Fillable SPECIAL RAFFLE PERMIT APPLICATION (County of Indiana)

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SPECIAL RAFFLE PERMIT APPLICATION (County of Indiana)

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U.S.A. forms for County of Indiana

BROWSE COUNTY OF INDIANA (PA) FORMS

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SPECIAL RAFFLE PERMIT APPLICATION
Local Option-Small Games of Chance
Act 156 of 1988
IN AUTHORIZED MUNICIPALITIES
SMALL GAMES OF CHANCE SPECIAL RAFFLE
LICENSE #________ PERMIT #_______
Organization applying for license:___________________________
Address of Organization: ____________________________________
____________________________________
Location of drawing: ____________________________________
Date of drawing: ____________________________________
Number of Chances: __________________
(Total number of tickets available for sale)
Price per Chance: ___________________
Cash value of prize/prizes: ___________________________________
Accumulated cash value of all prizes shall be no more than
$150,000 a year, and a licensed eligible organization may
obtain up to ten (10) special raffle permits.
Volunteer fire, ambulance, rescue or conservation organizations
may award up to $250,000 in prizes, and may obtain up to twelve
(12) special raffle permits per year.
Date of Application: ______________ Fee: $25.00
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SPECIAL RAFFLE PERMIT APPLICATION (County of Indiana)

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Completed 6 August 2020

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