Full Text
Instructions for Raffle Application 1) Name and address of applicant If the applicant is a corporation, association, or other similar legal entity: a) The names and home addresses of each of the officers of the organization, and b) The names and addresses of the directors, or other persons similarly situated, of the organization. 2) The names and home addresses of each of the persons who will be operating, advertising, or promoting the raffle. 3) The names and home addresses of any persons, organizations, or other legal entities that will act as security for the applicant or to which the applicant is financially indebted or to which any financial obligation is owed by the applicant. 4) Convictions, if any, for the criminal offenses other than minor traffic offenses of each of the persons listed in the numbers 1, 2, and 3 of this application. Each of these persons must present a signed consent form with the application. 5) Status of the organization. Must be one of the following: a) Non-profit, tax-exempt, church, school, civic organization or a related support group; or b) Non-profit organization as a determined and qualified under Section 501 © of the Internal Revenue Code, as amended; or c) A bona fide non-profit organization approved by the Sheriff. You must provide a letter from the Internal Revenue Service certifying that the applicant is an organization exempt under Federal Tax Law. You must provide a letter from the Georgia Department of Revenue certifying that the applicant is exempt under the Tax Laws of the State of Georgia. ---PAGE BREAK--- 6) The length of time and the date of the organization has been in existence. This must be the 24 months immediately prior to the issuance of the license. 7) The location at which the applicant will conduct the raffles. If the premises on which the raffles are to be conducted is to be leased, a copy of the lease or rental agreement should be provided with the application. 8) List the certified or registered public accountant and the organization responsible for filing the disclosure report of operation expenditures and receipts relating to the operations of raffles in the previous years. ---PAGE BREAK--- WALTON COUNTY SHERIFF’S OFFICE Application for License to Operate Raffles 1. Name of Applicant Social Security Number Date of Birth Address City State Zip Code Home Phone Number Cell Phone Number Work Phone Number If Corporation, Association, or other legal entity: Names and home addresses of each officer of the organization and names and addresses of the directors or other persons holding similar positions: Name of Applicant Title Address ---PAGE BREAK--- City State Zip Code Name of Applicant Title Address City State Zip Code Name of Applicant Title Address City State Zip Code (If more space is needed, attach additional sheet or write on the back of this page.) ---PAGE BREAK--- 2. Names and home addresses of each person who will operate, advertise, or promote the Raffle. Name of Applicant Address City State Zip Code Name of Applicant Address City State Zip Code Name of Applicant Address City State Zip Code (If more space is needed, attach additional sheet or write on the back of this page.) ---PAGE BREAK--- 3. The names and home addresses of any person, organizations, or other legal entities that will act as security for the applicant, or to which the applicant is financially indebted, or to which any financial obligation is owed by the applicant. Name of Applicant Address City State Zip Code Name of Applicant Address City State Zip Code Name of Applicant Address City State Zip Code ---PAGE BREAK--- (If more space is needed, attach additional sheet or write on the back of this page.) 4. List convictions, if any, for criminal offenses other than traffic offenses of each of the persons listed in numbers 1, 2, and 3 of this application. Name Date of Offense Offense Name Date of Offense Offense Name Date of Offense Offense ---PAGE BREAK--- 5. Status of the organization. Must be one of the following: ( ) non-profit, tax exempt church, school, civic organization, or related support group; or ( ) non-profit organization qualified under section 501 of the Internal Revenue Code, as amended; or ( ) bona fide non-profit organization approved by the sheriff. You must provide a determination letter from the Internal Revenue Service certifying that the applicant is an organization exempt under federal tax law. You must provide a letter from the Georgia Department of Revenue certifying that the applicant is exempt under the tax laws of the state of Georgia. 6. How long has the organization been in existence? Date of origin (must be 24 months immediately prior to issuance of license.) 7. Location at which applicant will conduct raffle. If the premises are to be rented or leased, a copy of the lease or rental agreement must be attached. ( ) Rented ( ) Leased ---PAGE BREAK--- 8. List certified or registered public accountant and organization responsible for filing disclosure report of the operation expenditures and receipts relating to the operation of raffles in the previous year. Name Address Business Name Address ---PAGE BREAK---