Fillable Form 490718: ADD OR CANCEL A GAME OF (Kansas Department of Revenue)

Fill Online, Printable, Fillable, Blank Form 490718: ADD OR CANCEL A GAME OF (Kansas Department of Revenue) Form

Use Fill to complete blank online KANSAS DEPARTMENT OF REVENUE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Form 490718: ADD OR CANCEL A GAME OF (Kansas Department of Revenue)

On average this form takes 10 minutes to complete

The Form 490718: ADD OR CANCEL A GAME OF (Kansas Department of Revenue) form is 1 page long and contains:

  • 0 signatures
  • 15 check-boxes
  • 33 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Kansas Department of Revenue forms online.

BROWSE KANSAS DEPARTMENT OF REVENUE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
KANSAS DEPARTMENT OF REVENUE
ADD OR CANCEL A GAME OF BINGO
Organization’s Name
Organization’s Mailing Address
Organization’s License Number
Section 1: Cancelling a Game of Bingo
Day/Date:__________________________ Time: (Indicate A.M. or P.M.)____________________
* This is a permanent cancellation. The effective date of this change is (mm/dd/yyyy): ______________________
*
This is a temporary cancellation. Reason for cancellation:________________________________________________
How long will this change be in effect? (Mark all that apply.)
* This is a one-time cancellation.
* This cancellation is for the month of ________________
* This cancellation runs from to______________ _____________
Other ____________________________________________________________________________________
Section 2: Adding a Game of Bingo
Day/Date:__________________________ Time:
(Indicate A.M. or P.M.)____________________
* This is a permanent addition. The effective date of this change is (mm/dd/yyyy): _______________________
* This is a temporary addition. How long will this change be in effect? (Mark all that apply.)
* This is a one-time addition.
* This addition is for the month of _________________
* This addition runs from to_______________ _______________
Other ____________________________________________________________________________________
Section 3: Adding a Location Address for Bingo Games
New Location Address: ______________________________________________________________________________
If this is a leased premises, provide the Bingo Premises Registration Certicate number:___________________________
* This is a permanent addition. The effective date of this change is (mm/dd/yyyy): _________________
* This is a temporary addition. How long will this change be in effect? (Mark all that apply.)
* This is a one-time addition.
* This addition is for the month of _________________
* This addition runs from to______________ ______________
Other ____________________________________________________________________________________
Vending machine(s) have been:
* Added * Removed Effective Date: _______________
If vending machines are added or removed, enter the number of vending machines: ___________
_________________________________________________________________________________________________
Signature Title
_________________________________________________________________________________________________
Printed or Typed Name Date
This form must be signed by an authorized contact as listed on the most recent application, Bingo Organization Change Form (BI-10)
or Power of Attorney Form (DO-10).
BI-20 (Rev. 8-19)
490718
Page 1
INSTRUCTIONS
To conduct bingo games on a date, time or a different location than is currently on le, the bingo licensee must submit written
notice of the change(s) to the Ofce of Charitable Gaming at least three days prior to the effective date of the change.
• Enter the Organization’s name, mailing address, and license number as listed on your license.
• If there are no changes being made to any of the following sections, leave those sections blank.
• Complete Section 1 if a bingo game is being cancelled. Complete all elds and indicate whether this is a permanent
or temporary change.
• Complete Section 2 if a bingo game is being added. Complete all elds and indicate whether this is a permanent or
temporary change.
• Complete Section 3 if a location address for bingo games is being added. Complete all elds and indicate whether this
is a permanent or temporary change.
• Check the appropriate box if there is a vending machine(s) being added or removed, then enter the effective date of
the change.
• Complete the signature portion. REMINDER: Add or Cancel a Game of Bingo Form (BI-20) will only be accepted if
signed by an authorized contact person for the organization. Authorized contacts include the presiding ofcer and/or
contact person listed on the organization’s most recent application.
GENERAL INFORMATION
• If you have questions call 785-368-8222; email kdor_bingo@ks.gov; or visit our website at: https://ksrevenue.org/
bustaxypes.html.
• This form must be received by the Kansas Department of Revenue at least three days prior to the effective date of the
change.
• This form can be faxed to 785-296-4993 or emailed to kdor_bingo@ks.gov
• Complete this form and mail or hand deliver to:
Kansas Department of Revenue
Charitable Gaming
120 SE 10th Ave
PO Box 750680
Topeka KS 66625-0680
Page 2
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Form 490718: ADD OR CANCEL A GAME OF (Kansas Department of Revenue)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 24 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document