Washington > Statewide > Liquor Control Board > Applications
Application For Permit To Raffle Liquor LIQ 84 - Washington
| Application For Permit To Raffle Liquor Form. This is a Washington form and can be used in Applications Liquor Control Board Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
For Office Use Only PO Box 43085 Olympia WA 98504-0385 (360) 664-1617 See Us on the Web: www.liq.wa.gov Date Check No. Amount Rec'd Rec'd by Application for Permit to Raffle Liquor Application by a bona fide charitable or nonprofit organization to raffle liquor. $10 Fee for Single Event $25 Fee for Annual Permit (Make check payable to WSLCB) New Application Renewal Raffle Permit No. Liquor License No. Name of Organization Organization Street Address (Street or Route, City, State, Zip Code) Organization Mailing Address (Street/Route/PO Box, City, State, Zip Code) Organization Representative In Charge of Raffle Telephone No. ( Date of Event (if individual event) ) As representative of the applicant organization, I certify the following: · The organization is a bona fide charitable or nonprofit organization, organized primarily for purposes other than conducting raffles (per RCW 9.46.0209). · The applicant organization does/will not gross more than $5,000 from raffle ticket sales in any calendar year. · Raffle tickets will be sold and prizes awarded only to members of the applicant organization who are 21 years of age or older. · Liquor to be raffled will be purchased at retail or donated by a private citizen (may not be donated by a liquor licensee). Signature Title Date LIQ 84 3/10 (s/RegSvcs/forms/LIQ08451 ap for raffle) American LegalNet, Inc. www.FormsWorkFlow.com
|
|||||||
