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HomeMy WebLinkAbout1985 .x r Sato 0 AMENDMENT TO Jp TEXAS APPLICATION FOR LICENSE TO CONDUCT BINGO _ AMtNUMpN1 nFt I, oinga nnli number ~pi,q$~ f Carlo r 00100 aett toot 163 rI p L G Q 7~ uof ' : ~Name of ol0enhenon rll,o tonne IBu4n on your Irernsol I J , - p Mailing, eddlilt (9/rrre,ll anal? "ea P.0, J141A or rural morel kk I, Clly _ tit to 7lp code , count _ H.,.. l Clhccet)r the lype of chnngd you are rerluesllhg f 4, J~ CHANCE OF OBOANIZATION OPPICEHS',- ty To change orpenlration of floors, conlrlloto Section I of Form 0,124, Supplement to 7 e.yas Appllcal[u!t /00 a 1,10OWe to { Collducl Ijbisru Return It With this emandmenl, 5, D CHANCE OF PERSONS WORKING FOR COMPCNSATION AS CASHIERS, USHERS ANO CALLERS AT YOUR F kr , "f' i• BINGO GAMES- To ehengo moles, complete Section Hi of the suppiorlent, 6. GCHANGEOFBINGOOPERATORS- 1 + 1 4, To chengo bingo operators, other than the I)rlmary operator, complete Sectiort 11 of the supPlemanG r 7, CHANOF OF PRIMARY SINGOOPERATOR- I If thu udnfo of the member primarily responsible for conducting garaus Is being changed, enter the Itafne of life new operator. eoolel$wuilty Number tlrlver't license lslfate is nu.) e Nim d 1 bit of yuN of in fai es n imber fly filalf Zip code phone pirea coda d nu 1 a Ho Iiadrres .G .~D I~ i~J L~ al u5a=~- I ~~r--- OIN of birth ! neFN Belt.. 8 k] 014ANOF OF DAY(S) AND TIMM) GAMES'WILL HE PLAVEO- Enter the entire tas y;schedule. ' FIfliflay Yin" - gee and dell If In" I M,to _~._kJ ek _M,t4 V -_~dJ i1 »bd td l7J F 4 r 9, U CHANGE OF LOCATION AT WHICH GAMES WILL BE PLAYED- Name of new location 11 wnlell gomm will be bleyad J 4 Lj City 9ml0 zip uode county . f$ Addlell 4rife Lund unrobvear din,lrlnfl t I I l I vL.__...-_.__.. J II_ 1 .J Ik ~c 1. t ~J L. ` -J.p uftibef It this lotallon inside tho city Ilmile of the oily 1adlcotedl e k~ I YLd 0 ' NO :i It [hit Iocailun ddfarmn Itorn Vill loatlon at your oryanflailo } U yes M NO a 0 "YES°, f Iplalit wIIY ills Wuahl latllo6 of Ill/ Oryl tllteliu611 not ade4uf to lot playing binge ge nNl. Wbet Is the maximum seating capacity (of bingo of this locsltool et r 'I Hq K this IoGtIOn controlled by your oision mlonT L«1 Olrned L.J Lewd (Allmh o copy of your nrn heft vino nsnl) K , 1 Other(7lxvrdh,) ` Ownes bingo lleenw ndmoof $ s NAM# or owner of leafed plemi N+ _ I` •m _ - _ rt -mi - nont her delendel mood, 't s.r AJd711/tit oilier lYrnd llunibrrur LU, tax, oils tlala 1111 cmfr) I y J Le_..._.__ I" 10, AMENtM eNT r'EF - II you requested a chonne in items 7, d or tl a lot of sa ipoyable to eTATE TUAS41lMPI must ba tubll Iled Wit. IhH anlendniom. HAiurn Your our Am ilcumr And it now Ilcunya will be issuud Naep a copy of file ntenee for your. e rodordl: You CANNOT elrnngA dove, ti n is or location ul,aimof until fidt edirnchnent Is eppt DVAd and V00 IONnYd PaymalA reseweu I YE9 0 NI) your new ilcerUl, 0 ' 11, APPIDAVIT OF RkSPONalbl6iTY .1 - ; We, !be Lnde Nlgned,' herAbV d1eAl1 sea lwllh he v~'lllNol fur ctouduEllflie Inugo gamAr an IalaralNlrlg alt laq tired rrlufrn I It'accDWd 11'9 1n; lumnan Llo active the pomit or me orom b 1 • wAh the ptmliont of trio luxes Uinyo Snabllny Act, Anil Il nl All not pwaf ads dadved frmn binyo yamea wqi UA 411ad for chu nui',v mns•m vl I i'm plo 61 Wllood In the haw Wo lurihel 'IAClato heal w6 hm lwm Ileaii r-unn.t"i ul' a lull umnli11 fgnolaa'Irt, cWlui 6) {fanlP of n wi l uVI ruwo~ Imoilude, dud tier U" bingo works 1 have neVOr bewi cnavlcted of a ruluny, g Vllt y u m Wilber Mitt, 11,61 ruins{ or flip e,Iplliabnr, h.ue ax w runt 13 S .11161 all Ite[olvillme ill 1114 lnpilrepon end dny 011110113ntt 4ns' 11uA And unfcct to ibu I,0at of our knowlodya end beliol < I}hC 9nle j111114. Writ 1 77< it Una ~ e~? rJ~ y,'1 ` 91 Mlr~t / [S/salon torn I ,tfsit, I I E ~ 7~+ :1141 ~f~{ q~ilef ndl r n 111111 net 06 10 1 Y . t .r , t 0- f4 , . . y a 4t1d11'1 I t;'~ i, 1 f ia u,I lE;lAo. 81IJPPI.EMf•NT TO ~ivrlllilt Pi>,!Ni APPLIC' 'S ION rUl'1 I.ICI.NSr. 1'U CC)mwc r CJINco co iri,gli;na,li :Il rslr nrPl16nn(P tt1 , 110 W(W Whitt IN SHn)l b 1r'r;,;;; I y t);o tlll9 eU,lptolllonl (b' Oro,itlo adcbtlo,lal-InfatmatiOn w(wo0nd ln• (oxat Applltallon I'll l.icollsi, lot } iIwno AP 1 17) tll roxA s Amolldnlunl 10 APpIh7nUJn. lilt ♦.Icshia to ('sruhiW lllnoo" lro.,n AP lil:0 f AIspIICatlllii ill nuorl(lil 111 will lltil be oppiovod if ullbntwtlnrt , c ,mijilnto 1",r raab tF)rrw li,1 r{ !1'iruaa rrllrr "h R' of Lfrdt' of im)II111 du,, year f ra„pt,•.. 1 he' Jrnfmo, 15 171111 a tfrr LOy 1 1) + I, t& 1 0celuLr I, I 1) l.-) , ver I f 2 0 G , ti 5 J ~fn n',+{T'/r~J I`i T„ l „uun t(o C1n• r/i ~i IQti ury.... I, 0 l3ANl7. TION OFFICERS No (L trill, m dip J lici Security Number title t L o.71'j c~G 4_h! eJ Holm eddreu Clly State 21 code. Ph ne (Area curie b nn.) MY ~e ~ Y1~ ~ow~ay _1 l J x~d ,7 ~gz 97zy/ I , NI 1Reef Atiol,'Altai Soalel deauiltY Nahi6 r Title ~.r//1 ~ I 7 v „ 1''`n N me eddre t clty Slate tip code Phone (Area code A nu) ' t r ) , r, ; ' oatr(~~~ J 17.1J , I" • ~t.r t social Ascurlly Number Title k N ei li #t I dig) if/p"q/Jy a`r(fail q City I~91ele Ail) et)cdo Phoyna (deed eude .f nn 1 9 1gj - r47 ".z y/ ~ 1 lie,tq (kit, lin 1, mfddl) soolal Star dly NumbW Title' ll`r.`'.G%ec ~l __..~p_J ~1__ ~~J l~I. _I:II.L~f).17~ IQua.± rrkral % Home e d ate city Mete tip code. Phone (Aced aide d no 1 ly~'~~ u,zl ~ ~ ~ 7 ~ 5 ~~1~T~~•,s'79/ ~ I l_1_~._...~~ ~ ~ ..~_:J L.. ,¢.H ~•_.....___J L ..,~J ' I_ I d,z.r__,_..J" f _ _ ,.J I; i`- j 11 nlNno CIPERATORS ; 5nInr 1ho,tomat of all bone fide gbtlve marn}kr! W1fd' ' 1 he wAdualing bingo flamos l Namir f).uel, 11. I IMddh 1 - Nlutbbef et vailt of an d, 1 ve tnenibal 9o, t,'!r, uri[ rl,nfl,nr otlyer's Ilcntnel9(ateAmi,) 1 1 ; ECU b //l PC/eva.rr~l_ l yt~l 1~, ,9',1 Z 6,d p l IOXI7YY4zJ; Nome nddlblt ! City Einin ZIt. rcda Phone (Arta e„ de A nn,) S L/%% _ 50-wk ~~1..,C,C J 1 -,Sa.H y~ 117, 1 17, 6 ,z t t~.l 1 8Race L.~ l it UK 1911 L._.1it rfleleatbllth V...7., riayrik (!.def1t l{{tal, oihrdhI tuber el yNn el Mt antlVC meml a+ ;njial nd,urltY Nu nhnr b„Yal't lt Ieulef96,(rA out). . t I.,S Q /aC.¢w' I'so b ~w I/. yrt.1 14 7 $ I IF3` l I~IV g 0 1 107774746 1 ` i1 ran ilme r CIIY laic 21u, ~r1 ' +'I+nha Lunt 1'i,dr .(rl rr ) io~.rt~s o,~~!~11_~._~ l.J.`1t< ~ 1 '~r, ~l 1 I~,Fw, } /.1 (~'/l rPz-tip«._~ j is, nici Sex Xf M L.JF [ "1f Ulrl11 19 HIP, J I l „W,~t4 1 C r Na +!Call Nei inhldfnl Number of Yaan of an ectrys mottl1w "dais! rnrolltY Nuinbet 08ver'1 Imanie191nlpd do ) t 1.eS~ ~i'b. Gpw~ ~~Ytt f 1 y G d l'i~ ~ I~l 9 ~ ,~f I I edG~ti/x7' 1 ti ere aildll~a~ j CItY 9 e1 tip Cade PI ne_7Irlno uele A n 17~1~1'Ix,dy7,~!J I13/~ rz,.y O 11 64 1 IitJ I. .,'r alto Ot bb,h 1 o7ij ' , ( uan, i! nil. )II N, fntdr111) rJUmHM of yiere ee en eetlun ,nen,t ni 9nn!el SeC4P "Vumbar miyu'e Ilranµ(N(dleA du.) I.. e a ~a-r IVy a, L1 , / 11.1 11, z ~ I, W ,y, I , : h t ~l B` 9 y l Ies"~~ ti v I 1 rie dtr 1, City ,,".lattl !Ili ct d4 Vhone i 11,11 eudr k lrn 1 , ~1/.. 1<',2y. x P.1 191.7x: y.~`! _J ll ace I„W..,.~ Ne>t It'J.. I,.:.-IF bale of llllUi f911,t,Z l.l.ir.~ to N 'b fl .aef /1rel, niiddlrl Numbw al yeNa al er. - IlcenlefNfeil A _ eelfvl merdber Sacral $ ItG f7bnmar tiNvali n.. l I I ,,,may E/ r.r x +Q'.h0hfle'~...~rl/d.)eiJ ~ _ I~!.v11.J 1y,ly.t ! I~ ~ fV. y, G _1 't 1 0 e. dealt icN~te H1 iAt~~ I f_,r Zito cone rl o t,t/ra c,d~ ae.l a,ae L )_J $r>, L fA 1 IP 11JIGof birth L J e!e N~e c1 (fntr, (vel, nil,itlfl i Numgqof of Yaart ee an Native nglnbar Inlet 3faurrty Number 1111,st911eenei(Ytc YrG id.) 1 I.Cr et /?neJ~1 lPorx~i~~1...._ L I J ,_IX aIIz ✓J I7% R n lr me1 clty 9 au ti rods Phone r,tteo rude A awl (V2 zy., _ J ` f' .6H~cC.~_ _J I Irlo ~.tz.,'JJ r ! Mkd _JY NOR Dili of blrlh y4 . eft l 1 M I 1 Sy T~f1 v ~ '13 +e .a S 5I'1 ~ ti +t. {i ~t 4. }~~`f t~{t ,t iiiY}f ~C~~~t d^. r iir~+j~~~{4 ~ ~ '~a r ~ ♦r.: p ' 1~ i,~ ~*p ~S#~ erg r 888 ry p ~j r r Name of lacetldn (1131 % r+i C}.tlintd.4in 110.1 J. ~d V O 3 r E 1 Address X00 I012 v Pee, ,b: aintlb ~laane numu `ar + T i'nlS r ~'TJ t @1 a,( Te aar oi)-~' J kS 91 ° S u'..E i r ?,f~ ~l SV 11~ ~ 1!{{ ~ ~.,-1 c r r I~,,Ilt,kiri ilAtn:+hnn t:1.u7~ Irv i M f +IJ 113 r Il\ . N ~T 1 7 "11 5 + A rS ~y 1 ~PACC, r ' Y C~Iw3PT V, £K S 4t r4 f i + ir,..:l nir r';a! r,' .'-.t ~ ''r ~10rr;i~ax,:,NtY ~~s/r',3[}nse }5i~!{Ti *r1 tJ ,•,4~+ t~Ar ?t?r'~}~4~ )r~rll~r+~t t! 't *tir fA ,j} rat T ~ Ye tT,•t e.aa-t dl ~ ~ n 7!'{xty ~ r 1~tt~a" ' ,°.a• KS r, 5r„>, e ~ T st ; 4 { ~q ,.w. t` i to R Y; i t'~ sb f r1 .'R lull, 1 ° k J _ L7f47~ , ' G- , far r. t i ~IrY q~ y,,~ 1V1 N. r, ~ 1 Y 1t k 11y t N P►i ft i 1r FflwMre~lMMrOrhl r)y+TVPE OR ' INa00P6R,rtOR'$f1!IlAR7EFitY iiEpORT' { r In k{ . (fi; Y;:; r•;yi' WMilk$iv m wrrE AMLAB ,1 \S~f'I ~ i h)'1 1 1 1. : 1 rTJ{':C , er+brt fig quNtN ` I y,.~,{ • if' Ih 'Elc4tr '1' 11~r t a "alkl'N~: 2.1~'tI C#zpt lrl''•~ ' ~nM14t if ~.Q~'t~~e { ,y rl r 1 _ t ~fd I~111,' E+pt 1 °'~f!(C~~ eenAu numbN r fit; 1~'a It f10 . trtx , w"..Sy © 7 •41h 1 060, °9 a1001 x ' s,d A ,~uM 3-000119786 . A , t 1 r tei ePE01AL MO I~ g+nl~etl0 t nar x and melllna edd+ae Vft+ POSt' 2205 t, jPdsSi} rMidvo r« of lea . a NIE '41e ryzIrteduJN rY~ P,O. Box 628 +txrei~rkte Krledsr z t Oenton, Tbxas 762Q1 Yildr.7ueucboxi'ohVeuewial f ~ ~ ~;,~f[~'ll~r'~re' +Y 55'rt3!T' r,r •=,Ylr t r ~I.~ZYl~iuw.w i t~l Val i'F.t ,nrj• , rP 't:•o 1 1 - ~I''~{/YJff' 'fl:: " _L RE EI S t "i«r,! 4~• 1 , y J r o c ~ j ~ ,I E .,~r3 7. Q rS I a '~1,i1'1 11r t ~ tl• 4 p L ~ r Y ~ •'s, S 5ele is InOo cerde end entro~cI feet 0 -v 'Y r X15 S Woulru~t from binyo Ilgeneeet t1. 1 ~1 nl r. ' ;y lu % ~y t 'S of 7 5e . ~+1~rh._ f ;ti' t rid .w W ECEI4S lh#e 644Item a - 7.TOTAL GROSS R ~ ,.t rv ' r yti L i t, 4~ ' f r a; ' p t i G, CASH PRIZESAWAR[1E0 'AM ~ Form 10108) , pYut! e+ fhe came to Item 7 txee Iodine of 81 + Form 14v if "7~rltw ehrdyk ~l ~+4t? p1~e14f+,~Le "w. ~K f ft f ,xiC t''llint or tit~l m (WO w. r 1 w 11, Blnpo equlpm+nt purchased ..,w Tai 12, 12 Marchendlu purclutad for bin0o Whet W 44 - ~y 13, other b1n0o related ex nses /►L'tBXPENSE$ (7~otaluj!l+aeel➢i1;J ` "a3t~°+sI~~ - ta,r~ G " r f iM tte+ e+mt et Item a oa Form 10.10, w B e'~(IVW.A,.7t,,t xrt itr ..v.. .:'tjkF {art d'}'`~.e 1 u 8 arid' ~1!' ` 1 - 15, /I N1T , ROCEEDfi (rrrm Ilk 471", ',.g ~l r Tr{ li~rr``{1~1 I ail ~ r ~y' ,:,z 1 4i iY 1711nterett noame received fro (~AM 11 ~Y Nt r•M+[ y ~ 1 :iV ' N ' I+ N 14 Nlt . Pf. 1 r P? NIA1 M, l II /F 'i ~~r ~ t W I 1 r tO,..y:~YriC ~ 151lJY IY abl0 To id othems ',,1o Net proeeede dlstrlbutud !f' + ~ , ' 1°" y~C~+ d ~Zu........ 9lnyo lhoceede,"laerm 10.10 _ 19, me at Item 8 on' Texas5chedule d~~iatrlbnfton of 1 1, ?A 20, NET PROCEEDS UNDISTRIBUT90 (Item 18 mfnut Item 10)r 20, pe` t1 a n ermil on n r otument eA a enechr>10nu le true and 0nrrbet la lhi o mV +ent~be-11n c0 y et copes _..a.. v.6 ~yy¢Iweneratt MSe eeororxlet+ NllfaIA 1'111! r "F~mea Iut,a+iledeglnt(IWMOrlhl fl/ / h -r r_y~ 1f ~•l/J ~t~r/S/1~ ~~/~r_ Uale __~w /l - if„Ci a nomuar JZ e gn 1 err .pent , r, t i 7- r -0-B BULLOCK r t ` )plate th s report i Vail ? raqulrad Acl+edufas end mall to! iCOMPOOLLER OP PUBLIC ACCOUNYS ~ W . G l~tt_01 Rtatlon Auttln, Toui 78774 t 'f IN l ' l r r tlo nat w+ktr In the tpwrabav► ,AS SCHEpULE OF INSTANT BINGO CARDS To be filed with the Texas Bingo Operator's Quarterly Report (r=oan 19.101) ` j ? np ranw numbs ors n quertst I dad It?a''G y'"c' ~r~ 1~~ y L Ai t" wr Mtltt e. - V F'" s f a JI ' d V All lleeneed otanlutions that have sales, expenses or prlras_awarded for, Instant Bingo cards f t to 1 must file this schedule, , t X"~ ` t Fs This schedule mutt be completed and filed with the quarterly report even If no Instant Bingo Cards were sold, "i GROSS RICEIP1'8_v_..- W.._..__..- W .._..W.. _ er CJd~,.C9~ + Total amount of plea of Instant Bingo Cards. (cannot be more than 60% of total arou rerelplt) include this amount In Item 7 on the quarterly repast, 'i I CASH PRIM AWARDED- _ _ 4. ' Yotai amount of ash prizes awarded for Inez}r.t Bingo Cardsr (Thle amount must be Ineluded as pot; of the $2,800 limit on ' g pr(raa per occaNon) j Inelade this amount in ,teM B on the quarterly reporli [ i „ EXPENSES _ - W _ w.N v. r____« _ _ rJ l ,t 'total amount spent for purchase of Instant Bingo Cards, Include this amount In Item 14 on the quarterly report t TOTAL MMES PLAYED . - W _ _ _ ~--1 Total number of boxes played J (This mutt be a whole membee) 4 '~r`'rtrEs`s NOTE; Tax, REG 3,054, Rule 10711 and (8) restrleis in otoinizatlon to selling or retaining complete series of Instant Bingo Cards during each occasion, r ' er,' yµr \ Ui', r S r i~ )9 r 1 ,4 I i{!S ,i ti 6i 1•it !r r, ,r 3ts ; E%~th`S 1 r tarn lr 't i , I oq $ V. t• 3l L-. _ Do hot wdle In the 10996 Abed i TEXAS SCHEDULE OF DISTRIBUTION OF BINGO PROCEEDS page of / W I To be flied with the Texas 811190 operators ouerforly Poporf {Dorm f9 f0i} i Inao IelnM number pe nrl ne 4u Iter - - I Plooso reed Iem i1 a. t eMe of preen t on 1f F.~~ ,•e} ~ o,Ithoruvermir lolldd Llst each dlrirlbutlon of net proceeds made during the reporting quarter and provide the information requested, ALL NET PRO f c¢¢pS MUST BE USCD tlfILY FOR "CHARITABLE PURPOSES" Of THE ORGANIZATION WITHIN THE STATE OF TEXAS, Prrcoeds may not be used to support or oppose a candidate(s) for publlo office or any measure that is submltted for a publlo vote, Usti additional echaddla pages N naeesumr, OATS OF AMOUNT NAMS: AND ADON588 OF PAYER PUMP03E On USG OF PROC8908 018TaIGUTION tf1/ f _1~_/~L. 50, D© nr } L L/aN.r s r?hti d e A-4. ~ l ~ .~uflru•~ ~ fa +t ✓ Wn,~r 1 J NO ~1-n a. yFO 1JR" ,ec' (L -ILV-i my_ rt~lde llrfGn ~Pa AM rrws~l_ N e a ayay f _ 3_ia~ ~ 4 Curtn Lea t 0 ~_L _ T ~-h S? ~sd/ .i cf _l ~a rj S_L~~tcs:~r 1/r t! t' ~~__!-n~~s~.~._ .~.>L~u11e1~-.s.ze~~r"c~2Y~~L~~ ~ ~'e.r~fi ~__~,22►_L.a Win: t7~~__._ i I 19v--~lW _ r L _ 4 2 r' 41Db lI.1~~1 15 J1 _ fit _ss~/./ _ye}t~tet y -y ~ J01- I -Y' 's-.~sl~atrr~,l (!.try /)4 o, e ~eLl - L-- T Ire TOo,IL OP tH181'Atl€ ' ~1 ryl b Q .oj t'ntor rhocomtdMd loW drtrem gall all rChodute page! i+l lion) f9 of ropott Votm 10 foil, I r (,~~y~;j,' pxv3 ' ~l%IlgS•941 L bo nal wr110In IN epees ebave , TEXAS SCHEDULE OP BINGO PRIZES To be filed with the rexes Bingo operalors Quarterly Deport (Form 14 fD) Page ~ of ~ t Cameo 114onee numbot ri. Reporting quarter erM o orgnTflr Please read lniUeodani v D on the revoree side 4 List each occasion on widch bingo games wail Conducted during the reporting quarter and provide the Information requested E PRIZES AWARDED FOR EACH OCCASION {aesh and merchandise) CANNOT EXCEED $2,600 00 NOT INCLUDE ANY 1 OTHER EXPENSES OR CONTRIBUTIONS FOR CHARITABLE PUHPOSE6 NOTE, The Mal of all cash p*es awarded ltatad to thM schedule (itdm 10) must equal the amount reported in t!e„I a of the quarterly report, Use addhlonal schedule pages If necessary. ri ° NUMBER OF OAMO5 PRIE&a A WARM l OATROP NO, OF 1TpYA~ PURCHA90O 'OtlNAT6O Miff I iCost) WWIIVetual ` It OCOASION PLAYERS pEr,ULAR 6Pi£CIAL TOTAL GASH P 77M =0 A W,2- 3-1 UAL tx °8t~ h w a5, _ 56 14 7 -IL 21 26 719 4 -S? 22 2q ~ t 30 82 04 3t1 • , - TOTALtl Gemhine the latal oJilem 10 on all btnpd prize schedule pages and I enter the combined total In ifem qjo Me Bingo opemlor'e Quarlerl ltepnrf, - 1 ' r:'; is . ~~dl( ,sxy ,rr • . - j ~ ~dJ`ISx` ~~ev°~s•aet 11 Un not write In the specu ebNo `TEXAS SCHEDULE OF BINGO EXPENSES „ To be filed with the Texas Bingo Operator's Quarterly Report (Form 19.101) par C2 o1 AL- i 6mo0 licew num a- W z Naponrna querut a. I °t ~ ~ sn+e o er' n~au on~/)~~/{ Plaeso read inatruatlona s , a $ ~ ory ~ on the royerae aide ~ ! 104 Lilt each Item of bingo related expense paid during the reporting pusher end provide the Inormetlon requested Group the expenses Into „1t31 :,s the five aetosi that correspond Whh the heft of expense hated In the "Taxes Singo Operator's Guartarly Rapers" Own number speelllad). Totai each category + BAllries and wages paid lot bingo personnel them 91 r Rant or mortage payment$ titers 101 r Bingo equlpmentiowcheied y r r IIloin 11t a Merehendp/ purchased for bingo prises iltem 121 r other bingo related expenses ittem 151 DO NOT INCLUDS e1NG0 P1p7ES AWAR090 Icalh or marohandlse) OR CONTRIBUTIONS FOR CHARITABLE PURPOSES: " 4 - NOM The told! of all exteemes listed In this eehedule must eeuaf the amount wparred in Item 14 of fhe quarterly reparl Vee. addli anal chi saute muto a V mdeuarv } ' s $ 7 DESCRIPTION OF ITEM OF EXPENSE 1 AYR OP PAYMENT AMOUNT NAME AND ADDRESS OF PAYEE an SERVICE RENOERED + y Airy. Ct/e,rS.~~t--/~~c { , 3 Nom" A4 yr 1 p ~ ~ ••rr.tu ewG¢. 1ZP wit I him r. w rS.G.a~1.1`'.ay N..i--y. :c k C re 4ji 1 .ter- : ~ r il• TOTAL OP , , - Combine (lie total ottlem 0 art all expenses aelretlulo pages orbs enter the conmbNted total THIS PACE ~r fit lfem 14 o] the Dh+go Operator's Quarterly Report r+ ,t~ r r , t IRONI.e al Do dbt wdta In the !pate above TEXAS SOMME OF BINGO EXPENSES r5 ~ I{` 7'o be filed with the 1'exes Bingo OpOralor;a Querlerly f?eport (Form 19 101) rAga _ oI ~GLY Apo alpN nurdbil . sy Please read l,m ruatlons efM 0 wn11 Ian ✓FGtJo S p J Awl _ on the reverse side L111 Oath Item of bingo feletad axpenle paid during the reporting buartAr and pfovlde the blformotlae reyVOlfed. Group the expanses into i the Ilve Cefegortes that aor(etpond With the Items of expanse listed In the "Texas Bingo Opeemor's OoartaflyReport" (Item aumbels spoalfied). Total eaab petegory r Solarles and Wages paid for bingo pArlonnel 111em e) r Rent or mortago poymentl (IAIn 101 • Bingo eqU pmenl puPohAlAd _ Ilum III + Merahandlta purcholed for bingo pritet (Item 121 0 Other bingo related expenteA deal 13) DO NOT INCLUOI BINOO PIR2EB AVYAMbgt) (0e1h of inerahand4f) OR CONTRIOUTIONS FOR CHARITABLE PUHPOSESf I .1 1101'91 The 1016J of all expenses !peed In this schedule mwl eaual the amounl repaired In Item 1,1 at the ouarteriy work i C Vie addkth "al aehedule- pa ee it manias . 1 S AT@ OP PAYMENT AMOUNT NAME AND ADDRESS OF PAYEE y ' UE3CRIP710N OF ITEM OF EXPtINSB 11~ OK S R VICE ma PBRED _E j r "rtf'ai'~r/ ~~hALn ~nr1.~~11)ar1YC.i/k! _ `.ar N'Ir? ( e/rnr., e:K~~4 f rrn2N - J C s1n,.lattlsln l1?1ni v /rle A) It k e r r.• au xe / i Q`S",'~rry SC,., w ~L~~tdl.~.P.Spyv C .A_ ✓ / -1r~~ t/4✓,>7Y 3~7V si. 1 y - ,t2sest 7t 1 /r~a nr~Lr tea' rJ K A. nom! z~/~ ~,~cs~ 1f~ r -44t Jr L ! / 7- -011A 'I. " e - /l.i nP f er1.,G % f ~7 e"Lr l r / n 7.. ' is Y'~ _ GCrnn u, , SA r, h 1?1/J- ~.i~.fcucr ; rU, aA ^.10,~.,f ^1 JD I' .1~.) Y/.•-tti-_..~ r' d .9.L/ - r..._ f r l /I + n.~, J_..,7~ I f ~.1 _ j y~ . X15___'/ ~L _ L /i 1112 L~'.u~ r e a l . _ U IJ _ - TOTAL OF J 0 ;~,rylr~tr, Combtilo the lofolo/Item D oil all omponse schedulepalles alld Adler the cor"blklerl lolof THIB PAtlI: 01 Item 14 of [he llhrgo Oparalor's Q14aricrly Arbor! ;l Y I ` fyt7,i~'1PIbi; 1 rt t.: trEXAS 81NGO OPERATOR'S OUAAT RLY REPORT INeafetoldlnr JAN 2 Q X9$5 s carefully •TYp[ 6H PRINT mom r Whl 11;Y k Ii Ape AE N - eparlTnp qu Ur Y MA r f~ a noo-7cinw number ...i ; 1tt IJen. • Mar,} q 3 . 7 ft(~;~ff •3rt IJuh•Sapt,} It •2nd to r. • June) I TI 4th Oct . peo I L'~/ Z 4. Organlzedon name entl melling eddreif I} / /i 5' C(,r7c,.Cl a~srG M AL L NOTE Pau mull tl coplet o/ thtt repbrf and. aeettrory tehedu)e to the r.; A' I;, I~FiL•/.r.:cr rr~')</WJ., .~G.if C•/ npproptkre¢acerninl body, rsee la,lruetlolu on rot, enet73tJ Y'. - FSCASH ingo cards end entrance lees _ - _ t from other b6fge )IceneaeS ROSS HECEIF'TS (Item IZESAWARDEt) frethe some ae Item 10 on Texas 8chedute of Bingo .prltes, "par m 18.108) ttach "Texae Schedule aj111n8o Expene¢s,"poI, 19.102) ' A, Salaries and ivegel paid to No pe el _ - Yibnn • 10, Rent 0 ►nortgo96 tteYments 1 0. t n90 equlPrnent purchased _ - - - - - - - y _ - W - 12, A4erohandlse purctlated for bingo prizes 12, I 13, Other bingo related eupensot 14, TOTAL`EXPENSES (Vora( o/Herrte 8.18j 13, "~"mil - MOCEE tot be the same mr Hcm 9 on p'o)-m 10.108) 44 C Lt t E fOCEEt55 14,x_- -Li 18, NT i PR (Ifdm '7 minat 116 - a, me 8 and 14) . - 15, I , f 01 { f 18, Net pr+aweds un hand. - ' w.,,,,,..,:, - {I >~t.~,_,~. ' - w•I~I••-4.Nw/'••r 4Yr• 1,,.,a M,N+r r f~i._.1. ' Interact Income r6celvad 'j from b)nyo etxonnt 6 .l - 17,~W~ _ I t 18, Net prtsoeeds evellabla (rtbla! of Item, 1517) k - ` 14 6 4 17 MAN Prae»ede dlstr{buted u W " (Same as Item 8 on "Texas Schrdut¢ o/bletrlbutlan o/dingo Hrne¢eda,!'Form 18104) - 16, r•~1 % G~ 20, NET PRQOEE05 UN6ISTHI9UTEU ()!¢ni 18 mttlus Ham i9)- W _ _ 20, t'~ vs , tt 1 ` +r° ii~t+'e n orrruf en n t 1 atuent and all ette¢ melt Is hUb an correol to e o m ' 4 ne en7c bo oT"iirT co" v ca entrttryeate pldnit 1 u,.~ _ arm Out or tea 4 ~-L., - _ 91 n AUt Of tad eeant~:eL.~ _J _ ~Jr is l L "tLt~, (Yt' ~ Y JJ~ I/f^'/r ,t qe) ~ Nhun-e nUmba Dire ` • ` _ Complete t report an ell Ug BULLOQK Noufredschedules andmalllo; " COMPTROLLER OP PUBLIC ACCOUNTS - Cap)[ol Station Austin I Axis 78774 J ~.`tt'efii ~t p. ,6 ti I 1 l 1 I I°(,rrh 191ei lnnc4lfnrv 1•ba! 1 : t INST RUCTLONS FOR 7E1( BINGO Of E:RA76f1'S Q!J~1fjTEjiLY H[{ CRT ITIEXAS BINGO ENABLING ACT sac, 231 WHO MUST PI LF, 1 • You must file this report If you hove an annual license or io nparary authorization to conduct bingo (lames. You must also file the following schedules with 11116 report) - i'Texas Schedule of Bingo Expenses" Form 10,102, Texas Schedule of Bingo Prizes" • Farm 10.103; and "Texas Schedule of Otstributlon of Bingo Proucods" • Form 10.104, WHEN TO FILE: 0 If you havo all annual Name or temporary eudtorlzatlon to conduct bingo games, file this report and schodulas by the end of the month following thu calondnr quarter In which your garnet were conduetod • YOU MUST NLE THE REPORT EVEN IF NO GAMES WERE CONDUCTEU DURING THE OUAR`fE R, 1 (Schedules arc not requlrod If no games ere roportodl FOR ASSISTANCE; 0 Call Bingo Regulation Oiylslon at 1.800.262.6566 toll free from anywhere in Texas? l e Ms ` SPECIAL NOTE; Coples of this report and schedules must be sent u) the fofloAylay: t i The County Comsnlssionr:r's Court If bingo ties bairn Icgallzed in the county or only In A Justice ptoolnct Q,fj the clay council at 011101 chief Inolslnturo body of the clay if bingo ties bean legah.:ecf • in a oity and not the county. i s r, ~ 1 VXAMPLE TEXAS 61400 L+9RATOR'6WARTEALYREPOAT L r rr,wAw4.lowrwv,w.wrInntxrxiNr I _ rexnt V.ur lx Nelf1,r11N Use thls example as r ` M rMMIVTy .1 ,iKlr. •rwl s.ru` a _ a guide to help you JAS 79dystf.-4ana1, AflOit- 71 fill out tho report nwir+Fe .1.1110 /1111140 rxl v, r~IR .~•Ot;., 32511 tti'.. f~J'4i 1 lw ~f,61 Mr/~n s~I Nu nrw S y ! ~N M(?uIV ,~r.L u/ IwN y rlNNIN p nc k•+nmr pin rrl/N Correctly; r1.1.n5~n (~'A '19`13@ ~III111~=MIbN /YD~MN :a.E+NbrbhptlfJlx.JMNNYawN .a..,~ _ _ s.~F21~1s,.1]S.+•. 6, 01" hM 4NUi, hill bk*10n N1 1~96t1_e)U_- ?.TOTAL4110aMOWN rb4MJpfulhim01 + CASH F0112 Fa AWANOEO - 1NwrW rM NN, p fuA 10 rA'Ywr&A#"r/able fAw"G rwr+ 111011..:1 1 t . UK111Eu (ANwA "Fur&A, 1.4 orllyo WW.wA"rain 11.101) . 0. i/rNM W MW W ro Nn p Fuwwl _ _ to, A1atp egryFlr 0~1 lo....._31P.6 csf--ac" If,Wrplarll,AMV.IFtMW .r. _ 11„1V12D.~S~~ I t 17 M/rtl~rMrN IWdwM IN bap plrN . 17 ~bb f 9fl7ar!_a.C~.'c_ Al) s ~ II ONw bMP rtl/Nd rlapru _ _ 17 •'aJ3~ ~ ~.ILa__,. ~ 14 fOT,lL F kN1E9 ~ ' (MNOI)IN107J) LAMS 11614 NMrup,Miw l'a•w 104 ago .r.,....«.__..,. 1{-.1 IA.r~Gt•9.&r'L. 1 w 16: NE1P~5MOOEE4a rfNn /nrrrY Mwd M/11J 16 ~"a„J„v~, Ff a ImwNhdNrrnsx.allnAbllr.waamr 1t,__._~./12_~2.5-. } ' ILrNlpoONdMl.bbrYbWsrlMw11171++.+... _ _•.te.A3T5~>7,~1.~.. 1 10.1A/Inewdr MN YNn,, 10" y.bf~.OsCL4Z: 1 IUn.rll lirN 45brJ.lr of l5rlr p~Lan nlN na~lrm-0r•`I „M lM nil. U~4 . w.NFT 1AOeFFe1 UNDIMAIOUTQO rH/w 7114AUN1N,N 111-, ...."....N.~~M. { - . (fil'iG"`r+n'"AG`rire7~Ae in'Zi fF~er urrMiwd`i enr"`%/e r/I,~u"iw`wYw."1eTfdiFiw"iYnr f%~w"'/~t~r "Ai wasri►«rc~1~,AteINr _ r `IiV~L,l~trulY,7lcilS _ Tcl :"1.~.uLY arG 111` , _ ~ Nl~~'IUINI "--"i6fYuYCdBit I .ywN4tlNdaN1111a rrtN la OOAIM114ll1 A 110 KWIC ACCOUNTS 1 5 °i~S 19 SO3 I t+ ,~y+IHaw 1•eAi - ho iwr Nato tr~ Iha snare abova TEXAS SCHEDULE OF BINGO PRIZES Page,._r..,of To be pled with the Texas Bingo Operator's Quartorly Popori (Form 18-101) - Adv-anlt 4uattar t ItIngo mots numb% sins orcroWATiolion - -Y FP aata roaJ InNNCllanl I t- r r....`ll on the revano elde List rich occasion on whleh bingo games were conducted durblg the reporting quarter and provide the Information requested. PRIZES AWAf DED FOR EACH OCCASION (cash and marehendlsel CANNOT EXCEED 62,600 DO NOT INCLUDE ANY OTHER EXPENSES OR CONTRIBUTIONS FOR CHARITABLE PURPOSES, w NOTE: The total of aN cash prizes awarded listed in flits se8edule (lien, 10) meal equal file a+nouid reported in Item 8 of the quarterly report, Use addl(lonal schedule pages Ij+reressary, PRIZES Of IIAMES AWARDED I ! 6. " ` / 1+ GATE OP NO OF Ib PURCNASEO 32'fSONA7E15' T07AL Ott) (paten velue) OCCA610N PLAYERS REGULAR SPECIAL TOTAL CASR~ Q1$R Ll1C _ J - ?L1tv4'_. , - - . .:,',T~Z'3J~, t tL~ L ~t ~ _ - , _ IUL`uL1'~ Ly1''mst 4~~`1t9r1.'4.L.L4('?TI'~' is ..t L ✓ ce -r-- 12 .~I LI I I~lL_l ! _ to t`f' .'Y ';y(•ebl~Y - l_ - _ lnC f t1 L l. _ ( - _ - _ 7 6 a t ___LL'Cll f JLj4 ~v~1j ` . '12L~j,13f1'l+~~'r =l. ' S ~ y Y _zu L~ " 4 ~Lyy : dtl i . 4 r -1 ILL >esL i, 13 1 ; 16 _J .L tz t~ rL ,t z' 19 f _ 11 i. 28 1 Sx,r 2t 1SS' _ Tt__ 22 JA-L.'u -'-r 23 S~`ifakl`j 4 4'24 r I; - - - - 20 : 27 30 3J 34 TOTALS /C C!✓. ~S ~Iv ~ F iv I'Ir74 ~1.~Z - I~1J J q t,t t'urilr,tna the idiot of Item 10 oil till bingo prize schedule pagan and tinter ilia combined total fo stern 0 0l thelc o U it erat_or's Quarterly ltcparl ~ 1 _ w r I INSTRUCTIONS FOR_COMPLCrlNC,TEXAS SCHVOULE OF BINGO, PRIZES WHO MUST FILE - You must file this schedule if you tiro required to file a' Texas Bingo 01Joroior'9 Ouartoriy Rouort" Dorm 19.101 i. Schedule Is flied with the report. (TEXAS BINGO ENABLING ACT secs 11 (f) and 731o)(0). WHEN TO FILE This whedulo must be filed foroech quarter in which you file a qunrterly report ! 'I I FOR ASSISTANCE - Cell the Taxes Comptroller's Bingo Regulation Division at 1 Sl7o J52 GSGG toll free from anywhere in Taxes, r 1(' . ~K SPECIFIC INSTRUCTIONS 0 liorne 1, 2 end 4 • Enter the same Iniormotlnn as shown on your quartaily report. ( + hams 0, 6, 7 0 and 9 • Enter the information requastod for oacfl oeeo9lors when bingo gamos waro conducted during the reporting quarter. l . •r . it " . Horns 10,1 1, 12 and 13 ? Enter the total value.. of aor~h typo of prize awarded an each occe• slon. Use your cost for rnorchendiso prizos you purrhosed and the retail value of rnorcheri, ' dice prizes donated to you, ) / Total each column, Enter the combinetl total or (,osh prizes (horn 10) from all scherfulo pages III ]torn 16 on tho quarterly ireportMIS ) tall W ear was ie enr roar Ma•a THAII SONCDULE Of EIHOO PRIZES Ma a{~ EXAMPLE - To bs Hfed+, h the rekee 61n^o OrIbleror! buorlOrip heron rFarm io ror} . + Pnpiue,e au.w aa~MMr,~w r~w . r ![.~l9t>>'d%G__r!~p~I ~ldlt:~d6r'.~~.r~~~ • j ' Use this example at ~c~~"y' ~ r r y~~~" 1 Ir hr,,,N 6,,,n,„n„ +I I H~ry11 PRIM CA agEXCA 0 Onla+M AN a Qldlfa to haip you ,KWOn w VRAI tiinp ofm wH La rueed 60 ,0 In+ rNll EC AWAaOEe FOA fOq EAOH otu,9101a ItleN !'ra , MiN~aull C.lIINN Ot [%Cd9D G.600,600. . 00 a0 NOT MUM ANY E aI11Ea Ek7EN9660N EONial9UfVOH6 YOa CHRRIfr l[ i kANES fill out IIIIs SCltedlllC MOM fi+(Oei ar lit tuA RNtllu✓d+d Iola r [lN kPMUfr rlllM rbl ho, 11111 iho ern •rnl rn nrlbi to inn! b/~1lYLtlllY malt j6e (v1d0oNiRM .f+rtlel, Ifmu+a,ry. 1 +IUN UNaf A47ir- correolly• - rPilil hW~R01D r b~`4~NaCl W0.00 a.._...- iL`-._'!SI'!~P(rrh 110 {A Hhifb YO••.•_ OttAUEN: Y00 F,-- R Yitie E1Fs tAa4 1 W lr Nwr.+ Iel L JJ .'.S_ ~daannt ~1-°-J1.XeP I .~La1c d1L K2 .-JA- - 6, M OL!.! wLlt, .14~ _W 101_...1J !tJ . .4 d£!rL .1 P1'-s!~n °t-°'" E C~~JA ~ • fAV_ __VP,e r .1l.Qe .Lf!E...}_d r I al a-14.'Il J1'--y.- /t 1.0 J...1.912iy 4i7R L I I I!./fc_1i4 .ne~J t-a l z 1'}al~rn 1 1>IL,..._La r." r ,45- L 1cY7 -~-.aae~.t....~,i.:tr I uL_IJLr~, r~z 1c LJ as._ ._.I,aaa:~` ~aa ~ .EhP~ [ .ztnti r } 1 ef,11.1 r2r c BLS r_ i- L~_ 11 diLJ2!Ilf. _I-t2 _JO 1 rldl.e.Otl.lla. PILL. ~../D .C. --4 a° -444a ir.,p6Ati:.1.4...192 tb' JLdli-lAe _114..__lr~._.:..LJ , rAJ....~~04..:_.-.~¢P~.__[o~.~_-_.L.fi•+. I! I.dJr.aLftL ..L11_ ~...JA _Lir _ca"~ /~7PP....i ~iPa .-.TrQi!u ~?~GJJl_•.1R• ,.IIG ~1P ~ _/J ds ~c,.AAZ.l-._ L ~u..~t.,ACa ' 1 r1.IfA. ,.LOA _y_La Lt ~ .ZJa4 LrP _ LPP~ I.d.Pa 11,1v.1A+ 1J~L . ! acfJ.. Jrx_.i _ .e.d,daa 1. I L1.1A1.:LL' C14 G -✓n /.r{ l 6 r. ~n'!^2,.1 ,.Y'd A,.tr? I. i ~ ! ~J~tn:Y1-{.L! .1F.{ ✓J ..mJ_:_ aP ,1.21_' --{1.--dr. ieP nt._A.ls.J.4 .eUlC_.._.L4 !'1 def ,?eJ4P a_ J.._•~ra!'Ag i d}.Er~EA ii r.a7J 1.1x3,. ~ .._.._.LP .L r+ ..d+~f.= .2aJ1AVl IT 7tl.LL l it l.at~tP Ldy _._._Il _l_,7 ._.deF_. _.e, 1AS_ 17f.. .Yle 2. ~~.a1.7/4e. 1 I N t L ( .4 Or ~ eon C' her r 4o, (Pp•f yrI G f5 lz.9 rene AGh ~/oo_ M1nr rh nnalyd~l frr hellF n(11rI hrJl pair dF~ l r -_-rnllr lh 10 nd W~lel w1=30rhIRN (Y aL/((ly-r,lrf A bn { r l I. :;Y+S Y~ IR i671 aa1 " Da riot who In the SPeca ah ova TEXAS SCHEDULE OF BINGO EXPENSES To be filed with the Texas bingo Operator's Qrlertarly Report (f=orm 19-101) ease j of i afnen Ilunee nutn r. 2 Rapnrpnp quarter . 0. ' lyl ~r Name o} oraanliitran PleB50 read IlnSituo11on5 - on the POYa PSe 5ICIa List each. Item of bingo related erpensa paid dulln® the raporting quarter and provide the Informatfon requested, 0roup the expenses Int i egWpmenl pu spfiedl. geepeymMisa(Itetm Iltarn numbers the flyo TWO theh c6eg fry Ih` 8416 les correspone with the items of wages peld for bingo po Iona! Itleid 191 the, "Taxes Hunt blngo reloted (Item 13) bONUtINCLUDE tfIN00PIHZPS r Si e+ t`~ , 6 Y A 11 sluash a or nmorchnrdlse} e OR CONTRIBUTIONS et FOR 12) bIriQ0 AWARDED S s NdTX' `lhe total of all uirehur Iteled In Ihh sehedvlr mart equal thr alnal141 reporled fit Win ld or the quarterly report ,~tt flee WINOnat echedu. , it pill a I neeeseory - - - DESCHIPTION OF iTEM OP EXPENSE A V OF PAYMENT 6 AMOUNT 7' NAME AND AbbRESS OF PAYEE t OR BERMCERENOFRED - ~f I-4C ~,Y, 4 l t rli.l:!~~liLv~s_ i ij+4~'r~N t ~,f4' is )I -W r ILr3f ~e - L C e ri}` - .~~lib _ ALL) 1~J ,lei LE _ - r _....:_..1.f 'i._7 j ft, Lc I ,y 'pry f LF t t s t a -4 ' 1 } E r 14__1 51 _ ~t ` - t t - is )71 t} f rF i 7 - y r r s r. l' -L -4-Ly- 11L AL 1~~M~,` ~Yk 1 t1 iir{ r rieFtrLi rr:!L _I_srt~!r f_.11111.1~ -.-fY1 ~_Ill u• Lk Is tl 'Ti✓ L ' j TOTAL OF v Corrlbine Ihr la tat of frill o as all expense schedule pago Still outer the eael billed total TIUB PAOE In If op ld of the WthloUperafor's QlAurlerly helrorC i e'd , r... I I l IJ 10 10~ Itta w11kc l l•s51 r l INSTIIUCTIONS FOR COMPLETINLi TEXAS SCHCUULL 01 BINGO IY.PENSES i WHO NIUS7 FILE- Yoo Must file tills schudulq If you ato required to file a ' TuxOS Bingo Oporatos's Quarterly ltepoitr' (Form f 10 1011, Snlrudulc ik filed with the report (TEXAS BINGO ENABLING ACT sec. 23(u]I2.3) j WHEN TO PILE - This srIlUdUle must be Illed for each quarter in wliich you fllc a quarterly teport, POET ASSISTANCE - Coll the Texas Compirollet's Bingo Itogdotior l)ivisloa al 1.000 262-13!3156 toll free Ifam anywhere In Texas. SilECIPIC INSTRUCTIONS + liams 1,2 and A • Litter the same hlfotnlalion os 0owh on your tltlartcrly l +poit 1 • Items. h, 0, 7 and S'- L.Isf cacti item of oxpanw poll du7ing the rupurling quaricr Hurl the Informallon requested for cacti Item. + Group the expenses in the categories slJecifled on this form. Total each category and enter the total I I In In the Corresponding Item oti the quarterly report, 1l)e correct Item number Is Indicated by each category halve on this form, Itom 0 -'Enter the total of all-uxponsos listed on each schedule page. Law like total of ltem 0 from 1 all scha(fula pages iri [turn 14 oil the quarterly report, fs ?+f `v EXAMPLE- - - - +i- _ VJn ItrS°!nu LA i ' h,a w;i11, nr lok, Had k. Lite tills OXomple as TEAS SCHEDULE OF SINO0 EXPENSES ra ho Lrld tldh the ldief Prhpo operew s ooeNetfr fkepNI rfaurr IB-ietl r,r r 11 guide to help You Y f5 , r7F:~tir r r aTr." `a lr y'.'.I i__..:__-_. j, fill Uut tills Lohclhdp 7L„n~on•`,n1~'•"-" tine nM rMlamat r l , r f f N N r p n P r. r f a. f l r r L b I' r r t Tarr r U , COrIilctlyr , + ariy, u f u re uae.r e, , u=r al r rl rr • f r 4 f r t4 a , rr1+n°v rr ' I r<, n., uJr br ufa rm r.! aM~W ru r , r. o t iq [ , p_. I4 r r. +R.cN wr..r .e i i • LLRU(L . , 1f11111•a rb ey.lUts w N . r 4..t,✓r. ~ p IP rO \tf,4 r14a1 eV.UrP t(1 ai0 44A4 i1N, e• 01f IrO.i OR cOH1aIPJNO 4 rr.p 1.00n rtitlf rpa'GII: - NW, 1'~ Inr hlr4u u+U In Ida 1 : rr•r 1, r ""',4 +'IR" , n uHNr nrsl r" art ,rr_ l i dt}IL 1 i Itf rcno erfU ortarr~ft-1 r - ufrrt r rtrutr .rw.r Wit er6 JCOnraor rr v " - a .Y__. _ [ -1!.^tff iQF °l nUthlt , ).L'1 ai Y.'L 'Y CLd (to~ lerltrc..l1 ii Sf:-w i t ;_,.J-L wF •••tttus .J r2. it f3 hhV R4J "'U! LIDO .3. 'Jit Jf 1u.,yf tlrr at s 1.Z it 1.~_ iJ:2 411 Cj 1 trfW% a ' sl"t- LL.. 1LCA11at.J~ ti 1JML Q[>. ~ 1a St Y;}_.a_t3rG.flO.l]AiP Jr.1_kie't'i V.~eJ15,.lt tw+ btt~u2b,k t++_1+uTrvF~ fol. 1 1i....Yb y.!,nav.rn APd. f{+1 '7112. ~~LJ~9nLn.?..tr. t ter ~t.S6etA.] ti:Yru:u jj Z _ .LJC F:Yi ?A .1k1~3 i'3~,5 1 , mil J~.1 ~.1,5-~.1_L'C7 ~ft~~y,~.t+Y+.U+.r;1f12J 1l r~Sy1 CL,tttA I 10 CAt Ic~„~g1]" ILL . t.L rL.f 4.L 1y rJ1 75 f L F S ~1i 'a..l 'f ii, 4J1.LC31f 1.[L4.1uaJUCU.a 4~.iic YSy1J1 Ire l~L.ts.r.w Vt.7r1t wi1.11.{t f ~ ISJU,Ii. i_td 7L rtJ tJA~Cn,1 cs.ab++ w J J L ' I1Swe3.au i.~tt ivn4-sJ ur 3 ' ~ ~ZtL .lµ , M4~ ~(.aw~f..LJif.u afLLL1 Y~rl,r rr.Y F+-wL«.i a(.J/.J+.M r',...rLL. _ kalJ iaYrr ~J,7>L 7J a•s 71;f E s4 dal IuL - f IJ Jlt a Il.f .s.7 1d ~.:w v.. .Ln ~ i1Art:.L~.J.r}n-.T.y..~ F t4rr 3v, KIT 1. 1 J1 J3 1'1a L ' il..r, - . . f _ _ IpGr tit. J~ ft laic blr rn inn air pKrNf Na! M1Nrr t de'~1 IAr r6n1 ad loft ' r W riff 'l in rlr# ire+fA1 K(+101 N 4 e r l}Nrp r I 4 Rely. I I. Do not write In the yrMe ehpw 1 TEXAS SCHEDULE OF BINGO EXPENSES To be filled With the Texas 6ir7go Operator's Quarterly Report (Form 18.101) Peat.-- - 0 rr r~ Kepartlnp querler 1, npp IafnwrlumWr L r fmf oVaro.el,ulan please read Instluctlons L ~L + ( (t/ G an the ravarae title Llll each 'Item o! hlnpo relpttd px¢ame pald duling the tf¢arling quatlar and providt tht tor's ari requailed, Oitem the ors sei Into ' 6 or ei that correspond w11h the liemt of txpehie IINtd In tne' Texts 81nge Operatar Ouauentriy Report" (Item numban soopectliedt '.the IWt Get g 1 t ,f"+ t 7ott1 Bech Cttpgory r 6alarlts and v+egtf pall far bVngo peti6nnel iltem 91 + Rent or monegt (Item 10) r INC DE DING p PIRI ad ' ~ sty t,~ n (Item 111 + Mtrchendlst purahastd Iot bingo prlaes (Ilea 121 +Othar binao reltttd expenset (itgrn tam 133! ' 00 NOT INCLUDE GOPIR7:E8 4 ' i` a JI ~ ~ ' AWARDED lcesh ar memhtndife) OA CONTRIBUTIONS fOR CNAKITABLE PURPOSES; r~ ~ ''TF Ira r ti NOM The lolai of all exDehiel Wed In this fabtd0v murl tpaa! the amauhl rtPOrled In Ilerci Id at Ilir auorltrl3 r+PorR 7 tq'y. i' use addlNa)1:pi. uhedalt 'aptl 1 nettua Ij,t1 8 8, DESCRIPTION OP I'rEM OF £XPENBE 1', r34rr,r S ATB OP PAYMENT AMOUNT 7 NAME AND ADDR£550F PAYEE SERVICE RENtJ~REb _ tL'~• r I ' ' 12.. ~1' r i Lr r y t"t:}11 h'+ '~,1i ~5 Ins ;.S•y -tr•.~~ 1 Il t , -h'41 I r r , ."~1 , .•j-~ r.(ti .ul,+ _ ~ ~~V ^E± t'?✓t .✓j~..~..V mY.1~rL.f',.._.~~S~.t1~° - p s' o IJ 1 ~,~ry1f S I'" {q l F Ir:. . tt~ll ~ f t Ilt ~ I ..r ~ +fj.MMiy+• 1 lr Y 1 >~~«1 1 ~ ~ J r~Yr+`1y~L• r....~rrar.J. ' t ra 1 'I ru.u 1' ~w TOTAL OF e, l.'ohjbiue rile Ioial o/110111`9 all all expenee 801e(ide paged and enter 1110 combltted lolof fi1115 PAGE in Was 14 o/ Ille 111rrgo Qperale)r'p Auarlerh' J2eport. dFl Fr' l I ~ ~1 Iea IsdVS.N ticvl1•P3) _ J I _ ✓ IWSTfiUCT10NS FOIL COMi'LE'fIWG TLXA6 SCHCDUL[ OF B100 D 'P rIJSCS WIiO MUST F14 - You miss tilt' this schcdufu if you ale required to life a "Texas olollu Operator's Quarterly Report' holm 19'1911. Schudulo is filed w;tI the laporh (TEXAS BINGO ENABLING ACT sec: 23(6112-3) - This soh6dule must bl Bled for cuu11 quarter h which you file a tluartutly rcpotll iVHkN TO PILE Rcr Ilom 0nywherr. ln j toll Texas. own ASSISTANCE Call 1110 Taxes Compuoller's Bingo 1`1001,1111t] 11 [)!vision at 1.8011 262-56K Li6t uch ilomoof 1091 onso paid hutting Ihu rI portinD tonotei and the Infowillinh you SI'[CIFIC INSTRUCTIONS - + Halos 112 A - ns G, f1A7 and Enter te Itnl requested (Or Cool) lam, +Oroup the uxpensos in the caldgorfes spaclhod on tills Icra1. Total each eatcgorY and onlcr the total t , 1 in 1110 carrmpOoding Rom onlhu 0oarlarly report, The correct item numbal Is Indicated by each calagoly name on this fomrl = i + Item 9 - Enter the total of all expenses !Meal on each sc)tedule page. Enter the Intel of ltam 9 troll) D t 1 K,; , n ah sohedulo paNOS in I Iem 14 on the quarterly ttlpol tl 1 } A ^AI 1. ' EXAMPLE- /YY 17~,°I, rrl V Lw Da,na,ii 1. lY U~-,Ida is Usti this example at TBXAB SCHEDULE OF BIHOO WEN8E6 ,a 10U „ t - t r I' To L61P0tl with M JPAe3 Bingo 00011101b ovdKifly Hopen i ofnl _ . r - - E ' „ a guida to hale you 1 1 ~I•I,IrA-n, ~ v,~r`1' ~ ~n31r:1S$'1oJJt ~.x5. I ~ I 61ua a 1 v , ~ i 1 . p'ri,iie V rl n v 1` IA11 11 f1, I l fill out 11111 schodule n t1Yu L ,ut~ ~iuvt.:dc t I M r S H "ro ill d u i Y lull r I n l d L.I 1 1 1 e, N o f N 1 tN f sw t I e 1 1 i N1 1 I f~ tlt~'' 43] IYq 1,I tltr rl 11 w4IG r , t 111111 eY Ift !I ll nnl O'nt4 Y co r re c [ f ,ft • a. Fe, 16.P 11"<Illii II 11'L P 0 YID L+1 0 'eY IIILWI , YI T ( 1 Ib tly al,l L a n ,1~11n 11 11 141 161 ,l l ! Y 1~ t1 a t' 11111br{! f016 I I I ; Ir+ G' t l tOAll1l JOIE ICI A1,ITAOLL I0Ih1IS r t „ 4 4411 1.+ y,}I tau L' , -3q !!V1 a on •n 1u ec m ul l rl s' , 6 hIg114b Abballi Gr NI111 _ I all [1e e,ll e,'Alulll,I A41oJUl l _ - _ f9 I 1 s _r 1- ~J I, :y~ ff V.pfj:unl}.-t~7a d.~l.rui~`Av.r ail _ (J:1...11 tea. f Il - G~ 6 ~1( t15uX a1L~Y 4.-l VJSk f>bf ra.,.i 1-2; fJ 1 ,J t1 -1.1-' 1 'x ytY n+J.n (J Al3'~ ~SU3e r.1.1..._ LJ,.iJ.:: 7 i . L,~•'r 1.. 1 t J sl_ t l sa'4 U'w''.t It AJ - ' ~9rrtsA ,.13 . 1.1."Ifid - • ,!.Jsac,.,ti {.sA.l+Lrr~, • NJaso:.JE QL-~f lhti `1110 "LL _ y1fiSJ11 ~4 LY(Y+IfI ' Lt1"-tr-s3_~e,aaacnlsNC.keJlfi+y-fauLf.lit>Lr..1.4.. ~irt~LS3ta Ill sc3°J , r , b`df i rJu:il,. 1 b 1 r, t1~t'1T1E i Jf H0_210r~iS~u~. ~Y'i'Swtx°i'I:I/tL ] t ell JGsL-r!fl.r-1 LA.3514A t 1 fr, 1 1 5 JI:., I ~L d ri,J•:1.A,t41- 5:11.}`iluluArl bZ tx Y34Gf 1JV t,t.. Lrl,<t V W'4ai~fuw 5 11,Lt1 I S h 71711 f I l illlil3. J W+,t ~ J J.Y( ~~1 ~ I} j.l N ~ LI11J ~ ~ F 11 .I_..L ~'F' 11 1t il,r✓.[f slyJ d~.-Y 1 Iw~n r.~.. Id .J r; 1 - C.~/),.y,~iwl.i. _'~it11 J..YJrtY.r r•~~i.' f i lIL>JfLliJf~rs 1 S 1 2 1! 5.,1-.L i'wtirf~ r a' ` 1J SL i h V.,t~,.ly~a L..J.:>L.v+Ji ~ I J2.•vJi T 111j__IJ SI 3 - I I CoTllsl lhl lib cl llr ion lb aNlu, Itdldoll /INII lHp IU IO Iwld Poll, 1 Id1Al6 mIll~lf of 141 NI l^eMNlarl lJu[Inpaepaf ,air r.Gl i~1L~c~I.Y?~ 1 ,tt >g 'tAi {Rev. 1383) bo not write In the tPice sbu:a t~.u•leq l.._.. TEXAA SCHEDULE OF DISTRIBUTION OF BINGO PROCEEDS Page_,, ot_ ' c / ] o be I'lled with the Texas Bingo Operator's Quarterly Report {Form 19-101) Z gopos tine quarter Ingo Ilaen" numbar amo of areenllHlen Piew read inslrU oilo n, on the rover so IItle ti I 4/4 5 tom' , c~: ; G G' t IS1't a List each dlstl Ibutlolt of not proceeds made during the reporting quarter and provide the Informnilon requested ALL NET i j CEEOS MUST BE USED ONLY FOR "CHARI7AEl.E pUHPOSE5" OF THE dN0ANI7A710N WITHIN THE STATE OF TEXAS 1 ' 'v7N f r Proceeds may not be used to a:nnort or oppose a caedldate(s) for public office or any measure that Is submitted for a public vote, Use rddlttonal uhedule peyos 11 ne„essery. ; NAME AND ADDRESS OF PAYEE PUf1POSC OR USE of Psocttos i7~r fi ! Srr 7~N NT - r, k ti ! ~ -~,"fGn/ _ L. Z ~ 'i .1~!1 C j r4_! i7 f' vU•' . s y~ e 4 _ _~.z.. - t~3 Skl't%Le iv _ - - _ - - _ = ,szct c ts~~ ,ti c ~y ^J~~ J' ti `~p - i - lot < X l i Jam? `".L _✓_'7 _t<l1; _ G 5 r1r Q&L _ -r- t f f i tri l fa~I/1 tr~vSi 1; - '-'S _J l~1_21-a_ Z / r= ,vftir tS + i "r L~.. %3 ^(L t_( A nil.t )1I11E Cy0 IS 7 t`. LL f S 3. }t ' 1 'r Y J - • LL L~~~ LS.t~Lr'~l 'r jse ~~r ' ~,x..` A~`t4 ef -'x 7 TOTAL OF THIS PAUL 1r~ 'Im All IN J l l to 104 laetk)tnlty 11.83) J~JS7RUQTlONS FOFi C!1fNl I E7VNG TEXAS SCHEDULE tlF.DISTRIBUTION OF NE7 PROCEEDS WHO MUST FILE You must "file this schedule If YOU 3(e roqulred to flle a "Toxfis 01noo Oporotor's Ouatlurly Report" {Form 1B•ioll. Sahotiule Is filed will the report (TEXAS aINGO ENAB. ING ACT secs, 20)) find 23(a)(5) WHEN TO FILE , This schedule must be flleel for each quarter In which you flto a quarterly report, FOR ASIASTANCE. Cell tho Texas Comptroller's Bingo Regulation pivislor) at 1.000.262•131513G toll free from ariywhero InTexee. SPECIric 11MYRUCTIONS • + Items 1, 2 and 4 • Enter tho semis Information as shown on your r)unrteAy report. Items B, 0, 7 and B - Emor the information requested for each dislrlbulion of not prciceods for "charhahle purposes" made during the reporting quarter. v + 1 1-l }I It t I ' EXAMPLE ®t#„Wt,,, TEXAS SCHEDULE OF 018TRIBUTICN OF BINOD PROCEEDS _ Use, this exempla At 9 gllltle To he Med with Ina 1-,-.e~AU Brnpo opatdfarf ouvroily neUCrl?room 19, ra11 to help you fill out this f, i 1 6ChedUlb Ctlrreatly, Oil t ll lUt anal ntl VO for rdfol TA M,fl'OMmE11"tlr OF to, lM O A141JI010UP 1111IN Trit All e 4ttbt RlltT r USEDetrCS'f0e CIUpkYA64FPUateSF3" 7111 ORrtO AlUth110I+tlltAU1 >It 9flTr 711 i[)LAAS ~ M1Ool id, wy not be oW to WiNd 01 000ON t CA l Mlllel IN Wli 1 Olllp V IV ell IJ It VII it ILWAI I1 If I OAlit tell f the w1 l MOWIMtpiP, N nBtw - ` OA1tof -`'-AMULt. A•AVt Aka A00MIPbI tArlly-fir IIPe 51(5u1t of uW 11Uf~ Y aftANUfl07r~ .l ...I - f . .IL ~!J J i:. ~S CVb Ll] 11u ~~t"''-11111tt,1V ~a~IltGi... LW~ }Sdr-J1lat~t6 i.a , Ak:M ,~`Y~3'L4S,__ ,T uoQ. ulA2. s., F }L 11 _N.3 1 tl~4~Gl CY? 11 ~N_I`1 151LYrIJflLt4.r.') `Sf W 1J i,} l t dI 4 - - }krs_. 4 : JY.\vn tittJ.r t ~lC Vl.+,r _ J - 1SJ w.'t'x 717 Bid.. --i - - . - r, r CiJ,s3xWY"s}aJU uy..tr1!'..du y~ ,whJpu,>l't~, .`w.~A+1- ' Jib LL J~Tx ~AtARlu JJ x,3: W l 5,O~u 4`Gt~lJn4.,~Gn ~-talr've§~I ftr ,Wa.Jr1a ll~,.Jl tiw~d.; y i~}L.l _S:1,G W+~'fld~- •,GltdJJLLV titlJ.~11.Ls1 ? 1 1►J,ntty i l >i ~ till _ ' '.i 81 w l1 y, dntJ. ^gC,..r.`rlFW1C,1(VS+~lw ' if J.>tiattt t tJ4 t,n.M~-..-u x UILVi1.Lisn.+.i, AA, a j 1. _ t t J t l4}nfs,+..,'-T t 101 4Lt 91 ffAW 1•Ja IrH FII(rMF IJ IBA'IprvM Id MIMAIJu4Npl M 1400 )1&OWPI ltYw l/1011 irwrwr~ k r f s I y r..• l~~u tr JAN U lU~ Wit" inavn•ea} TEXAS APPLICATION I~ {l~ilili +i,l'r POP LICENSE TO CONDUCT 61NYG0HrNtrr r0~4n (tolnsundodmees' ei'l0nla rea d inatru911unt - --""""-"-I Cll~'idlll' ~ Vlt,r ' I nfo BPPlled for .J n •LAnnuel LJ T TOMPOray 1, TYPO of 904 Number of temporary licenses received by your Orpanirotlon urIno theP X012 mo iIMYOS ' ealtr Who llcensu n~nibor ' 2, pit this orgenltallen eVer boon 114ued a Wag Ilconfo) V•xu Cmamerclel License to Lasso I Togas IIII: nee to Conduot uingo may) ''~•h fI l 5. 1c!3Ja4hdalU 41r11U1 - } KNIGNiS OF COILUMUUS 4771 - ' 140`1 i INUSOR OKI1X 7601 a, DENTON ~J rt"e"s 411, Coat Courtly e ` ' tI t city j • t eel and uum hrn tfU, the mraufns'/ul rrlert lfnin U lo, urrn7 faun err) a I phV W~ 1 tyo lltel location at your araenln liba (tiff (f p, 4zi4~~ itiTlY l~ IN ] _ . , 4, betalW the spec"i"e pu+POtald lot which bingo proceeds will he used, ~k I t V 0, Tyoe of non ptoillargenlaetlon t^'1 Fretornet 4 • Volunteer pha paPt• • 1 ~Flellglaw. l.1 2•MOJltel YES NO) E 51 VENr$at fie thfa VMWAe, Ortanl+allan ahnrltrad by ill, U.B Contreas f a<F ' c Olhet f~ix(lieln) I :-I- YES NO I av r; 11 ShllOrganiralldn elllllalad wllha elate or nlflonel 0r9enlUl1667 i S Ir 11 ,yeS,,, enlor the name of the orgonlaatlon end the state or neitonal eddraH i I V8B, NO a 4, Oooe thlc olganleeHCn nawhWs 1001 (01 exomptlOn IfOm the infernal nevenua 68 vEge7 a d { If " ytil"tattach at eopy of the In$ nuting of doierminetlor laUer on Yet rexempt auius,I Yt++a ohuur of CoA no, < nett f 8, N this ar )anf:eho! It a corpotellon Wall - ' at - " with thG epPllcaNUn 3 I(~ A wpy of the Afttdfef of incotporallon must be (lied of UVI it this atgenltetian Is not a Ooiootetlon, doloriba the mofllod OI orgenfeellon and submit (Yldtnce orgxnlrellon, (flee fntlrucllont7 Uate o+ •rganlretltl~ ~ 10 t nttlt YourorgeOlaatlan'a Fede"al EmpIaY11'i IdenlUlcatlen IFEi} NO, ill en, l I § 11 OOIt Youf otgarllaetion now hive a texpeyort mbar I~tpordng any Toxet sex of a7exriVandotidanllfleetlOnNursdadf? SS N011"'y9S',enlernillooar Ll' e'er r 1 C a f urrn All-1114) -tills 12, 1tInA0 ! Numbef of eOtlve membeN In good 11006 In thla orgahleellen / r all orgenlU110M1 ollleerl, f7f dddfltonel state h hacaNeril, VIC "Pfeaee btdf goeus lllV Nambl~lfon Tor Lltamtl 10 rL F111•} IVjkt1 ~.45 ir1 t + it ig• Litt N ma l:GI_ a Td 1~5 LJ _ 4~S GS i slPitL~1~ n L J WtLI r~ Styrt~t ` 1 55. J . zip aatle af,ona IArce Onto 4 Flo') ~tty sate 3 7' l X,~ v [J ilk ~1. Hama address X, Eli ilrl I 90clai saaullty Nulnbar • lt('Y 12,ytllliY 1~1 Woods 3f ~,l r = x r~ t ? ~ f htlM JAnte suds k nn,) Vie- zlriaade ~ ®tele ay f I .ILL." AS ~'tr ~•1 a' CITY r fLJ NOMta tell ^ fy e,~ t7 oil 1 . t I , $atul security NurnUar Tide Naha r' I'4pb+it-~Y J i e~.. ~,I d s1.S.. l.+,r'_r`~ r. ..t l ~a.._ ~..+~..a--.., r flltoao Arra cads la till fl6LVO~)l.Y~_ CI y eifste j 1 tlPCade J f1 _~t(( Items eddrale L.T.' n 1 I_l..eV Z' t' f ola~ ~s14os(- ..~~I who af( ...W1 V pos 14 knfr jhj ms of a b e c e acitive met 26 end will bO 011ar Irll6mat WIIISfappeal r on Yuar l Canto r Lilt bingo AMaan011ell 0111 m0 1Uera hl! "or' hit mamb er mQi wh0 will be opololorl On kilo eppilcellon Wellman IFO++n Al' 1241, ~ I SooUl 94aulGy NurnUer Driver s ""tense fvl/al~larrE nn.J Noma end 110MU61 al Ware a{ so aallVO Member --7 y++J s ' q l IL ~.1.! 1 1'-9-k 0-r t-1 ~ 2, ~Ih/h`ana Glrt'e Code A nu.l lam' Pilr_~~, i( ~y~ 1 L1 nri_1jS~~-- gtetn lIp COJO ~r 41~a7na eddroH Chv It t',~,J f l 1 ~tl 111 nor lt, I',> J I..L~ 1.....4J! J - f- affecitild dill NatY A I.. Sex =y Dote Of nhth hon End teller at your ` Jp_L J 5 16, Litt the. namte of all pal lone who w111 work and fecalva tomoooeetlon at W111on, us L Ulf the IPpllcellon ouppl0mant IAf l24}, 1`r0vldo ALL reoueftad Informailon fed aatk Peron bingo - - ' game" - s J f , f Y l" AP. 1172 TEXA5 Alll'ICATION : - ! 1+' rNw IIiCV 4971 _ POIt LICENSE TOCONDUCT nIN00 page 2•. 7 18, Name of mpe nleolron I•t'awnru Ifrln Jl CONU LICI Ns f: PEE ML_L\t•}I.i(~t C:S 0~ QOI Lo.w6 td.S lEPLOtl TCodo'~00100 L`LDO TCodo.OD100 f S. City {50±110 al H rd n dl Dopollt code a 701 0000111 told . 43 u ~i A7tTbI7R1 71'mari'n~- , _ ~L LI 1 IJ_l_J 1 1: ,1 11 1 1 1 LV f aft o t d Week end lime rl gemaa w fl bl played, f~InY rfn~ pXt~`~d~u In inurr in any 2r hour err In rT) Pll,tdey Ti '++a : aaegnd day Tlmo Yhid day Tlm> e Jail n bl d4_____ W nt .Lw1JY; zr- M [ t r LI '~J > n( _ IU; J 1"~ 17 1 'MOnlh, day 7hl~u-~~- II this Is an eppllcallon for temporary Hearst, enter (he month, day and time of _iha temporary gemtl, _ - - _ ' II the above temporary game Wit replace a regular Varna, enter the day and tlma of Day Time - the regular game that 11 replaced ` - j ' LOCATION INFm6I1MA71bN~ " 19, NOm`af location At which genias iwll be played t~ *"i~`~~. 1~tL.vi~Jll~rf/lr=J.t?.T_,1v~4tSt1(~Sly~~'1~/ J eL~l-1 ~~1~ F ft ' .Atl era fafreelm unbar or dlydelfaid)CIW 51e1q Zip code county.. - - e~ I`100 r''+~L ~~__~d~.J eL ~U r~ J eL7:r J eL7 ;'!-rte iJ ~~1, ra,J i - J,p, number r 3 ,x , 20, Is thli 1eEetfOn In11 de the arty Ithalti. of the ally Indldoted In loam 197 a L'7 I Ye9. ❑ 0 . No e~ 21, 11 011 loeatlan tlllfllant from the IOelllon of your brgantiellont LJ V68' ❑ No 1 vim' „ If "Y115", exploln why the present location of the orgonlratlon It not adequate for playing bingo games; (sae miuatHOnr) N, . -14 I rho, ~.~r1 •r.l:.' i % s + e ` 22, Mal la the maximum looting Capacity for bingo of the location In Item ID? 23. Horrw- Ii this location aonholted.by year o,r66,a,nlaellbn7 L )Owned- Data acquired 1 Ceapd I f Lobed lop temporary game only q k a other flrxplln) I' '.t Name of 6Wnee et tailed pramUaf ~ Owhu4bingo license number Addraia~~ ol owns (street and number or o, box, ti1y, mate, rip <uddl intent per colander month 21. BetiD iNFOq,MATION fro bl committed only by applteemli Idr annttel Heense sea Uulmeffdai I r e, Estimated monlhly bingo groll reC8IPII II010 dollars only) V! t b: Exemption 11lawod par month „ • _ _ r y _ _ 2,500 l a." B1Urnaled monthly bingU. reaelp11 mbleat 10 law lRnsil a Inlnul Ilmn b)_ _ _ `W _ _ _ _ _ - - - _ IihO Of Estimated monthly tax at rate of 29 olumnly Item a by ,02) U r e, ;AIr1OUNT OP BOND HHOUInEb fhluHiply Peal it bS 3) _ _ r - W to r U y~~ r -NOTHI f/ /lam I to fell then 1roo. Ilion no band Ir raaulred, t, . .r f r Type bf_ bend s 00 - Not fiqulted l y Ot • Cash I C2 r Su sly bond LLS 0 AWgnmant a! hoylog coolant 25, LIC5N9B FBBl Payment el like required Ifeeold lea mull be rubmtled wllh We appliedllon, T- 3, s 741 orer _IlEenle. fee , Poo for 6 tomporery llcamo to aonducl only One acaeslomil $29, ! tS ` `sit a Annual Ilcomie. Igoe • Pep for an annuel ileonsu to blood on your oroenlldtlon4 Ynnuol 01011 rodolpll Your Ilconso 01611 end amount of fou will be found In a table In the InitetoUant, S' It You now have a llcanlel your 6nnuel grass receipti will be the total of your grow Noolpis lot (he 12 months foreteding the ionowal, ''r I - 11 No 11 our first application lopa lfcenle, you will determine your Annual gross ii by multiplying the amount you omitted In 11 ' IIAIar.the ertteum of Your ennupl gross racelpil I5 Z)~61)000 / payment rare-elred r Bitter cur itemse-a - „ «.~._T.. It..ll ~ Licensd Ibt } - l?.4 Or) _j 0 YES El IVD rr ' rry~r-..--,.. ~_::'.Tf?.=s.z!~.vms:s_ 20,APPIDAVIT OP RESPONSIBILITY ` N'e, the underllgned, Malty tfAoleto 11161 the orgnnltotlon Idontlrida above 11 o bohO 'Ida monp(ollt organRatfon, that we its ao(iva moinbora dl ` the olga'hliallon, 11141 we will be i6sponNblo for conducting bingo gemaa and for 1111ng 011 requited returns In aoe0rdonco with theprovlslons of the - Texas BingO Bnabllnp Act, and that all net proceeds derived Irnm bIri gon111 will be tiled lop charitable Pur0016161 tfoflmed In the law. We furli+cl declare that sea hays RAVer ISaon convicted of 6 felony, gnrnblielp ollonle, criminal hold or a crime 01 a moral lurpliude and Iha1 the bIrl wnikdls baye never bean convldledOf a foloby, gambling oHOnse, eflminot fraud or a orimo of moral turifliudo. We fyrlhm certify that Copies of this arrItcollom IIAva heed sent to C ff tfl. .L. J.+Sze.1„u 11Y.'~:....._........._..... end that Ail sletemanis in this appteatlon and Any attachments are duo and cot act to tho bolt of our knOWtpdge end ballot 31 n ' Member /lima f Date / r.•~r~,frY hee~'K!✓~ 17144 It sign Mn of TWO Dale I r I'- hers p leld Oflla narnbir nelna and number _ ffodint number Ueta ...J ~.._.,r... ---.-_...~.J 1 I. 1 r ' a `nP•tan TCXA5 SUP"I.uMMT TO I ;coNjlp Grl 4lioirablocsll nl~r+unoLu , Ub 140 l' Wlili L IN III lhbl It nltrnG APPLICATION roll L10111\1,311 TO CONDUCT BINGO Ui0 tlllt,Suliplatnrnt7oxosj1Anm~dmcooliVloryAppp albd6 forrcLicanlsotiloyCo~!loci !lingo t{WoncAPll7~la la Ccuduct Uulll!i` 77( (Form AP •1171 I__._. r f JIForm ion or ottandneal w111 nol lia nLlaovacl,lf Ynlauc4i~n It aotom loia id, cnr11 nnma Il~tul_ " (r'Notor elite( ' lldfe (If bh lh"rn mnnfll, rlrN +1 ur 1 indiplr e I 2 D rdJ p I_} _ - yy for UdoWll6V1 , 1414 rrurY for cJeuuarl 1G, rf160" dfller I - iav 14.111 mso s11i7u 111oua olio ism 1 oleri~a l...fori I OItd ANI ZAT1Q0UNCCfiS _ - tta 1 fiodlel eeEUEItY UMUer r.- ~ , 1 L 1Y { Nami (LeaG 11,11, middle) L. / o I el LS „,AJ1 Nf'ali-'~4 1r/!1( 4 ftI i~ L7~_FJ IyLt PltOne (Art, CnrIC A Ilr, l r'""_ Will ZIP code y Dlly LtXJ Lr7L~.,~- U / s'2 .rL~ Henri addreel ,~•u 11 I ~ Social BaeulllY Nu What : ~ u fall. ~ 1 ~(rl h). [ E S` r Namiftadr Nrlh ni rddldlCJ L4i`I'1Li 1441 ' code ~Peons ,irrd for tr do'; bA V - ~ m . Antis w J L 6 xt i" ' ` t Nom iddriH 1 fie' ra tit t; 4' 1~ Title rlal security Number - y 1 L U G sU'ul e;+ 1 s i ,t Name (Griot ffreflmlddie) ~l''77! I ' L ~'i 4 1-1 ?••I I an~ I.1~- Phone rhroo Coda d nd 1 i 1 I{ r IL _-L4{1 V9~ Idu.----- ' 8^-- rlti tip dodo - I{I't{~v,,~I 1 r . coo .~u►•t '~-h L-[ .3 t3" ~tatl~ Hdlsie,rddr4~+... LS/'116~-so I, l i A r , 'I, 1. a Lt's r''i , i. l 7 " 'flits 31~ `j{S`j~$;P A+I,:'l I' ` 1 Baettl 9iduflty Number 'f l.fN"1}'fal}/Inl,mlddleS_~ (AraE Cdda 6 nu.J r I l ~ , '{f I'Blelefl~~ Zip ode I Phene 1i Hameaddnfa city $ ! II BINO0115138ftAT01;9 inter the names of all bona fide actlya membals who will ba aanducttnq bingo tiemee, Drwar`etldintaf5raraddoJ r N+Mi 1Lad !M)! middle! ' Numl.fr of yiereee ON active member 86cte19~ f rItY.NUmber.~ l G (A+KI.; ) '5n L u / 'y 1 b 1 Mon f$ ed.. u O J Al'1maol _ Y- f ' I-- L10 code ddreu P e a dakndl s city s111e 1 .7 w LI ! LEI /L'/, Sr / I L iJ V L / I y t-- ~I r'~~--~`n7 4 1S7.fi_,~,..!((. iti ul ulrlN ~.JJ.'r.i~ f ` Il pioe: `(1lltti l . N Box l r4 LJ 11 lie AA , ttill ISi ;1+. t { 011vef' 11J1 e~eppul'd!nltA lbl,! NUm5e1 of yeerl is en fictive mambel B8EH1 BeEdrtty Nu~myber y UV .I V,/ . 1 f o f ell, Nraf, hlfdrrldl. .g d Y 'L f Fb r I / yn.j 0 If3 111 ~ -1 .47 1 . A rd dude A na I .Y ~~y+ ~rd1171 a Biala alto code Ph7one/ ( LLY y oil t 'C;t^ , F. Slum i dri 1 ~ ~11 ~0'K .,...-..:f W-'1 , • s., 1~ 1/ ~ r}}4, L': - I/~'.,ut; Bre I-.JM LJp Ddla or With vLrGco i' ' ~ plea = I! t a1 Urlvar'a llcen,af}S f~ntl/rA Vl Nlrmbir of veeJf it en eotrva mombil Bade! Security Number !i yr I,, 5%" 1('_.3-vJ ' j I rLId l~L ~LW, c J 1 ` Y, N e ftalh lrref, mfddlrl - r r'' r~ , ' r1 W ( !rdS! ' f Yrl L7 ~P~b ~a/felted Code k uud 81e1i 2tn code J. Ir-/ atr C•ox it 1,6 u f ~i~ n 7 L~nJ l~ see L LJP Debarbinh lfLi-~L ' --f L-j CIO RICO 4 ' Ddva'111eenpl(sidleduuA ' ` r Nulnbef or Veen el in e641ve rdembm Bd~dlel Beevil t lNumdar 41y 00 r~~G S_.~a{{ me fhaJr Thal, mldrlfel zlu soda iris r -red a ~ Ilriidr ^D~.4w_(VIl/r.Gl14y-1'(x1~L;?1~~-LL•LUyL~-. ~V aodd lia1 . Fla aid lul . r: 3d'a•. rr'~$„ , Data of birth c/o 1.x..1 P !lace l~1_r , ' (.o eae Duver'I lleanHf8lalaa nod Name (bath lrnr, w afdlel Number of YOM if All active member A!Sllerl Bicutl{4~lNumber L C' ' ~v n lr~l/v y'I~ ~t'~~~I..L7. 1.L•.r.~.a....s. 6 116 l,aDC'.t~I.-#v Il 210 code rlni r'i•rndrdriui Homea`d411 ll%v, I'o11 l I xl L7 71 ~b J~1 Lbl7 ~ "~~7ay 1 I1)~~ ~ L~M up onto or birth LY.~.-~1-1-~ mo gaol `IA'µu.-.1 Sae 'xj Dflvarti lleanlalgtdfeknn.l Nami!Gall, lrFlh huddle} NomUH or yeen of en active membot 9oa1119iE IIIYrNumbei: a tigPif y PbOf a i nd Curia ,d ilu,91 '""41c.~11 -u e- I Bills .I Elide Hold rL2~.t1'J'"f!LLaI addrife j koily / rn U (I/~0 G141~Li'Yvf: I ~~1i1 ~IJ~C ~ryeJ L. Bee s.l L J11 0611611 Poll LO..d.~ 1.4z1Y~1- ale" Aeee Lla'~1Sia~ 1 r .3r ON i r i KNIMTS OF COLUMBUS 4771 nyvi'ON, 'ix ADDITIONAL BINGO OPIRATORS kr I s x; Hartman, is'iRene Martin 25 SS 4:i0-647277 1N4:i39445 818 Stanley Denton, TX )6201 8'17/382-5295 1 Cam, PS 11.18-40 t Jones, Paul Ronald 12 S5 0`.i8-32-5021 U069G9983 1409 Windsor Denton, T`: 76201 817/387-4943 Cauc, M 12/19/40 T114 "I Soileau, Kirion Joseph Jr 3 SS 43360-6748 '1X10618019 jr`E t 2113 Smerson Denton, 1X 16201 817/382-8896 lrv Cauc+ M OG--2744 1 1 <]t Stocker, 11rnest Eugene 26 SS 455-68-1553 TX0059937 Rt, 1 Krum '1X 76249 817/482-361] CallC. M 10-06-46 I F 'N'dious, Raymond Herman 25 SS 505-48-6277 IX08587327 i, 607 Magnolia Denton, 1% 76201 817/382.8826 Cauc,' M 10-04.28 r Poirot, James Louis 6 SS 460-70-1676 1X05135093 } 3801 Hampton Denton, '1X 76201 817/387--3759 f, -quo. M 04-26-44 t. r s [ } tr Slj;TFs 1 1',, 1Y ~ ~+r+",. is rt a 1 d i v r i 1 l .h`¢ It sc t r f a , 1 ~J f i r e,~ w AP.124 r ` r ar~tp-oal TEXAS SUPPLEMENT TO APPLICATION FOR LICENSE TO CONDUCT BINGO e7Vt'b (lrt l'i1~ i~ rCOMI'LE YI; t f~151t11 .+1f'APPI IC/ltll.l~ r~ I DC NOi WRIT[ N SIIAIMLI. Use Ihis sUUPl6m0+11 10 Provide additional Infurmalion regyostod by "Tnxns Applitation for Llcuhso tLLbTCondurih~iflp;' (Form AP•117) or "Texas Ammtdmunt to Application for Licullse to Conduot 61119o" (Form All-123), Ailpllcollon or alllutidmant will not be m1provad if Information is riot ramplate for uaeit nninu Ileturl, f1'NosoelNu"Data of Wllr'usdtoullr,day' year, !sutiiplss , t t for 1/upwarl' 16, 1750" enlce L01 t , 1_j 6 6 yp)t for "beCent('u 6, 1065"ell(ef 1 0, 6 , & 8) ) emo of of panYt atat an I , 0!101 LlCallJi Itl V'r Ur l BmpV nli miler L AIi©ANIZATip... 1!I r it 1.1 r i I _ I r I 4 - N OFFIC~iiS Noma (Lad, /Orr, rnldale__l// social 9oaudry N': r be! Ylefe l/~szr4~!stnc•.fI3rLJ Ndmo addraJS OIW I State ZIPCode Phone (A704 code A nv.1 5 se do, 47a 3~sa, I } Name (L401 ffrilr middle) 90414 9AdurllY Numbk Title o- fj home etltllbli CitY~ cwlA Yip cadD one (Aced eude d nu,) 1 " i NaIM float lovb mlddlel - C1110e9urlrv NnmbOr 714+ ltnmeeddrArl IC'rv elate ZIP code Phone (Area eude & nvj e , - "NArni flat ilir+% ndddlAl ` 960161 security Numtik , .7140 LamsAddfeoll"_ 'L1 t > _~°I ~,.J•. L_- . _J~: city Btni Yfp code Phoni (Area code & no,) • Ii. s1Nm oPGAATCRS ` r Cntol lhr) hafnall of all bona We noUvo rnofribers who will be condudtbly blrigo yamos, N+mO (Call; 1601 nnddio) Nuinbir of VOare ee ed +ottva hiernbef SCOW 8+ouilty N lrnber ~ r dfIVU'i IfCene6 f8(utCA rfV / { L!`HZ~?~trc4~tLluC_ f I YrA . I./ Q N~40 ceS/ /r I! eJ.e 01010 YtP Caao F'Itana iti rwla L~ 1 r geJ I. _ __l ru 1'' [7dt 4 rI nma ✓~J LJr - M naeea%bulh ILl1..~J 1 j Name fLnlh 11,01 mlddlP) Nwnber al VAere *1 in 10110 Member 11003619ACuilly Nurdbsr t J , / _ nr,urr A Iicanto ?ir,r7PA mud tidm+eddJett Clsv a7 1 1 , . 9rAri Yip code Pbdhi Arrn t 1e A nu, 00 1------1. Sox km ~J1, 0111401 birth IG~4Lrr-.Lti'rf_,Oj Nl+rn e+lLal, I1rft, mfdd u) Number of vain al in eolhs member 800141 &eOufIW NUrllb+f * L.SP2A/CG~ Aoh _ nNVOf'eilcdn0al6taleAU~,I _ . L1r..Yf e ! If f6 Ll b C~ / I ry + y _Y~ Home address I _ Cr L13! 1-J. :J~~d'~~~~!SL / k r IJS ' I.u 91ete YIP eude P 6nel tro coda hI } M Lie _ _._.,.._...7.: ,y.I_l:.J_~~•'_~Z f Dare tll Ufrth L~ 051 u Ne/gli ILaei, Poll, mld/d'lc)/ Number of VMS AI en adiivi mornWr Wild 9+auNIV Number / _ Y6 a1PAgt 1~5,?~Ut/{ y{/j,~y ~afh (e12~6 a._.~ : UJ1,_i!I-Y,rl. 7 G J J Gd (Allaenf of 5r rJ.. i 1{omo6JUrer+ frv - J L_._~~111Llr?U`:,r...~'~d//7/y.'d,3 ,,}}l~) /1 Cj J / Stale 910 code Phone (Ar.•a emir 6 rm.l 9+>t I• _ M ._._J I r~~kJ "L!~~ r~~_~J_l.1 ~~~y rr~y_• ~.~.~.r, J L_J P 0110 Of birth 1rLJ..A..L2t(v.J - .-A Ole Noto 140, kicuJf.411 o Number Of Yeere er en Aabve,namua I,karl/u 6 w1w Nu/mbu r pl A~Ilpe fSlofcbuu) jw.rlyd `l ,r_ ~,1/: i sl Yf!J LZ:,S~1 LJ ,K l L' 1 _y (vats ahsd II m1 aide is CIi ~ F' / 1 ~ ~y L°.-~~•,'~~• ' ~e9~e xy~ BtelA r Ylp eadA Pifonol Wro eude A ne,) Sex LXjm UP nafe6fbblh I.~.rLt.s~r,:i,i~,~' J Nami (1,dN, /lnl, middliq~ II Number of Vene 11 in a4uv4 memu4r , 960101 Sedulity Number d~ l~ r ,all Url , rAlsr rd ' L.X 4 L~ ~Vl r!-f.. 4 ,U ' ild/'e Idapp cloy ' L G), ~Iv rx CItYy / state Yfp code / Phone (Arrn eude A flu 'l t%xJ Ul,_ yYVI lr, 0000 t-. =~-_.J 8art Y~JM J P } J I-. _Y(_~`=L+/~J bate Of bUth U-9.111 0/0 t rr l ov1%43) TEXAS APPLICATION FOR LICENSE TO CONDUCT BINGO . Please reed nitsuellont r TYPL, On PRINT . Do not iyrllo In shndud areal ~~~~••II il._~l._L:1J._,_l._.1.- l 1_J_I__hl.__I_-.Lc.J I Yypo of Ilconlf appllbd for ♦ZA • Annual U 7 • Yomparary' Nulnbol Of 10111130r0ry IlCaneal facalVad by your Organiveilon during iho pit 12 months 2, kes it, I 10 ro0n 14 0(fon ever bean Issu ada bingo Iicomav EYES NO It "YES", entor tho tlconso number. Texas Liconse 10 Conduct Bingo Yoxee Cornmorel0l Licomo to Leese 4I r' i I 1' r Sr E ~ LH. I ..J.l.a Ci _11LLC1(,'.'~,. F.1 ' I Name of organ4illon i if 3Ul~ULll7bb`I 41uUL J VFW ROOT 2235 let F 0 BOX 6r?8 DLNYON iX 76BU1 oaniv `.-.._1 Physical lotatlon al your arganitesfon (airrel and nnnlbee, ally. (live memlurgifiddrreoNwu V Ile ilraor Muhl bay ~ r,r t' I J!1e,- 61 8, Desorlbe Ina specific purpatell} (of which bingo proceed, will be used, ( vJ4 0, Type of n0n'prellt otganltatlan ff~~11 Ii~~''ry'I I a 1 • nellginul i_i 9' Medical l l 3 • prdiunal ht-y r~~~il A • Vafunleor Fire Dept, ty 81 volerr[I1 fit ihil Volvo I0Oita It it etldn 411011104 by the V.8,.Calvelif L) YES W NO) 8 • other (RKJllain) ...»,.r............,.:......,r. ...._._..........~._.r.~p - -~5- ;J , If title 010e611atlo t elflllsied with a stab or nptlonel otgeAhetionl l l YtlC + NO y~ 4u If "YES", anforAe nameol the organlcavon and the 1161401 national Address, r 1, Does IhfsorfNnlsallgn now havea 801 1o} olliffli l0'n from the Imefnel Awenue 80mcil? • t.t YE9 { ,I NO r 3 If "Yes", altadh a COPY Of 111611`18 nulling OF titettrminotlon letter Im your exempt itetui l Bute TONS$ charter of 00A 00, Otto 8, 11 thlaargonteallon 10 a corpoJetlan Smart S j SI_ ~ ~Y al_ r A copy of tha klielel of homporelroe must be Illod with this application, G 0, If (hhAfpehmllion, is not a corporation, tleldelbe the mothodol orllanliallon and inbft eyidanoaof orgertuallon, (Sep fru)rboNunsJ ` Dow of ulgenltetlall- I ! I 10'enter your organliatIdn'l Federal5mp1nVor'i Identitiaatl0m tFBN Na (/fail),) i L_...1---I.....L..L_~..L~1..... III Does your orgatlrelfonMOW hove ataxpayer number lj~ epaftnilanyTax&$loxor I 0 Texei Vendor identification NumboO I Yes d NO if"Y08",entof rumbas I L_,r l . , 17, Nuthimr of Saliva membeft In good handing In thls organization _ - st t' 13. LIH all o'01119111bn officer$, (iladdlifanal tom If nedattary Ulf "Yexdl 8upLlenlenl to Application (or bleente to conduct alma" Fatal Al'J74) dWeI A114111 Y Number THIS ,0-21 ci ljom y address 0'ri al Elf coda Phone (Ana rude 6 nu.) l!- ~1:sCtill>./%Y L~~2.ur~o u _J L!s~l 17~~ ci r l(~i! 1d~~"~' ~~,uJ Names! 110411111' 6114111rily 1410011 title 1''1 / 4% C ~ilr y' 1 min adds t .1 I sr! sLe_u;L_AU.L17 1!~ t f/ Oi o1eIS !.aN lode Phona fdf(ra coda R a",) JC'~ CctW / ( J I Nnne fiociel abourliv Number Tltl Is Hamaaddresl Ct1Y Siete 210 abU6 Pitons (Arta cod[ & nu,) ~;oNt4'i ~s~<z c J U?-cr d± -__l E .'d l td L!J 14 EMIR the mama of 'a bone fide dative momhor who will be ptimarliy foinuntiblo lot tbnduoting your bingo gamot end filing tax raturnl. Thl1 momblur niult viin this application III Itolp 28, and Ihll memtor'1 name will appI on your Ilconlo, LIM (lie namao of all alhar alumbere whin will be nperalarl on the appliution eupplomont IPofm Amv), _ { E Nameend number Of Yeats as in Saliva mamma elation! Sauurlly Numbot Oliver's litume fsfafe R nu,) 5 lam/I ,•~_&J 1:,ifjo7.1._.Se'~~~r~ L./1~'-~L.. In•-IA-1~d.L11•~.t/.J I..~~!&~7-~ve_ !fl It (tame Small Clly state 911) adde Phone to rra a"rl Arlo ) 'S ft 6 /A t. - L2m Irlc, ,6 1J I t s"~,~~Gzosj 18, List the names 0I all palms Wic wfil woflr end raceiva. aomponsatlon at calhlarlr Veleta find. toilers At your Cifaotlva dale ` bloga vaasel Use fire Sr.pllcatlon Iupplemont IAP4241 Provide ALL requelad Infafmalf011 lot tecli holson .~Jlu4Q~- ) I , I I i A0417.2 TEXAS APPLICATION Papa Y I A,tr Incy,Zeal FORL1061_T0CONDUCT UINO_0 _ 1aNomaof,rLanlastlon ,Sena.-ar item 9l ,~QNO.. LKUAUIEB, r } c CLU6 T Coda It 00100 EL 06TCodo a 00100 wU~ UapWli taus a 70 Depotn ro,fo 1153 17 city r5'amc as lrem •U a - - _ sl!>elfa u J Ll l1_ _I~.l I ! l.__ 1. yJ l L~ J 1 ie paYlii~o7i(lo wick gnu IIme7N Ennioi V4111 ~o Prayer! 71Twiiai ciccedTdur nolvi fnanY 2T-Mori",'mar --J- 'PI,riit Time - ttoo nd dby Time p T hard day T1,1111 a 177io/L. M1 Month, Joy 1llne t thh is an application Ior tompafary Itcenap, aniar the month, day and time of the tarnporerv game L~_;-.~I ._Myio M _ - _ ~ ~ - Tl,td if ilia above temporary gomo will replace a regular game, enter the day and time of bay rise re far me het Is ra leaad - - M~io~ ----V I LOCATION INFORMATION 1 0, Name et location it which gamer will be Olsytd I a d"all fsrWcl an.i n57 ,rr+ar d1reeflond city l siato Zip code county fume 1 ~t3~ fJV C crJ/D U 2 Ij~ .I S 20, Is thla Well n indde the oily limits 01 the Oily indldated In Tram IOi a krr~yyl 1 • yea r4e[_~~f 0 • NO a~ 21.1$ this (aeetlOn different from tho location of you( ofganitation? IJ yGe VeL NO if "YES", explain why the preignt location of the oranltation it not sdequato for nlnylng bingu pimps, (Sce Irutrpotiono 22, 1M1111 b the moxlmum soaiing oeptolly Ior hingo of the location III ]lom 107 __.__.J ,x 23, Now i (Ili Iodation damiollod by your 6/~lHUstlonl CD owned- - - - Data aquliod d Listed {J Lasted for temporary game only e © Diner (H)ipfalnl Noma Of owner Of Wind primisae owner'! bingo license mumbir ant Pena lemon Ad o} Own or. tlrree and nu Pit tier or .0. Bo.v, 6G. eta la, dip •u 0) - I I Most 24, BOND INFORMATION (To be curnplelvi only 0Y dppllcmlia for annual fldclov. Net frufnaflunt) i . « - - - - - - - « - - - - - - - e. BatlmMord monthly bingo yrai raoelpb (Whole dullard nntY) bou 6 gxamptd 1110001d Per month r- li- W ?u 0, Bglmaled menlhly bingo l9a01pi{ 10111110t l0 tar x fI laln d nllnne 1raA1 b1.. ° - %dG I 8, BRIMaUdmonthly lax pi rato of 2%fM1WfUAIV Ma n d h! ,ogl ' vrO~b t C AMOUNT Olt BOND 40OUIROD(Alau,ply Pont d by B1-'«---- NOrhr It Ilarm a rr tau than l tali, N1an no bond 4 required r _ _ tType of band 00 - NoI retie . If [101 , Cash L.1 07 } Biroty bolltl M 03, Attlgnmont4of saylnpi account 26, WOONII FOB,Poynltril of Ilia reautred Neared lee nltfel be WbolNfed Ltlh Into oppRealron, f d T, empalar _IIdON14 ie¢, Pao for a temporary Ifaanto to conduct only one oacaelan If $26; + AhaUll dpgp{e fao • pee for on annual ircorno Is bated on your urgonleatfon't annual grout reablpli. Your licomr; class and amount of lot will be found In a table in the Intbualtun, - if you now lave a Iteoufe, your annual Broil rMaloR vdlt be the total al your Dials ratelpt• for ilia 12 months preeading ilia renewal i If this Is your lint epplicatlOA for a Ildarne, you will determine youf annual gross recelphi by multiplying tin; amount you ontered III ltim 24s above by 12, Enter the amoUhl of Your aallu61 gross fadolpti . - - - « La'-/-~L/y+~, V /J ~•,,,,J ` Payment naalvad - icanw fao 6•64 YH 0 NO l Un~ter your Ilcahie aleiV-- - v «e~1~ ~J L U RBBFONBIdILITY 2B,AFFIDAWT OF Wit, ilia umdorelDnod, horsily declare that Ilia 6100m7otlon Identified above la 0 Gera 11Ue nonprofit orpenfeedbn, flat we are eadoa mombaN of a trhs orgaMee4lon, that we wHl be fievonill?o for corlduoting bingo Damao end (or fllmg all faqutiod futulna in accordance wllh the pldvalons of the Taxes Bingo Bnabllng Act, and that all ndl pfccoodi derlvad from bingo games will be Well for elrarlable purpdiei di damned to the low, vvo fatillor a doclara that we have mayor clean conviolod of a felony, gambling aftOnla, erlminal Wulf, of a drlmD Of 0 moral turpitude and cat the bllloo workers I r have never been nonylaad 61 a felony, gambling altenso, ofiminol (mutt of a aflnig of Moll] lufpltuda W.Y _u We furifiar aar111y Iltat Oaploi 01 ,lift aPPliceltop nova Ikon soul to .&_)j and that all Hetainontt in this DOOM tlan and any ottoohmenle are true and Med1 lo the Imi of our knowlodga and belief, M b or N l Tfua Dale Mere it"lot /-10 ~_y 'd"' ~ - ~ bale • OI h e Ur THIe n} / ~3a d S here lald OINei numbH a name slid marnbo r{te illN fI U1nUp (Otte . r i t r I r ,tIRK7DK1ISf~iD(©CYC,NF1pUlIlC><(31bs7 [LFKfI.IKti.?R]gA~tlIDD'd~XCll]Ii1FALg:fUialtSLlL.iCYUDk1CliFGat1W1J[1idC~7fer~illkuLrJ.tLt Ut~lt~;}1?;UL1t?t'~(161[7DIuud7L;effa.U.k1C8f1GiP~iltlLY~r , ` ' TEXAS,LICENS~~ '~'O CUNU~JC'1` U ill Ali4CONl7l16i(SU TlVdl p Y U , 1191.1C~Nr3l[lJ f~(~~•fip ~~'1 r7ern rvP(~IO P~ in ..L.y(-•-ry--I~b~Y01 ~ 8 Inr i~41A1~orTi 9 1 A! f ennOnum µ r { w..~ _fi y(;i"1vtiYVlrt ~ ° 0 7 2 0 4-- M7 Apl`i3rFl~Siltl}tntl c)parolor 1 a7 1.m(. t Irsoll afl-libTfciNi-ananlmr neidrnn ~)r11lOflI _Taxps 76201 11.a1~,44tlFs~ 410Us3.~_ V.uCnilurr yllibll.+ Of 61ulttl>UG_im1 CiTOCltN6poTO-u t ,aiPainn 1700 Rlhuy Road - Dan Wil lexal 7U91 PUrmm~ D)tarI tnblu an'l benw Vol 6ni ft(1. 866 Bevan IInOV gaillus fFO pmt Oro6woon Rona AnC Mell`nn Arlrlroli sull 6:00 10, 1.U;3~} pii 41x(1 6;10 Knight: of Gobjmbua 4771 1{a;3l)'.pn1__..~: ` 1409 l'linoor ur1V( balenffeau0'~ ia` (Jcintun, ToKng 76601 i14! 1`r/t1il 141inua l 1t /(7 860 IJULLOOK L S ttViPV~0,L91 CbMtliFtOLLdntlFPUU1ICACGtlUfJY6 r 6 241CtlGG9L1C1~fi31SYf11fft~Far~ttIUTR1tVtF7Y~r.9UtT6in15r,ft~dlr,r,tri~l'1C1i4~ 1~15rh~~~l')i1F~r~r(IIIIl7CY[tSF~I~7~t~(uC11tlDL~L111SLIkfAY7t$7619Ck1fSt~lIt3l~f(hCStU7S3A1lCNFF ,y ir. s-aF , v I ` i I. 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