INSTRUCTIONS TO COMPLETE A BAZAAR APPLICATION
Please complete each section on the Application for a Permit to Conduct a Bazaar form, and the Statement
of Active Members form. Please keep in mind that a bazaar event only encompasses games of chance and
not games of skill.
APPLICATION FOR A PERMIT TO CONDUCT A BAZAAR (CGR-1)
1. If the organization has a determination letter from the IRS confirming the organization’s exempt
status, please include a copy.
2. Provide a complete name and address (number, street, city/town, state, zip) of the sponsoring
3. Provide a complete mailing address (number, street, city/town, state, zip) of the sponsoring organization.
4. Provide a telephone number and email address.
5. Provide the name, telephone number, and email address of the contact person for this application.
6. Choose one of the seven (7) categories that applies to your organization.
7. Give the complete name, date of birth (month, day, year) and telephone number for each of the three
Designated Active Members
Note: The three Designated Active Members MUST be residents of the State of
Connecticut and at least eighteen years of age.
8. Provide the title, complete name (first, middle, last), complete home address (number, street,
city/town, state, zip) and a complete date of birth (month, day, year) for the officer of the sponsoring
9. Provide the date(s) (month, day, year), along with the commencing time and terminating time
(including a.m. or p.m.), for each day the bazaar is to be conducted.
10. Provide a complete address of the place where the bazaar is to be held (name of place, number, street,
city/town, state, zip).
11. Please check the types and number of games to be operated.
12. Provide the registered dealer information if applicable.
13. Provide all of the expenses directly incurred for the bazaar activity including permit fees and coupon
ticket purchases etc. and the names and addresses to whom they were paid.
14. Provide all the merchandise information that will be awarded for the bazaar activity including the
names and addresses of the persons/organizations from whom the items were purchased or donated.
Note: If an item is donated then the “Retail Value” must be completed.
If the item is purchased then the “Amt. Paid by Org.” must be completed.
If an item is purchased at a reduced price, complete the “Amt. Paid by Org.”
15. Provide the specific purpose of the entire net proceeds.
16. The ranking officer of the sponsoring organization must sign his/her name, provide his/her title,
and date the form.
Note: Only the individual listed on the front of this application is recognized as an
officer and may sign as the ranking officer.