Bingo and Pull-tab Gaming Managers
_______________________________
Name
___________________________
Organization
___________________________
Permit Number
Instructions: (1) Completely fill in the square that corresponds to the answer for that number.
Caution: fill only one square per question.
Example:
a
b
c
d
(2) Complete the certification that the test was taken without assistance.
1 a
b
c
d
31 a
b
c
d
2 a
b
c
d
32 a
b
c
d
3 a
b
c
d
33 a
b
c
d
4 a
b
c
d
34 a
b
c
d
5 a
b
c
d
35 a
b
c
d
6 a
b
c
d
36 a
b
c
d
7 a
b
c
d
37 a
b
c
d
8 a
b
c
d
38 a
b
c
d
9 a
b
c
d
39 a
b
c
d
10 a
b
c
d
40 a
b
c
d
11 a
b
c
d
41 a
b
c
d
12 a
b
c
d
42 a
b
c
d
13 a
b
c
d
43 a
b
c
d
14 a
b
c
d
44 a
b
c
d
15 a
b
c
d
45 a
b
c
d
16 a
b
c
d
46 a
b
c
d
17 a
b
c
d
47 a
b
c
d
18 a
b
c
d
48 a
b
c
d
19 a
b
c
d
49 a
b
c
d
20 a
b
c
d
50 a
b
c
d
21 a
b
c
d
51 a
b
c
d
22 a
b
c
d
52 a
b
c
d
23 a
b
c
d
53 a
b
c
d
24 a
b
c
d
54 a
b
c
d
25 a
b
c
d
55 a
b
c
d
26 a
b
c
d
56 a
b
c
d
27 a
b
c
d
57 a
b
c
d
28 a
b
c
d
58 a
b
c
d
29 a
b
c
d
59 a
b
c
d
30 a
b
c
d
60 a
b
c
d
I declare, under penalty of unsworn falsification,
that I completed this test without assistance from
any other person, and that I used only the gaming
statutes and regulations to complete it.
Signature
Date
Photocopy this blank answer sheet as needed.
This answer sheet must be attached to an original or an amended application form when submitted.
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