City of Wildwood, Florida
Development Services Department
100 N. Main St., Wildwood, FL 34785
Tel: 352.330.1334 Fax: 352.330.1338
www.wildwood-fl.gov
Revised 1/2017
Staff Use Only
Fee Paid:
Method of Payment:
Permit Number:
Class B Bingo Permit - For Property Owners / Lessors
Review Ordinance Number O2014-31 Wildwood Bingo Ordinance as amended (O2015-12) for a list of rules/regulations/requirements
regarding bingo permits prior to submitting an application.
Contact Information (Please print legibly):
Bingo Operator / Charity Name:
Address:
Phone: Email:
Owner / Property Lessor Name:
Address:
Phone: Email:
Site Information:
Property Address:
Parcel Number(s): Dimensions of Property:
Existing Zoning: Design District:
ITEMS REQUIRED AT THE TIME OF APPLICATION
$2,000.00 non-refundable application fee.
Complete information on rentals / financial benefits received from any Bingo Operators using the premises during the last 12
months (or an estimate thereof, based on the Owner's business plan, if this is the first year of operation).
Complete list of all Owner(s) or Lessor(s) (and the operating document governing their business structure, if applicable).
Complete list of all properties held by the Owner(s) or Lessor(s) where any and all bingo games are held by any Operator.
For an Owner / Lessor that is owned by another entity(ies) or individual(s), provide a list of the names and addresses whose direct or
indirect ownership interest of the Owner / Lessor exceeds ten percent (10%).
A financial statement of the Owner or Lessor, detailing the previous year's gross revenue. Must be certified correct; unaudited ok.
Sworn affidavit that the Owner / Lessor complies with Florida Statute § 849.0931.
List of phone numbers and contact information on-site.
By submitting this application, the undersigned acknowledges that no person shall make a false, untrue, or misleading oral statement to
any code enforcement officer, or any other City official, as to any matter investigated in relation to the provisions or enforcement of this
ordinance.
The undersigned certifies under oath and penalties of perjury, that the information provided herein is true and correct to the best of his/
her knowledge, and that any person who knowingly and willfully violates the terms of this ordinance, upon being found guilty, shall be
punished by a civil fine not to exceed $5,000.00 for each occurrence in addition to automatic revocation of their Bingo Permit. Each act
of violation and each day any violation shall occur shall constitute a separate offense.
Owner / Lessor Signature: Date:
NOTE: The application MUST be signed by the Owner / Lessor. For Corporations, Partnerships, Limited Liability Corporations, or other types of
business organization, appropriate authorization from the firm must be provided at the time of application.
click to sign
signature
click to edit
![]()
