APPLICATION FOR BINGO LICENSE
BEAVER COUNTY, PENNSYLVANIA
OFFICE OF COUNTY TREASURER
INSTRUCTIONS FOR COMPLETING APPLICATION:
a) All information must be typed or printed in black or blue ink.
b) Upon completion, submit the application to the County Treasurer’s Office: 810 Third Street, Beaver, PA 15009.
c) Associations which conduct bingo during one period each year for not more than three consecutive days shall pay a $15.00 annual license fee. Recognized senior citizens’
groups who conduct bingo for their members only shall pay a fee of $50.00 per year. The license fee for all other non‐profit associations, including agricultural associations and
county fairs, is $100.00 per year.
d) The application shall be signed by the executive officer or secretary of the association.
e) The association must have existed and conducted business in furtherance of its written constitution, charter, articles of incorporation or express purpose for two years prior to
applying for a license. Exception: An association whose membership consists exclusively of elderly residents of senior citizens housing project may apply for a license
immediately after it’s organized.
Name of Association (Area Code) Telephone Number
Street Address City County State Zip Code
Location of Bingo Games Address City (Area Code) Telephone Number
1) The association is a senior citizens’ group which conducts bingo for its members only: ( ) YES ( ) NO
2) The association is an agricultural association or county Fair: ( ) YES ( ) NO
3) This year the association will conduct bingo during only one period which shall not
exceed three consecutive days: ( ) YES ( ) NO
4) The membership of the association consists exclusively of elderly residents of a senior
citizens housing project: ( ) YES ( ) NO
5) The association was formed (Day/Month/Year):____________________________________________
6) No individual under the age of 18 will be permitted to play bingo unless accompanied by an adult
7) The facility where bingo will be played must have adequate entrances, exits, and sanitary facilities
8) The association (Check appropriate box)
( ) is sole owner of the equipment used for playing bingo.
( ) is joint owner with a licensed association of the equipment used for playing bingo.
( ) leases the equipment from another licensed association under a written agreement for a fee which is not contingent upon the
amount of receipts realized from the playing of bingo or the number of people attending the bingo games.
( ) is contracting with a charitable organization or outside operator to conduct bingo at expositions, carnivals or fairs.
9) The premises on which bingo is played (check appropriate box)
( ) Are owned by the association ( ) is not leased from the owner under an oral agreement
( ) Are not leased from the owner under a written agreement providing for the rental price to be determined by the receipts realized
from the bingo games or the number of people attending the bingo games.
10) Bingo games:
( ) Will not be conducted by the association more than twice in any one week.
( ) Will be conducted at carnivals or expositions not exceeding ten days in duration.
• The association will not lease the premises or personal property used to play bingo from an individual who has been convicted of a felony
or a violation of the bingo law.
• The association will not award a total of more than $4000.00 in prizes in one calendar day.
• The association is a nonprofit association as defined in the bingo law.
11) The personal property used in the conduct of the game (check appropriate line)
( ) Is owned by the association
( ) Is not leased from the owner under an oral agreement
( ) Is not leased from the owner under a written agreement providing for the rental price to be determined by the receipts realized from
the bingo games or the number of people attending the bingo games.
_____________________________________________________
(Signature of executive office or secretary of association)
COMMONWEALTH OF PENNSYLVANIA
:
COUNTY OF BEAVER:
BEFORE ME THIS DAY PERSONALLY APPEARED ____________________________________ WHO, BEING DULY SWORN ACCORDING TO LAW,
DEPOSES AND SAYS THE STATEMENTS CONTAINED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT.
SUBSCRIBED AND SWORN TO BEFORE ME THIS ________________________ DAY OF __________, 20______.
