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Games Of Chance Registration DOS-0255-f-l-a - New York

Games Of Chance Registration Form. This is a New York form and can be used in Miscellaneous Secretary Of State .
 Fillable pdf Last Modified 8/7/2012
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NYS Department of State Division of Corporations, State Records and Uniform Commercial Code One Commerce Plaza, 99 Washington Avenue Albany, NY 12231-0001 Games of Chance Registration (In connection with Sale of Commodities) Send this completed form and all necessary attachments to the above address along with a nonrefundable $100 filing fee. Please make your check payable to NYS Department of State. Attach: --Certificate of Deposit or prize monies in a trust account OR Surety Bond for total prize amount; and --Rules and Regulations pertaining to the promotion, advertising scheme or plan. 1. NAME AND ADDRESS OF PERSON, FIRM OR CORPORATION PROPOSING TO ENGAGE IN THE GAME, CONTEST OR PROMOTION 2. GEOGRAPHIC AREA IN NEW YORK STATE COVERED BY PROMOTION (List by county, if not statewide) 3. DESCRIPTION OF GAME, CONTEST OR PROMOTION (if not provided by your rules and regulations) 4. TIME PERIOD COVERED BY CONTEST BEGINNING: 5. NUMBER OF ENTRY BLANKS TO BE MADE AVAILABLE IN NEW YORK STATE ENDING: 8. PROPORTIONATE OPPORTUNITY OF WINNING PRIZES Level of Prize Proportionate Opportunity 6. NUMBER OF PRIZE WINNING CHANCES INCLUDED IN PLAN IN NEW YORK STATE 7. RETAIL VALUE OF PRIZES TO BE MADE AVAILABLE IN NEW YORK STATE 9. NAME OF PERSON SUBMITTING FORM RELATIONSHIP TO FIRM ADDRESS Signature X Date REMINDER: Filing fee and specified documentation must accompany this registration statement. DOS-0255-f-l-a (Rev. 09/11) American LegalNet, Inc. www.FormsWorkFlow.com
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