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1986
f rlsav TEXAS APPLICAYI 1> j{F~` ~rl1 ft j Rov, 3•~D/J ~ a F 1 j• ii ( , y r = r + FOR r,icEtias TC roNau~ri,~ . ww.. i~16?.wY.,r~I~:fUCtlono , ( 1 iE~ v e ~ f + ~ 'r ~ ` 'I tj~,V 1 TY~ pI Ilfjl~}y aM,l loll for A • AnnuA1 T •-TYi~ w~ i N+(Y IIHllali aftir rt Ow iwon lowed p hlnp8 1140nou7 ~ y1116f ~NdYCt~uarnraznaunAlnoo ~ 8 Nimi a~g~MtaildA'' M0068'13417il X11174 s L 4,MAI GJ/3Z/$6 S t CLKS LOUi,, i!(14L w I OX VIM c u, U F N T O N Ix 71o iI?~~D,,,~~tti}}f'~i 1. a~AMI'V6'M7 ''J Counly -'~~'~$rN luWrlan Of ydlll orgenluihui Sfrl. 7d+rd uln •Z C r~ i ' 7R f I ILcq flk r~ +'p +ei l for Mier 6i[ll p,nrdrrdf wl ~W p'r r'=i~nlts•Cf1~.tS..4dc1~1 lanTf br D} 1rr0 Il~tiAll w111lionmwill bouievdd f 7 ,VO~J l Ir s o ~ fl4l/rtP1 A dluHL,fr ar domes aonlrtl laordrnn. F,rnn7Jlal 9"~ f ~p~ 1tiM1514'~~~~ ~ I , city (nio " f J^n y I ) /l IV coda tlaUn1Y 1 e ' ~4-- i~ir♦~t~•~n.~' E ~ ~ t/n~ 11 _A 4'1 ~4~ ~ 1 1 I, t 1 } '1 t i~~S ht 14uf I]ml of I~i Vlly Inr#gftp'' f~a~r4 ,'#~¢r ~``yyf r ltl I ( 9 ' v i ~ n ~ t IJ d , 1 , { i ; , ! ! Va 'Ill Rli f a. ai vw~r ~ ' `,tt r i~,ll> gllin . uli m+rin +a (aa oi' its , A I~ .i t 'E t , ~ r i >~Vt ! , t J r,4p~~~4~~+ ra a~ , t\ i ` ` I id GV YWI"a l~bilUYI~A, Y r TUtflji NA Torp;-; l olrrl iu~rgt+vr ~ U, nrr.e, ally ~tafol lath;ndu/"~;f QI 4t~T'`(~[~e/y~`}'(/ ~ "tt i L ,i~ i t~l;<,;l t'(; e: ~d TA"fir ~,;.n.4 i'}-.ti'ibNytyli(•kVbGSt{AF¢152a.SY.iI/lTil.Vlf:tlttf'Y`r41 r{ 4 lr ,l}yM(~rOlgl{nlziffll IYfecWtpl~mplayAr`Iltl6ntl}Ic0 (loll lpNl i164 n: t z vYppnlaMtbn ~tnow hmw a m paver m(»r f off- ~y`y 4 der ~Y 41;'t ~A I" 3ill lbkllgh Namboti UYam ~,~N r _ ( 4 I ~$"z'. ~fI~A r +J+ 'T+'r f§ {_d( ~;Yi Mt/fl( (I~#Ood lllndlog in lhlr ofp6nleitlgtt G I l~ir~~S en/s7 1'tlXAB APPLIQA'TIQ(~ ,'S~' r'V!}" , ! ~ y , t r ~ rr„_ feQr Vrflllp in ln9l'~tl Jfaal xt~~ t~ i ~ 51 i,ri7~ h r. ~ ih' `~'~;r`,,,t,..:r:.A~ ~...}•--e_._r«..~_;..~ ~ ~ _t- -r- t.u1],(~{~~ , e~ # : ~ r r I ~ ; 1~ N 8t lb'pi(Qlrntloii ldalrlu a, rlrm a,l !rS 'a tl ~ , r ~ • ~ dr;~r try' fell lft1re81 addrerf, 1'.o. n,., It rv1 Iruu le, 8amn ~r)ftm•frj ~r+ r'i r i M+h i. K.'' achy „ e Nrav . T - . Stele 21P aode county tq~ lY1~~fitp"Wolloo 0L 11 ur t , I LJ Maenad! {r , v Syr 1]k ~tfj~~i;th~l wl~r~m; or~arllrbtlan rlrorrered'IS~') y AnRi~flUi1bd with a:iota or naltonal Orpt111144lylS J:1! Ir L .Ir IA 1Alp.t, 11(11~1 of ilia orpanl7Btlom,ond (hl ltrft90f 141 ill „'!l1 61'a II . ~ . 1'!,' y RY i''IlS ..tip .~VQ(k'!^_ (?/lQ1SrP o! ._~!'~-'G1a!_____._•--- ~t4 ~ itlq flaVpo eq(,Iaf ene npsly flrgm thA 1 r t t~IrrfShb~NFllilflfnf}oliblplMlnltl0nl !~If l~, ~ C (lpll,Bn~eN "~r~ drriara}Ion Ii IN Illar W ih 1fiN nrt~#re Ir 7Nt Rornnretlnn, tldlcrlba ilia method l{ tlC' R7 kn t~b6}Y>A1~~,Sf9l I ar xh ~ x Y-•. rata n1 p hnlfou ' lei , +tt ~t{m3 or ll' 1 11rh aollyPrmolnw/ who will t ~ n rpkllr&Ilh~J`til '1}dto Nnd this s ,r¢ ' 'r ' "f `~°it~bn~Cho,liSplloFtlgn wylslNn4nt (FOl1Ci ` , " ~ ' ' dfWlrl it enndtNa mernba Ilorno addlnlt -Y.'e'~~1 rr-~f- r~ (..10. .I~.IL110C1. t1(11).J IL__~._ _ ~I 91a1e 21P eUUe Phone.(Area Code A rrU,) C~ yy(~~ O I ,l CSI 1 St . r(. ~ '+kIro to 1a a I dfrof !I t n1 to will WA slid Vp x will" Zf' Ju t' Ion l1v (1'i7~1 {p f to d3l~ It it, e + 98o0uddeY', ;i.~ n.,;~s ~,rb try, frr. 1;WASM j~ C, r7r 1 ts~l r 1 A- If 1t1!!CF F~hf)dr1t~}Iirlaa, enter the Ai¢1 ? V!c " t 1, 41 ty ;sllf-t; eV.fA~0110a.rpular lj;H,a~11WNIM, r" y r 4th0;f1t"I yIIS' +l if r: t ,,tlaCrJ_ m~+eH:.rr: ~rr:ixr"ti + •r J M t M. r ~►'/,alt aadp 101:l6tl1. Pont per ii ,h f N y.-r~k.ts~~.-., r.». j.l,..L~.J ti ~ • ~ .......i .Y. f Y' 'r 1'vl ~ "R'AY''~r;' nUn1Wr ; 1 I'ermft nUfnl>'r' h rn~ •"'~rh ~ 1! irl; , ~ 4+~ kr, !r ~V I 'A ~ . •.'~~1'hl +Ntl , i.il---~,.«~1..:.•L I.. J._...,1 ..t I. 1uy'~ t~``~y,,aa1 ,iy t 1s'. h~'Q ~ lr Pjr"~ .t r nvmbal I LICb7ua1'talU(hv,!ir,}hti 71t1i 1~ Jf~ i rifJ: ' S' ' r r } , t if L 1' r AA jJ L ..1~ tld,i if 1 ~~.~......i...'.~.,._.~...`.. .i r'-•'N:+ 77 I I~ i ! f plJ 7-d } f~+v 1,8413) TEXAS APPLICATION ~ ~r' rr 3 t n , to fir ` p "(J ~~n~>,in~iArfd Pon LICENSE TO G'ONDIju all r 43 d eraks i ' rF' NYM►Ftll Orb/n1rn llnn fsmrkd dl 37rm 31 J y 1, _,,e 1~ y,, f ( y,k J^ u tJGr 14 / Uri ~w oN l) 'A y J dry k' RI , dly it aellnm4) a - ~n , )q0br difigark flruddfllonni rno. r la n rwrarY ure ~ r ~ Ilar+e x,ldr¢H Oily p nod Phone 1`4 fiad. b Jr15 7-1 1 Ha 07 ~r k.,rr1N_ /U O; Well ~J77jj Y t 1f,~t, 4 i rtr }i~ a~ r Ho Its 1~4 Y2 r:,3.4i-1 ~L LY~~r Home xddnb ~IJ (Illy 9lIN X31 tln ¢oda _phone (dreg coded n^ I :rr ••zcsrs=:cst:.~srk s'T~sr. r sd- N rr `~''IQN I~ kip Mrhnirtnd old, by anpilmnlr /m eli+ it t ti',; ~ llr,1~ P~n~d;r, a i~ : h~'~I i 14 FA 'I~tl~r~QJ ~ffprY kecelpte (N 4olc ~l~Ifd33 ooik~,~, r ~F `,Y4 t r a l() f I,~klq,Gl l l 04001o tax (ltem e snWp - - f v'Z G Cd.~. r(IriplY Itxdi a by, 02 19%1. ~I(r ~l~ ~'"1 filar 0160, Mom J10 D d 7e Yd pC4ygt r YNoI( Uf lit r r r, rr1-. r,} IQSM I vy ° ly,` JIrl706il fill ~q j~a rksolf b!i rlt y ~i Iprl y etu, 1lbensv to d" tii { ' ~enrrEof nY~Mwd~y{{ ,,{r r " i aleR Oyl~j the lnf 4illi , 1 yt~1rh ls,~ r „a ,i. J r. 14~ rr . y~~~, it rbAl r t!`4ttipta dhllfaAl ordu rab0 to Y S , N~~k ' dal ,4, 000 r o Juai_ r f hA131MFd~~i,4r~Yi~IRMidtfl r z y ~r`~~ , . ;Prni~e rar abrrrh,apnv f 'Aa p f~al,pl~'ktot hrOpetb dbnvad ~,yflirba i+.I , I : kl'dbA4iated 81 b fid6 ganll>linp J7~ v1ald~{~rA_falrn OmWinSgrfen rru,ilneftrio r.,r h ' i7~ U,s{; aa~1aJ b! u,ll`~iffc~Udn Nava twee ~`b~. ' tfrJC '1 ~4.;;t /JrKN7' N' , kyle O)sry I~qn grd Oily Ott Monts ate y i J/, C ~I{j~.', y„'(+/ J R~ A `r it r~~:+1Y, 5 y i' . !t~y~bmpleJ~iN~euflrtAUdnal~I'li(t,U ` t14' I • , i {~a1Mrlr hl¢(Se /rtd lld~lk►(jlObl y 1' i d > I) ((fFFY".1 _a jjf_f"'!~~l~F~fir li{, tC edtl~~ r r ~ s r~ ~~11 4 ,w~)y rF' ~ 1'.- _.t:-....L,.~_ ..:~i.._.~..,...._ ~..~.`.;i ~.r i~ h . 4f: ~!h + VHF ..•v li ( ' Y1., S~ifl! aaldrJy',. 111 lu pltl lNp,R lu. Murmu unq I~,m pi i im Rltlp Ni I Y$yfl •1 i. dlhdnI to Anh1104100n for LIca,rlw fo Canl dv4 q0"` I o +IIyJ ~9r ae~oll name f~jm InformiI1 0.0411 yy X ~ 1, z ({f pBtor j df Glrlll"ul ell oil (It, day, year, Cfd fdi 'f1pI1,1~A,1'J' ta6d" ell I ' I iCHhlYallot U '17 y h11~ At " 1i attte vap code ph;no {Alm coda 11 01 , } oine a nr ~rtt a r.,lv u~A 1ytf i " ' 14~IPIr}f Ate l ~I y~S~r~l AV1P,'.~, to j. , Homa atjr~d% II ruy III xlP dodo Phone (Area wide 4 do) r.... C rd .I (1~♦`f 1(flli alfdlllU) / 1 }1, floma 0,111101% I city B!N/ YIP on de t Phone (Area oodt 4 mo.) 5 fo IIIFFF r; l % , y 00Y. ,1>~H~1'~~11i~a:i'.ntor th't rtprtyo9 of all I,onn if2ti ! y. , illGnrklddli) Num~erorvwr,udnJaslaihi 1 ~t9r{I_D1`I~S._..... I_IcZer~.) l~A,► ,311_~.S?Liu'tz L./!i!/ 17-/..~__ t Home addrose City BIHl LIP code Phone (Area corlo 4 r!Pd X~ ~.d ; ja I L 1 Ben I. JM L qoo lter♦ by fhe 1/rnr irp6ttntp Nl aj I, II, a(yFYy I r>r ,J fl f dtdf;hpit,Mfdd! 1 idlrt , t7YU / -0A)--hunryaarda,und/uVjt JaeiL$.t1_Z1?I 1~2y1.1. AS Aid 4 / yrd t l _91 rJ', a~J y~,r Hdme eddll~ clly Bleb YIP code Phprf~ (Aied S U M-16 1 `t'iy klf fp ~~Pille7axarArtybtlMlnf`clY<lblfs 9d)uJ.~,t ,r rAb, (f, lre6 mlddlr) Numna of views of an eallyll hi !yl a-- t~ Home addrall rely aisle ZIP code Phone (Argo III I'&ll.. - ff~¢k•do75(/Ybxnrl)'tIlNphfb/larlot3lsM 1S' a 3 .;rvr pp)^ ~hf {~W I ~ 17, M(~t1181 NhPlibeY dl VMra at Id t~lthl~lff r ~ rl` tS r +"17` t ~P'h-o.I.l k i r i s r Homa bdth/dr t Ity 9tbie 21p code IJr'il ea cod/ 4 tl f'Il I- L ope ' L JM if~19A, ~~5 A t I u lby fli/Paxdr t)nilarllfe of Pubtlr fal ()!'.~d'i .fr•' ~'t '~}1 fr fLabl, l7fil, ndddrel Number of veue as in wl4e ;1: "'V+ ° I (Jdrrt ..1------ rI~ A...-`_t:c~a._..A__,_J Homo /ddraH I City + OWo I I LIP code I Phone (Arta cod/ 4 nod 11 r' _ J l [ _..lll 'L t 1 J. L..J 4 Y`!'pd~ Uy lha T/4abbangi7rnenid/Aubt . ~WI ~`Rlla / r/C?Ii M7ddlel Nufhber o} 4Rr41i fn i611Ve rl+~f~~ ~ (~Nti~Hglld{~. f~ ~ 111 • i t4., Homo addled, City aUU YIP code Phone (Area totes A do.) J ~.'.ti1~f.1~Yc Yf1ft I' r Farm All. 12411,x; yHOw Ia5Ary ¢Fu CA, /~q,' Rd M4SlurdaplYetlor r , F A F. I ,t ,Oelvron) a, a 90 1-1 6'lO:nnrlon~ r ,~pyr''aRKOSs Enler the rian ffnof oil t~, NC~Q y1nfloOl 'Total ufilaunt old to e all calf i r~ j,+,.y fneoi ortoeed 6x0 por occaslon per,1lwc n. &nlor A _ 1 1 f~ltga (L dih ltnl tnldAle/ j hl,. Y't ~ r. I e1,-~~-..r, , pro l1 Cr) tl enl4%d,i/rig's/~~/ ) cu~y\ / yJ r014te Zip~code Pow* (A,.ur.d, na,) eJ V/` I62+~1 I I..d/Ci -~~J(t11t~7J J[:-jjri7 3T'~ r l t. _ ~O 1A, ~!,"k, ~l~~tlrl[J ~Oe>, 1. .1M IXJr onet/41 ,~,a~~~p~~ f ~rb,i1 t Rtvedlrrd by Illp lean, Ikpnrlvieril nl Po ON 69140) r Jph 4-F_.._3,...W..V fi.. J%.R..,.-...-~ Camft~^tittiohrt/ l?_~' ff / K /b I Home iddren 1 Glt 1 44trtY 211) WO J Pone 5 1 ' 4006 41 uLI1 hFl eOxIXJM 1. r ~ a ) IJ11f q g y+he'rrxao Wownnn'iiolPbrl!r CId ~lpi II\I I ' rR~t f^j? t ZJ` d4M 1441. 1d41, in Wolfe) I.F Cr ,V a/lc ~<<Y A4Z... ! f a,lt home addrett cloy 01410 zip code Plloty, ^r~1 t MYrr ~ I 88x Ix. j f.._.~1'/ OAM IJI~ t7 .~e i`' I bl. oho, rifles lieparlol IV MINI Yo ~t` 9 1 1 k~ry rdo:y+flr~ as Y`,.[~ )Et}~ .j,'.) `r 6` e .r. J 1 ~I 6~ ~ r t~t~ lY ~QI ~ ) ty ID b .V n ~Kx{ot~/(f(lrlr?n(r✓111) „I') ' •~vk~t~ii~~,~,it~l$~'E', r, a, MI, a f{liY Cloy uro ......._'tu stall .I.ZiP~ads Phol 164 eAdp Ind,) h I>zr't~ , 1.xfF djti ~fY t~ (lflan~re:1 by the 91~ xat DO bcI) perbnrnl uIl444 pbi yl r r'i lf i a a ll --dv c ~+~t u _ camq ls~}r) r T'r{ I V 1 r✓.i thr, I'.. (,'IbekmldQ7u) r.jl't~~E N.S1~~/2_Iyl:t31~.L1.(q 1y 1 flom4 eddreu b `r CND cnv 9410 alp bode taeiq,lAe'ep00 rF n 1 n6~lk20 NA i,it` LJi 7 l t ti~ail)ldr~li~ Po, A,Xos t)tperlrh Aldlirllbl t r 4 r~ , 1 '1. e tt r RKrR „n y' 1 tl+~ ~ 4TAIM ~+r'1 r(r'/rrer,td;~ )e) y r. _ }e`r}tSIV.S/ et aie t~ .1..114 redaey_.f2. ?r 1, phone (Area quQl~ .n>.) I ~y t 1Q.. / 1 I. _lJINZl?rU i ~,~,~~~~rdJ' .1 + r o ' tit, J Six I. _ I M Wr bete of b[/--lr f, " r t Hlgnbed by lope levap I/rporhdrrll ul ! ublle 9n/d1Y ila. b 1 y b t Yr f il, you j.ka?J 1c/° cam '4nutl3rl`~2 ~t , ' 4 1g4r a4sr! 1 )11 'i,Flyml,(Ltlrl,7fn! nrfdd(dl ~ I dti4e rf ~ o r r. a, r c,i N 1Y NG'aw .i I , C,i ` r~864 q 4-. S!'N 1.0 tl J ~ t 1lo,F/.~_I -i,~ Marne edcu011 Cloy 041a 211o C41110 Mond (Area 1uM 0 Ftw. tiroN f Simi JM 1x_1r Vitibilial k1 ,l,~1./,U l> ,~1t1 yy1 t , r :~,4f ,r 1,• - ' J II ffffII"iIfIYQ by Ehe 14x44 IN arfnlrtll lr I nbll0 M/~ jai - I t ? ink l~:; l ,~p ass r. I E ~rI_ ~rur z TEXAS APPLICATION i I)~;La ~~T Iney, 1.65/31 FOR LICENSE TO CONDUCT BINGO "„„...~1'leafl read lnslrucUonl-~' , - TYPO r)r T1.4 Do not wrlto In thieloi, vea$ 1. Two of licen,.,,,,,r ltod foe ® ff'~--11 A, Am;uDl LJ T • Twnrwrery Ctif r ; , elbulo-e uele Ot1Y f. AN+r,I T, Hal title orgWietion eye, boon lowed a hlnflo leanlo7 YES Q NU it "Yes", enter the Ilcanso,numlwr, 1I-`--'~--'---~•--~•~ Taxet l.taana to Conduct 4lingu TINU Commerclel I.Icanre to Loat1 k"'" .....1.__1-.-,--...iti...,... _i-......_..,. ......,.__i_.~-...,._~J L, .:.J.`_ f , _r.1 ;,..I. _lC -1 3. Nalnool otpenleatlon ' 3{J0(]3,1'IMk94100r? 02/10/$6 d;l VFIJ POST 1'05 DONTON br' TX 76801 - du couniy PhYslaal lots ldn of your Organisation f 000 and nurdber, cllY, U11,0 hmantmobI dlruo(lard it no 11roel hullbeN ~r ' i A ,rj i' t" ° ~ Jr?,CI ,w^ t.;r % ,v . lYri , f Doserllro tho aPecllla qurIfoilis1 for Witch binCo prot4ad1 will all used -J f 1.. f .1 Jv ' e' I..t ( /.1.r.A. -~,-_`+LLt .J-1 S e'e e- Me 4, 3, Name of looauor, at wldch tame, will be pteyod • Addicts esj,eel A nohLbernr due lbe Orion, focall,o,, hxarelrre: 0 hrrfer lOOlli rt! 01, 1060 on JOrus lid, !JO oaf hie 1',6. AOx or liurni II„ule Nu,l 1..,, 91b1/e I 91Y cane County - 7, 11 jell location insluo the city Iimftt of Iha city h+dlcDted In Isom 67. eLil ,I • YCti © 0 , NO 3. If title location dlfletenl train fire lot flan of your olgenltetlonl ygg If "Y"", explain wiry 1116 W01011t I Jcnllon of lire organlaollon Is not l doquolo for ploylog bin gamirli, 9, Muff It ilia mexr num tooting capaahy rot buigo of the location in liem Elie IL.~ J! J 10, t10rv H 1114 lrkalirn+ contratled by your oryenliethen7 9 + Q Uwned„ _ w Uota acquired 8Lofted Leafed for tam wiar f Y tame only 0thef fNeylofnl - Name of awnor of IMfaJ pl0mltse owner'$ bingo Ilelnse number ~ Ad-. -drlu o...... .rownar(§la... -rrer_-mi_-_-....-._:.. II' I`I` //~1 (A1 a '/q (f [ d nom bar or !'U box, eltY Uaru, e0+role) r..r. 1.„,..__ ;10111 per cnron ldr munth -"=.lr•+~:t~•=•~ ._svx•°• _ve>_~.er*._._._..=.ras,crx.d5_xin•1« 11, linlDr your orgenilalidn's Federal Urnployor'I Idontillcollon IF III) No Nl any) 11, Ikea your or2enIretlon now have a faxpayar Mbar l epnrting any Texal taw Or a TOM Velttlor Idonlfflcatlan Number? t Yfi3 NO 11 "'trig", enter number 1.z.'_r-L, (~,.L, .r }8. NurnLer of Dative frarnb/r1ln 200dttnhdinil In the olyonisellnn TEXAS APP:WCA'TION V011 r.Ir.:ENSE TO CONDUCT BINGO ~tU. cr,r -h It~.\hS BOB RULI.OOK--COMPTAULL0 OF PUBLIC ACCOUNTS NOTICE TO APPLICANTS A Taxes 1.Ioonse to Conduct Ingo can only ho issued to a quallflad, non-profit, charitable orgonizatlon. 11 your group Is grorind a ]iconso, a dosignated member of your group m_usl bo Lr. Ajvhr. at each and overy bingo game played using this l1ronso. This liconso cannot be sold, ruritud, transferred ur usvignod to any other group r`r Individuul. Your group must maintain a bingo chocking account for dopos4 of all bingo procauds and payment of all bingo expenses, You must knup acaweto records of bingo proceeds and uxponsos baaausc that' are subjoct to audit by thu State ContCtroller, f niluru to abide by the provislons of the Dingo Enabling Act could sublvct Ilia slgnors of this opplicatlon to revocation of (iris license air(] orlmirtal prosucution, 1, tiro undorsignod, do heroby declare thot I am the heats of the organlzation and have road and will abide by the above statement. al M GENERAL INSTRUCTIONS • Pleeso wrno only In whito areas, • Men ontoring a 900101 5acurlty Number, Fodaral Employer's Identlllcallon WEli Number or Vendor Idontlfl0atlon Number, do not enter dailies, Dlsolosuro of Soolal Socurlty Number is roqulmd by law. • PUBLIC INSPECTION • The applention and all 011e0ha+onts are open to public Inspeation, You must Bond a copy of the appllcotlon to ilia govumino body of Ilia legalized area In wldch your bingo gamer aru held, VAMLe Or ANNUAL I.ICEME FrFS CLASO ANNUAL (111059 RECEIPTS LIMY. FEE _,•a•, ~,-=:-~~-„-mot r~~- -~..~d=- A $ 20,000 or IM1t9 $ 100 0 26,OOI thro.1h $ 60,000 200 C 60,001 through 70,000 300 D 76,001 through 100,000 400 E 100,001 through 150,000 000 P 160,001 through 200,000 goo a 200,(101 through 250,000 1,200 I1 260,001 through 000,000 1,600 1 300,001 dtrough 400,000.- , 21000 J WON than $400,000 . t ` 21600 Novo At Ilia and of each annual license period, ilia amount of your total gross retelph repored for 'lht hemding ygar will be reviewed. Any depoienoy of the fee paid for the period mWI be n1' 'pa!d'oS ar 16 Yonewu! Any sxhoi of leg pald upW be oredlra8, (aeolrort IO fo), TRXAS DINUO ttNA71G1N0A07`,7, - 'n7i Inav 1 aG/31 '~"~~~--~•W~ I I F rrWY~cLaaM.l111rll~lllltrr i i i a y+ pit7.9 TEXAS APPLICATION K, j~ter, t ep/el ff1N LICENSE TO CONDUCT BINOO Ll..... i0o not willo In illoded oreot page 2. v L *L, -J aL) pLoe T Code 0 601000 ~L'"L06_ Tcode , 00100 IA Nome of orgonliatldn (Sarno as lioar ily oepvilt aooi e 2 061,011t Cade n 193 AffiWil i 7S, ell ng 00dre is d97realcaddropr, 1', 0, Uox, li nral TtoNlo, borne oe ldem 4.j J Clrv theta LIP coon Cuumy w "'I 10 10 Typo of nomprufll organliallon i I"' 1.,1 d•,~1 1 114ugtous 2 • Medical L.J 9• Prpternpl 4. Volunlaer Fire Uept, 9. Vatorani (b thlr 1'eferanrl urannhuHnn vlorlered ey Iha (/.a, Qanern4f ❑ Yn NOI 77.1i lhisofganlratlan offhlaied with a auto of national oroanlretlon7 a YES NO If "YES", enter Sha demo of the organia6tlon nd the itela of national oddeen /F enNs_t'F l .?_r-1F v ARS ~F pWer o 11~ air ~?f~ Y 1 v 4 s e rear ~;V W r 0"ey IG.Do eiihIsofgenltatlon now have 6 901 ItI vxelnpt Ion limn the Internal ftevenbo Su vli.nT a LJ Y.YtI k h(d~ w II "Y Ell", etieelt a copy of the f A S Flu II nil or dot arm l n atlon lot for on your axOmpt it a lot, otate Tex atonartsr of 00A no. bate IE,If this oroaniaellonif auoryrormlononion al.r.I~J A copy of the Articles oI Incorporators must be filed with this epplfcatlon. 20.111 ndtoigmHtatlon Is not is corporation, ametbe the motltodol organlaetlon and Judi evldoneu of organitalton, i 44 Dale of orgenliallon ff --A a 21.rintar the Puma of a bona Ilde active momlwr who will Lea primarily rolponilble for eonduCling Your bll.ge games and Nllno lax returns, This membor must sign this Application In darn 20, and this mornbor's nomu will appear on your license. Llil pia names at 61! other rnombors who will be opeoilori on life application suppiamant (pohn AP-124), Name and number of years el on aatlye mambas Boolel Bemiritq Number WIVAr'111041110 (Srah, A nn.) aL/_'/Lc / .}!`.)l..r flomo 40drail City Mile 41F, ode YNhune rAr2a VA* b no') LZ eJ Ia,~ (1606 sex."j Oaca of birth 22. List ilia na(nel of nil pcrsont wife will work and re Calye romplintallun a4 caahlare, ulhotl foul callols at your Bffecllya(lots I binpo game. Ulu the application iupplomout (AP•1241, Provide ALL requested InlurmaCo i for il"h person lislod, L,__.1.._..1,-i-i..~ YYaiY.a14iF3fgltl.L.ic. :-a c1'..• ~Cx3arx'ui2~•ii.vVi:n~LLrM,Y V:23~~t_aC~r.~~..~_..itlC ~f~~ti_.~ 1.GY!G`YSt1[Y:`CT ~-~j~t -~ti~~ __T.~~.~_.1_S:2fl 23, nN(tl of ilia waok and lbdalil fmmet will u0 played. (Hily hui rxecrd Lnpr h2mi1 W atiy 24 , hnurparnld) 1'inidayl Time gnoand use, Tlms .I Tfdrddey Time IL..!.V <_•'_I( Cf__, 1, h1 t1 /Gi 1111.._... -'.-MJ (TS+~r _:~Jr It r, / M..ts_L rli~f ll.:( <F ~.....1...,~ .-L-j L j a i I...J....1~ LJ...J_..I...J LJ If this Ii all appllcailan for tomporOty limits, enter the month, day Ann time of ills Month, Vey. TInN lomporary gains „ - - _ - - - - _ - _ _ - - - - w _ If ilia drove tomporafy game W111 teffloca a regular game, enter ilia day end Ihno of uty Tfini ilia felulel game that Is replaced - a - - - Caifnly/olty code ICL/001. Vnom per calendar month gl0/tU0 ❑ 80Nb LIChN9G )'E0 e L_.LJ.~ L. J.....L J _ J ♦ l • L. _.-..J Ts%17ayar 110, _ Texp4yer numbs, Permit number License elan pafmll ne, •L., ~_L_ t:_t ,__t~ _t_ _.1 iLtV.,._, ..,_-J eL-J tcada. 40 0B00 Typo of bond Lfo4na Inlmluse , -Licania sutut prig OLN e L.,_..J i L_i. L-,.1.,.,J • LJ Y•Yas N ,No Amount k 1 i s I Aplsa,4 (Big nby, 1 aepl TEXAS APPLICATION DO n0l wltolt III shedod areas FOR LICENSE TO CONDUCT BINGO 24, Nam$ of 0104a iiii (8'arrleu /film gJ - a e r' 2G, Ully fBahlaas Mont J) 20, tilt ell orbnn iJellart of Nceri. !!l adAlflnnnl epees b me W,Ory, NgnO tile ."l'e.tor SaPpfuann1 to Appiraliun for 1'rermr to Cund"01 IF nPo"F(l rill .t p.l 21)v-- 800101 Security Numbor - L-'.'"-~r: Title I 110"10 diet, rlr.ldlln City r+ i Ole I 81+to Zll+code Phone (Apor Vol(" a, +W,) UIL. Narita, u,/,y 800161 Sacurliv Number Title,. IY 1(A..r•r ll1_,1., I1lalna aUU1111 5 / / pity J- J 1_ J• Ll. c - II r I kIP code Phon0 1 tr,a r0dr A to ua,) ~L_~~~. ~Yt .C(M 1"'<~,ir r' 7~Y, grata 'sue S' +ie Noble / 600101 aecurlw Nui, b1. Title u Namaddrarr girl oily y/ slam 21 1, pnOne I Irra eudl fi 11 „,I V. BOND INFOIIMATION h'o be conrplele,l only by appheonfr/ar an aila(hl lfrerur lop n locaJ14 NaN kae pnlln,rd Mope lox.) 0, Glllnialolt quarterly bingo Grob receipt! fq'h01e dn!!an ants!„ $ 6,Tax UxompUon_,.~-_,, c. Gtlimolcd quarferly binpo rocolpis subloet to tax filter, a minue llenl b) _ - - _ _ " - - d. Amount of bond requlrod/MufNVlyNolnaLy.02(g,I W - - AOt O f7 ltehl it late Man 11(00, Ihr01 nu bur I u requlrcd _ _ ~ - k .Typo O! lJOnd -a" Nrrl ru❑ulffd d Cash t.U Ong Sura` t Unnd d 0 00 0 lot~`= 0$ Alsigmmaot fit WVings account I : - 28, LICOM60 11117 I'cpmrnl W Olt rro+dred Ilewrm fi'v nnul be eubmlfted rolln tbir alWilcufbui, ~ ~~1 ' 'tompofery I,ICOnm~lea Poo for a tompoi llcemo to conduct only Ono oacodon Is $26. Annum fleoma }ua . Foe for on annual license b belod on Yout organita0on'0 annual orot0 ro olpU. Your license dials end amount of foe will bo Found M o table in Ilia Inehuotlonl, Enlor Ilia amount of your annual gfoit roaomis Cnlur your iI0Vn1o ciau - ` J I Payment tac0lvad Cleanse loo ~t1 / l r t 1 C~ YES 20 AFpICSAV)r Vt' IIOGPOlIkIUILITY ~CJ N0 We, the underilgned, nareby declare That Ilia oromfizatibn identified nbovo Is it bona IJdo nonprolb ofganhollon, that we ore abtlvo 11:0 a o1 ilia br Gonliailon, dial we will IV responsible for cmlducling bingo g2n1b and lot filing elf required returns In aceordanco With ilia provblans Of Ilia ` Teas Uingo Goeblh p Act, and that ell not proceeds dorlved flop bingo gorme wilt t» utnd for chbritablopuglolnl at clo(fried ht Ilia low, We further d6cfeto that we have novor been abnvloted of a felony, yembUnl. offama, cilmirtol hnud or o crlnie of moral turpitude end thin file binoo workers 1 have novai bnen convicted of o felony, go obllno offense, criminal fraud os a crlnle of moral turpltudo, We furlbtrt certify that :00101 Of title appllcetlon have boon "lit to L/1' Y ez?~)a`Nftt and shat all statement$ In this applicatlnn and Ally attaohniente era Irua and obrrool to ilia bast of our knowlodoo and Iwlfot, sign n Read of urgenlredon h _ f - Tad. Date ; y ,LnlL C(IJtlq, / C G f1 " MOmb tlii Rte0 tam - L - _ Tide beu Ab / Fitt Compfoto this application and hiall all 000 GULLOCk, COnrplroller of Public Account Poo 91, etlenhmanlf and W"1110 foe tot t'aphol station Auufn, Texas 70714 siTriRioY numGor'"' t ,,,,nl and numbs; - It ac 11V1 nurnhor ~--yyl -tab ~-"~`••~.'''~•~If a V1 I TEXAS SUPPLEM{ NT TO APPi.ICATION FOR LICENSE TO CONDUCT 13ING0 Usn this supplemem to Provide additional information requostod by 1 T~Oil MINT . Do NO'' W11TE IN Sl AHEAS ,a Y TVxat APPllaalloil far 1.Icanse to Conlucl Bingo" fFo mEgP 1171nar "Texas Amondma0l 10 Applltatfon for Lleonle to Conduct Ilintlo' IFOrfr! AP•1 pafaloq And o onfdiyn or Amandmanl will not be o rowel it lnfoh A motion it not co did In! oach name Jlrrad, ttlJormellml requeltad for Ifingo O y0rkera IE nacof~ rar~ y'~ fp,7 al actlYlly bnak• Around avert patlon, (Plenae eller "pale olblrfh `ax asorltll, iftly, yoar', F.%,urnpfeer (or rVnuudey Ili 1960"eenler D i P.._PJl (0r"peceilibee 5, 1068"enter ~I 2 0 9 Cr g~ ,J Name of raenle liters - S 7 To,taiLfceme to Couuuct (b; ntl Vynu Mhor s .~~L J.. _1-L lr-1_~Lu-Lc L~ r ! ! I, 0Fi3 ANIY1ITION OrFICE1IS __f1.~ -~p.1--~ Name (Lull first, ntfddla/ c 9ocgl OocuNty Number Tills s_71`'/t•/S.E1~ r.-4,:•(~Ca„1 / ~ ~ z•' r iomoaddran^ rllY - L)n 81eU ZIP Cede Phone f Vearurla 6 nn,) -l ~i 4,.C _xl~7~J Noma fl.url, 11,41, m,ddre) t2 BoElur security Numhor TNIa Pawls nitwits - .l.rt~~ ~ Z -1 State I / Clty `~J_13, let d /J ICQ{f ~~y~~~ Phone (,trrd radP & no.) 111KJ V,4,4 a ~ 10 Namo (L,,,1, first, rolddfa) Sorrel SacuNiy Number 1'1110 Ildine nJUrtla/ 21P Colin I I-~ City 91ett Yln ade Phone (Arw suds 9 no.l 1-~J s IL BINGO OPERATORS. Enter Um name t of all hood 1419 ucllvo mornLurs who witl be conduoUnL- b Igo nalnus, f Name flasl, first, middle) Number of teases as an aouvn mompor soclel soNfitY Number brlvor'r lfcenlo(YIefUAr,)aJ f r+~G l/ City Nonni adwess ! _ . L_ _1l yrl;~ ~f ~~J ! ^,f „r s',LJ 'lJ slate Vie Coud I Phone r,lreu c<,d, , nu,) t N nets M Sax ~~t m l-..._r- V, ~ C.,_!J L~'( > c'/! / ict (:1 Wepubed by the '1'crar 11e1,arnflmN of Pual(e lnfuly) Dais of blrih Name (loll flrrf, middle) Number of vents at an active momuur Stdlsl Security Numbar 0e I 1 ~..,la r/-~~~dl.. ~jf d r_',lr~__4 il.p ,•t 1l /udrall - r2 -I -YM_,..~1.J / ~ drly~t ~lE mle iSla fe,~a C 14,5.1 7 n,l rte 41 Code ?J ~ s J Orty Stale c __,I I l~~r, ~l~~r /Zln code I ~Pp L.hone l.Itea code nuJ A . Hate Sax , 1 ( ,ill e7.3 14,J ~c~ %~r • T d d " 17(aeUfrad GY the 7Yxu JlaparBrfe`nl %l!'ub fC /,I y) i bale o1 I,Hllt if l` etc L,t.1 !t r__J Nowis (1,111, lfrsl, rnfddle) Number of years as an active member ! 1_~~1~ O/ ~ Cb 04 8dolef SecurltY Nuinuer brlver4ltcenwlRlorod no,l Ifpnyle eddra !.`l _ / vn' -..81_l.l,~L1.1I d r fd « J 1.E3 G `ern d City Strata L__.17one a no L.~.,~iw~~~ ~•y`Y ~ 1 w~~ y Flo torso Phone (Area cone a ire,) nets l UP beta-al1blrl,s lr _yJ L~1o,. zJ ~'_Unu:..-rz 4re _j fnaoulred aY fhe 4'txas Lry erfiitL' nm 1'll blfP Aelul Yl I u- J~ z No (Lars, 1tral)r mlddld) Number of weeJ. o Year seen aaUva Mandela aUlaf Security Nunillef L (l tit A1Nw~- _ bdver ellcemef5feNl nol' r9 aeddraty - 1__.yri J 11.i~,t~L1.1,1 L~.:Z ! bit/b/711 reT J L/ 1/tl ! Sex X c1f ' @tgte , YIP Code Phone rA,ca code a nit)) + FJOrY % •JS Olt t. tT l _ _ J Lr. n,a. L6411 , z (11coutred by flu Taxed Poloplinenl ollh11114 5u/aly) bale of bblh i /+x, 'i,~r Name (Loss, 14,11, nskldlel Number of earl as on daily$ mamba / i v Soafd FleauNlY Number n /o I brlYU'e lfunre (RfrfeJ no.J SE.!-.~~! ~'t 1 ff ! r Y florrra adu!/1i CITY .:-Bier P J Phone . (Arta ea-ead~jt ne;.';.~ ~,~.C,yl tl>✓~ r _/M%/ r 81116 Yip cola Phon A neJ f ~ I7 naao ln $ex LJ M Q patealbblh j rquhaa by 'he faxes brlmrhntvlf Of IhrUllt 5e/e IY) P Normal (Loll, 14,111 tnlddlo) Number of Vitals 41 on dative fnornllor social o Il ~~ll ! 9laurllY NuuYber __f.7Ll./_~:~Lsrt"T. ra - t7rlu's lNertee(RfofMria,J I^ Ha+ne addrgfe City n L151nte Ph Zip tole L • __J ' h, I , ono (Arse ends rs nu,J ICJ I mime ~ ~ J P II._XJ LCi~' a ~Isv , % •J l t.1t'~~~~-T~Is~J .>.-,,.•.-.._.,......r..d,.~,W......`Pax tlesr or birth I /4 J Tr 14 IA iff~J}U6a1:IJJtAc U.Illr~lClc~Ic;J.ut~c l~1 ~~I~kBIG `.XJ flulki()8J0X)3Cl1 'A$j;"0 CJaf1'1[X>lrrl!Sdt1tF1€~i1+c.Vi iaSuL'1t11'it,9~~1;iiCl:+Ji+1 ,C~~tr7,r.11 ~J~l!\~~~.~~a1 ~U S An GffDVC NN 1 XA5j1CEN~ 1!l gg C 7 p N c{t(. pA E~cILV - Ii.InaY d u Ufon p Hqry M F~ M N 'I 1 I T.. ~Q[l , OT YAN~I!I H~4~WI11,pi?Wl,y-o~ravok~ll~el ln~lY 1~n74 to lvuAtlnl fUdw l,,.io a,~Jfe7r q~lonb~ ItYn. or T)IIS UI CN9U 11 Ninwo r 1"I VCyCUI) WE1tkA1113 (Jpnrd wr + 131hpp Ico HSdo OuiiiLol ~I 1U9 C,h nUdrnp J.~~turill3)xJln1 l+' Vo IM- t~ ,A1yy yyII,, /J!(1VJ i 'ic~w!e Zf 741 ' Iadd110i1 ~ l7fucatvm o 91st - - of puvu vtvr Pool i 1`uJ J 909 slulr'o txntl~m, '~~1xnd. 7G7Ua. 4'~!]0lJ3 41/~S~/E11.. _ f ( Plrrrrosn _j~1J1 3~J4I~S! ..llS3I1~01T~~ S±a.315C(~XV tfi li ~1~S7lli_ hn'ydnclt1woofynlndl ),n i,~.tllra T n true , cnt itain~i 'hl3nln :it vn r c>ttirJLra] c,utl: flzUV 10100 „S r9Nn,zatlrns NnMa and nil Of Udrus9 'lilt b 0(J tQ;(Jp till ( t 1 vl.Vt Pcoll 'LG!i '~IH1 G:Ot) IMou )1)1. f t}f.I1N,CJ}t ~ (sZtl Auld al~n~d • ~ vl"' s iir,Il i~'+lEll i~f! - a , 'Cnxt11:1 7Gd(17 11., ~ 7/B(1_/11kll131 ~ i~i f< f3Ul! k1Ut l U(,H ;`~t~.u (Iio ~4 a9) L;UMI TfIULI O(1 Uf PUF1l.lf AC(,OUNT6 71 t71?1U II i, 1.l.-StvnL ciuC>' If "j' 1 t C~,L` iu0.7trntr,;llcuhdPt Jt~a 1[.i Jtidn~ll SRC111icITaT'IL'1F1hi J17N>;tTU7![?1c7T}7CI~~'tli~lpt)1G.% Fai k::CIAN~;tS l;rl JltIIlJ,c •1Sti1 ~!i4.'If,~\tL'IILr'Yi/rd,1'A':.'S-L.i "!n'A. ~l:[a.IN1,F~.'r "fFr .~i %a .3lryrr:l#, d4.t'K~r.•c_f ~Y{.✓Gfix\..ir...-S+it....>s'te r'~IrV f, rF. I 1 i i I i 3 s S 'rEXAS APPLICATION FOR REQUEST I 'ro AMEND OR RENEW LICENSE TO CONDUCT 11.00 S Sill cr?t,~, 1 llj l+ wit Ia1 1 j c BOB BULLOCK COMPTROLLER OF PUBLIC ACCOUNTS GENERAL INFORMATION WHO MUST SUBMIT THIS APPLICATION • You must submit INS appllcailon lo: +0110ngo Any existing information to an organizailon`s bingo record; • ronew an organlrallon's liconso, FOR ASSISTANCE For nssi5tnnce in comploung tws oppilcallom plonso call ilia :Hato Comptrollor's Office At 512/400.4600 or call 1.800.252.56SO toll free from nnyvrhoro in Texas, PUBLIC INSPECTION • Tho Application and any supplomonis and aliacimnonts will be opom to public Iospoctlon as roqulrod by Sactlon 28 of the Bingo Enabling Act, GENERAL INSTRUCTIONS Oo not write in shaded aroaa, • Olsctosuro of Information concaroing the mco, sox, date of b?rth and aoclal security Millibar of individuals Is roqulrod arid oulhorliodundor the Wrigo Cnouiu+g Act (TrX, nEV. CIV. STAT. ANN, art. 170d) and 0 U,8.0, Soo. 562a aid will be used fora Crlmhlal Aotlvlly background irlvostigat on, • A Chnngo to the curront bingo Ilcnnao fjlUS'r bo submitted with the $26 00 Amendment Foe. It an organization chAngos Informatian Io Its Lhlclo record at Via limo of rdnowol, Ilia $20,00 Amandatont foe is not reclused. i SPECIFIC INSTRUCTIONS • Tho form AP-124, `Tom Suppfomem to Blip lkansA "_MUST uo compiolad and 6UIJA11tIW with Ihls appilcatton to add offloors, bingo oporntoro, And patd bingo workars 10 Ilia orgnnizollon s bingo record. To romovo an fndl ddual'A nAmo from ilia organlaallon's bingo racord, a wrlltan roquosl must bo mado to ilia Bingo nogulsllon octlnn, 11 you are roquoshng a change to the primary bingo oitarolor, you must rolurn your current I!aanso and a now license will be issund to you, Koop a Copy of your current liconso Be you may eoinlnuo Iii conduct bingo, It you Oro raquosling a chmigo to the locatfon of your gamou, or a chAngn to ilvs deyts) and hma(o) of Iho games; you nnlst raturn your current license, and a now license will to Ism ad to you. Koop a copy of your current liconta, no you may eonlinuo lo conduct bingo gnmos at that focalion. You canna, chnngo to the now location or now day(s) and limo{e) until ilia requost has boon opprovod And YOU rocalvo your now Ilcenso, Lease Amount par occasion • f Alor ilia total Amount of loaoo payment nlndo for onch bingo occASlon, Tho nppllcallon must bo n1gnad by 1110 hand of 010 orilanlzallon and ilia primary bingo uperalor. Carriplote mils application and moil n4 paps mid attachments to: UUU IWLLOCK CCMPTnOLLCn Or I)IJULIC ACCOUNTS CaJhlol Stallan Auslin. laxas 78174 AVVia (tier IBG+31 t h r I f ill ,u `r R4."ar.lra x TEXAS REQUEST TO AMEND/RENEW LICENSE TO CONDUCT PLEASE-" COAZPLEIE ALL APPLICARr ITEMS BINGO l of 1! 1Grs rs O ro2uosl la reJlowa r~arl~ prrlgo Lr'-~Q -ro c7fnrlr~os and you~OnNOT W/iJT IN SNA(.+ED AREAS I. llnnrs 1, 2, 8 18 and 1 !I you loaso, y Ivig, y err nArsl odorl r1c1v Item 10 elso. Vour IocoUon I, , coalplolo 7YPo of f0(IuCSI ~.~'1 -Lt _ca~~,era lrso a ol~~ 3 m E_..~ I Ilmlp4val Moslm name <ha~p 7. 2, texas lazpuyec nmandmn O dumber C7 Pi. to ■01110 (Use loo 1I-digi! niltrtbor drown on your Ircoeso 1 ■ L1_L• L7~ ~I_Lit_Lti J L~J ~12J ■ I 1 . oo Ial :dad 0 3. Namo of olganlzalion (()so 1110 11011no sflolvrt On M 09 ad o ofIye ILL your lrconse) Cl r • as undo MaSIN PRvna no ackf/chanpa 0 P4 00 ■ Of 105 n< A. Mailing ad[fross (SROW address, PO. Box or rural rou7o munboq _~.___J COUf,L,. r ary meNy t 17 k 1 `_i . r1 ~•1 _ , I CawLy dtklyd 5 N,anga I tl - flrca C we ann rwm6er h ",U Plea d 1,s 02721 HI r your husihoss phone number v, r r_7-~ 1 > ■ 0 Q j 9j .l..t Cp1111y CWa r I...] clicu 71116 [lox II' - - _ _ ■ +L- . r: I.1 G. Name of 11OW TH[li L. IS A ClrnNr,E OI LoCMlcr! AT V, HloH c;nt,11i.9 OPL 00 a 01000 WC711bl1 WILL Eir t LAYro. Locaoai A•Ia, r s fOn rxa daRr P6 Pu ar mm rumr ICOW/ coda V Qty ICLICCL 1 Stall . ~J za IIr ■ a~.__I 1 a~. Lb, iy austno59 codd 0. IS illis locnlloh fnsldo Iho "y hmfls Of 1110 City earned In horn G? r r bnl. or Y01010 Yes PJti Locauorl J If(u'w is this 10Cnllon conlrollud by your organiratlon? t._`.~ Own (11 ap;naU rauv0 !lams 9, !0 and 11 1,1eRk Y ) LJ Lmmv (d leased. i,d ILaanoo IypO L). ra Ihis 10Cati0n UilfarOnt 1r0in IRO f ` v0 IMnls f2 aRU I3 GlmlkJ L.._1-J.J ()Cation of your ortJanl;jt~pn? L.~ Yes CI NO if "Yes, nenawd'lanloiw Gyw Icenso explain why, CIrL o9 ■ <slao I LOcawn CMad r1 Name 01 c ma r of teasel promises _ Llssur-s IpspSyar nuitllOr - 2 Ad !1066 II J_J Lit ii),Is Ihis leaso baud on altondanco? _ ~ Yip bG+IlOe 11~ Is Ills lOnse for a ono yaar poriod? 1 Yes CJ NO M as r is Iho loaso amount fair and roosonablu in your Opinion? _ '(yes No E Is INS tuaso sl(lired by both pmUos7 _ ° - No oaid ■tqu ati r _ _ . _ _ Cl t'1 Yos M L] No L1_..LLj~_L..1~J f i pacliv f oasu an10Uf11 for &e L Ca- I 1 c cnsfon 001 r L 1_- 1 you nrusf allaclr a copy of tho 10030 aglovolow with this opplicalion. _ W A1kXMa bn lY1io I 12. What (11110 (lid you aequfro the p+ayulc3 ioeaaon7 HMO uey~~ - YYd= C'aso envA,i,l II I Pot atasxy r 0 13. What Is th0 rnaAlnlunl poalfncd capacity for bingo? I ~1 I 1 J -j•_L._) IT -L--L f r if ';yfMa2166ra1 I 'r • r TEXAS REQUEST TO 1AMLENO/RENCW LICENSE TO CONDUCT BINGO Flagg 2, Naive of oigamialion YsnLel L11 f LIA1i4 II 1 nir till 7 LuTaKpayor number r rn, Con-r1rolf Use 0,j, 1A C/CHECK THIS BOX IF 1HEHG IS A ClfANGE OF DAY(S) AND TIME(S) GAME?S WILL Ilfi i'LAYLD (Enlee Nln owiro flaw schodU(o). Q PL 06 a 00900 - f~ ISeWul d1yl / 7rnj Ilwd Mai I1 Tame Iron NY Time I.a LV\7}.tl~.p-_I,L to I~i__t>_I 11, li-.SQ~f_L~?v ~l~n1 to~~:~~U~r.1J I_r Yir_LVJX11 IL O. 10 _is.l.I it LQ-J-.J.-J 1' 1 F= r l_ J ■ L_ _ ~-J r l- I ■ 1- L- J ■ L-, J r L-_I r I-1 ■ L-rIt L__.3 z r l - _J r I-J ■ L.-j_.u-r-_J I L_J r k-ii.i_ J il Amendlitnew a,~ eves [3 PL 04 a 0M nequcsied stall dale r 16. Il this 16 an application for an amendment to your bingo license, enter 1110 date YOU wish to start conducting bingo under your now license. 1,10 oay Yew { Loy J LilLiJ, s&] ■ FEE 16. D CFIECKTHIS BOX IF THERE IS ANADDI110DI OFOFfICEilS, O'RECTCRS, WOFIKEFIS ANDJon SEC0%)AnY Amendnlonl OPERAICRS (workers for componsallorl such ss cashiers, ushers, callers) 2 a Coarploie a "Texas Suppfomahf to Application Pol Blom LJconso" (AP. 124) and relurn it wilh this INew 1.en x tog II requesf. L J I14M tstenso class p 17, ❑ CHECK THIS BOX IF THERE IS A CHANGE OF 111IIMARY i31NG0 OPERATOR, ■ LJ d If the narno of Itle mcmbor primarily reSponsiblo lot conducting gernos is being changed, enter the, Pdy„wrnl received t fat Intormallon requested for the now operator, This Information is required for a criminal activity CJ Yes E] No f background investigation, o Namne (tsar IHI "fiddle rnJi'aIJ Nd. of years ei tlL bvc lrombCa Q II II 01 Ll PI, 07 0 40390 Sx,al Stteu,y Nruslber I br ueI s rKnlse rw. Sia1a ■ ~_.LLL'i J _1-L i__L_LJ r r ~~L s 0 6 Irons aldrese Qty 5lMO 71P Cale ' Plux+c (area code aryl nurntle q r ----•----_.._1 r L.L~ r~-_i51~; uiurr~ ■ l~-J_-_...-J Noce L..-_.-._._..l r IJ sox te❑ m ❑ r a Ll t ._-L_1_1 __1 10. AMENDMENT FEE If you retuested a change in items 6. 14 or 17 you must submit a too of $25 (payablo to the STATE TREASURER) with htls request, Return your current license, and a now license will be Issued to you Keep a copy of the tleonso for your rocords, You CANNOT change location iii days end llmos of games until rhls request has been approved AND you receive your holy license, If you mako those changes attire flnlo of renewal, the $26.00 Amendment Foo is not required. RENEWAL FEE 11 you are requesting a renewal of a CBrrolli I100nse to conduol bingo, you must submit a renewal toe (payable to tho STATE TREASURER) with this rugvosl, The renewal too is based en 1110 annual gloss receipts Thal you roporled for tiro provtous year. Enter life Information requested below from 1110 ronawal 1 notice. rlo'Ir 1{ease class New I@ensa Ieo LJ 1,- - - --°D~ f 1 I I I 1 y(4;;,(ROV -oil t i Page 3 10. AFFIDAVIT OF RESPONS1131LITY - We. the undersigrlod drelaro 4rat flip or(anitatiorl Idenllhod heroin i's a uona fldo nonpfolll organization that wo are moniborsof the organbmon, Ili at Wo vdill be responsible for condudrip bingo games and for active for irlin~ all r0qulretl returns in aceordancU Willi Oro provisions of the TOXfl9 13090 Enabling Act. Thal all 1101 procoods derived from bingo Mines avlll be used pu charilabW rnosos of dohned hi Oto law and "hat no person named in this request atld its supplumnntfsl has over boon convicted of a letony, yameu„0 offense rirninnl baud or a crimp of moral lurpitudo. 1 We furlhor corllly that copios of this roquost have been sent to CO aro Iwo and correct to Ilia best of our knowledge and boNQland that all slaleninnts in this request and any a lachmanls a1rraJpi ur the a9arUtat~oi, If rfgn i,llo here ~C+;fx~ \ Uale sign) 1a1E hero / Dale Fief) OKO Mnnbv a 0, aamJ an11 liurulnr aM4-11 numbs' 0ato Fp .TA13LE OF ANNUAL LICENSE FEESASS OSS RCCCIPTS FEE $ 25,000 25,001or loss 100 50,001 through $ 50.000 200 75,001 through 75,000 300 100,001 Ihrough 100,010 400 150,001 Ihrougfl 150,000 coo p 200,001 through 200,000 goo !t 250,001 through 250,000 1,200 000,001 through 000,000 1,500 J more Ihah $400,000hrou011 400A00 2,000 2,5oa NOTC At 110 and of eoolr annua171conso period, file amount of your lotof gross racolpfa opoltod 101 fire pracoding year 101 be reviewed. Any dofrclopcy of tiro loo paid for 0101 Porf0d must be pall pool to renewal. Any oxcuss of loo paid wilt be credited, (Saeltort f3N), ICXAS RINGO I.WAO 1N0 AC7'.J 3 I t ~I i i a U, :dkxuJ'lt?k~[J7L~.&+k r.:L iL~ica7tJ1 ~ s ~ISa~catntuaur~+ N.~C Jt~;rUCONDUC F BII~1G~ tUJ,>XlC'1k1~11.t bl AC3",87£~'Sl}GI~IfBRd, 'l$)t i+71d.. (dl'4A2 .ti'L-4~bl CA(b4No n n9 A{[4 RRp GON DIIGTEU r` r '66 N A As U c COMOrt aYU~I sfaen w 17~!aw, °r rove o, r_~JY 11mo 3or v ~tlUns of tl7o fexM nY _TIIIS l,ICF.N WE IS fjt03m '(f71!C~FE13o~~LElPIuJD fhnUST BC DI:SI'uI YCZ) nn°f 1698$ • ,Y 1 k P 1 Nairo of I~pgl ! 151 G`>i1ri{l Ul pingo Ilconido umnb~r ppOralor Addra(r {ill ihl:itou 1020:1 l:l!'ri(i073~t3~41001 tt ntull~ u.asl a , o< 7:. 11tt11 r.f CYa~ j~~ i LOchubm Illi a t f (,I' r u ) 'Gti" 1715 ~fi " 1„.. of gama Iknit;Ull 0 ) It)t) n1SR'y )til ) d21Mix hl`' UaY am"ilmoorWmoc Pr~rn oso _Ci)!1 i{,` t,(1 r~llll('tl ialHl ISUIl-)7Y3f7 (1{1tiC LI Oi7S<J _ son: 6101) .~~i Ut1 fin 1 _ 6rptnlrallooNam9hnJMalRnpAddrpd tkYj.. b ?•U 7U [An 3 _-_10 l~- L(11 ~ vrh W U -IQU(Ihlr, c.)P r.,)Li J67u`S rt"i'1! ba7ao!luua-TYPtl Rc.nJC1:IL L( ~ x917 1~. r:<nl tza '16201 of tt zu1t111131.^ - Em BULLOCK I TlIfkd6t~fltJle7[$[S~~ ` S 19,p60 COMPTROLLER OF PUIILSO ACCOUNTS tSCiCSi1T'aAKiP1k)OA7 _ R.SI?J2RS[~IYilCfiRC3GIR~S13t1'47CLT'~ 1,21 ~4hP' k'1 A'-fU rG4[I[~ ~ i~ J t ~ uI A Ti tii i P u rICt1!tlr P uTCSiI;(a~a 71~k JtTSS~~~ l y f TEXAS APPLICATION ~l r FOR LICENSE TO CONDUCT BINGO t ~A ~i 1 ' ~f l7 r >r xnllll]]7ijr~ciirrr, 808 BULLOCK--COMPTROLLER W PUBLIC A J jS ll rth,'c"rrCp NOTICE TO APPLICANTS A Texas License to Conduct Bingo can only be Issued to a quallfioul, non-profit, charitable organizatlon, If your group Is granted a license, a dusignatod nE°mber of your group must, be present at each and every bingo game played using this license, This Ilconse cannot be sold, rented, transferred or asslgned to any other group or Individual, Your group must maintain a bingo checking account for deposit of all bingo proceeds and payment of all bingo expenses. You must keep accurate records of bingo proceeds and expenses because they are subject to audit by the State Comptroller, Failure to abide by the provislons of the Bingo Enabling Act could subject the signors of this npplicaVon to revocation of this license end criminal prosecution, 1, the undersigned, do hereby declare that I am the head of tiro organization and have read and wlll abide by the above statement, sign hatedCtl~~4T/ ✓r't4~~5''~~A e`r r tifr}f4JJ It k Trv+ v' I itr J>,RF ti! }C 71 E: ,~I ti1'y'. ~.t~!elY~u J c~r V1 ` 7 a tE f F 1 ~t 1 't 4li + `,t'J tali ve, t~tE '+5' F , u !v i} {e..l E! 1,, 1 f s v ( r. 5 , i(ti, t r ~ n r t~.J ,s 5 t is 4 5 4J~^J s J.'. VJ s./t [t' f u"}, a~1Rr'f NIf y 5, A ! s r ~lee W~7 s r 444 t ! 1 ~~t ~s' t ,1 ~t ; Ott 'L ht}l1 ti ; ~~{I @rb7 E"i Y, r t I~ rai fit,{4~eat4 ridge Stobliiaf Seurlt~+ IN 044~r41 'mploYgt el ti d1 jldetlen IFHI~'r~u`i;lUeifo~Iltl`d~b~~f~ I Iyont ~I qo ~Ur hstfer d4110t en ~lS ti }i'`eB ! E ~if 1 s r, Y i. r} } } e~ j ~~Rl ill l'B OT .5b0iel ~ffl .NUffitle~~h ~ttU1rC{t 1y ~a1'~'i 4'~si ~"j>'F J°Jt ~l,'i tart' ~i1S 7~Ere~t~v ll5~ry ~Si IVY' ~~e Pi1F;t l~ INdp4' TIpNI1The Ippfin6liah'endoll atfaclaniah3e:er~r bN~ ow' utill$fY~ie'pe ~a' 's°S ` f , Il) jt w4 ':'o You must send a copy of the epplleation to )GO r Jening kwdy o} the legalized Brea il~whlch 1foL~r bL~~ptt "eamee ue held 9 s 1 Y r s t ii+~E i v ~}7 '~7 , 'E , r t s; r,~l c~ 5 1 1 f.11~ v JS r I i ~7f15I I ~ ~ l I s 71, ~ rti lW tl+.v v t p` a,+ J "C.t~ Ji _ t t E E TABLB,~N 2iNNUAt L11,Hl~4~c[ E dt~ASS aNN~fALCROSSRC-CEIPtS'tJyv~~,E,~ 7f'L°G~ 9FS Jr,d a`' Ft t s 1 ~ `ST' e$e. 1 , r ,vt s t t7! ',v 1t( t J r i' r lS~~ 1yt{{~ i ` (I~' 2~J i or s sP L r'f tt~ 4S, , IJ E s svs 1}E„y;r,.J S ~f t ,tvt/t5~, s i7 -?Lit 'E (~~J:/,!t rttl~rouoh 11 i t~? .t ll l y~ ~7 >7 It 7 s v~1Y tJl~ t 4 }p y5}f1,601 ,through' fi~Y qd0. D ` '+>h5 t •r;i, 1300 {I~~1 I7090 kE ! ~.i ~threVgh, ,1J IC~f~~ VW. I,r I )1400 " s z 1 7~}i ~Wr ~ rs th Oh' vI ~QsQi~Q,' `it} t E I~t liVz L '4' F, tJ 160r04j through 204,t1d0 8Q0 it I} s t e , Y ! i s: r ,t , 5 1 J£ t 4Rwf, ,'c 24(i,Wf Js 8thrpUgh_ E , fno004p at {te`}tSr~E ,R 280,401 ir~,.Er tllrqugllr 7r 380t44U~5 r}If, {$tj~ji6~OQ~~~;t~, o4r° 3 roUgh 444,000.1 r f „ {JI~~ ;k Da0,l1U Yq tjt~r ~41E000 ' ` i f E,)I~+o .`4111,' f ,rt t s( else r~s+{~lt j+ij 7 1 j v t 7 ip i r l Ey. , , +s 1 F 1 v S utJ NO AJ +thp. Nfija(ens o1iN t f p n off amoX { pW b~ OP Vd t~ ? rop J, t? bt ni"tlrla~d p y35r Wu b~ r'gV1pl Ad; nny'tjl~1df111cy Jf~~'lgo, .aft 1 `fritu~l~~s t P el /f gr ra ~9},vi4u7 itny dxaaga o/ lee Paid will be b e;1(led f iul 1s 10-W k 8 gIN(fQy J, } sp iS},r Ffv 5'`[ ~~~/Yp E']d~~~., vn .l y - 5i [ IJ }e Ai tJ+( 71J i J ¢ 1 , td V~ t•e~e 13~". rte w'..:.~d..3.~.1' i , .~.J.F tl EJI 55 ~r i X16 t~4 ~i "'t ~ 4k,~{,~t~([ 'r<;~J ~t h 4~`(rt ~1{5t g~+ 7f4eYt<' t~tP' i I r I I I TEXAS APPLICATION tar i.~aldl FOR LICENSE TO CONDUCT BINGO Ls__, . Plaeto reed Iniquotions M r TYPE OR P111NT .00 not writo In shaded Brats 1. Type of license applied for t A - Annual ❑ T • Tompoiary Etlectivedate Z Ha fhrsorgenitation ever boon Issueda bingo license? 1 YEs UNo if "YES",enter lire license number,, Texas Ltero" to Conduct Dingo Texas Commuolel License to. Lease 8. Name of organization 4 ;I LN?3754L 061848002 ? 02117/86 19ZGHTE EOSO(OLIJMBUS 4771 - DENTON N TX 76001 CaOB County "Physical rocarlon of your organlzorlon (SW91 and i°rlnbar, airy, Ofpc moanlhpyul 0voifonr it 'to street nu rnber) i~ oa l„~ I>TX ~J E, 6Blcrlf» Iha apecifla purpafa(el for which bingo proceeds will be utod, - (J6nCY."f rtYlAs I,o V(W,9'1,0 (i tkff C, Y (WJ LO-1,11ti16f,N _7 -!t 1,•.vdT,~C~AUbI/C~DI o(^G-/a rLrt Tt r LOCATION NPORMATION '1+J (7 I I I yJ g, Name of focetlon of which games will be plaVed K I ~ faTS U ~ Cpl ~N1 p 11$ , Q' f Address rstreot A nurnbor or desarlboaoldol location, l:xolrlMr a miles south of 1.11. 1000 on donor Rd. Uo not pie P.O. 06x or Rural Houle Me.) City T, W14) Lin code County 7. Is this l0catlon Imlde the city limits of the ally Indicated In Item E7 a Irr-1tEb rl.-.-J,/b NO B, Is this locallon different from the locidlon of your organization? LJ Yee LTJ N0 If "YES", explain why the pinsont location of the organization Is not achnivi a.for playing bingo games. 9. What Is the maximum waling eapaolly for bingo of the location In Item 67 10, Now is i location controlled by your o~r~ganntzotlo-s7 ❑ Owned- _ - _ Dale acquired Lowed L.l LeeMd for lempoeary gamo only - + N'{e~me of owns of ignwd Premlvel . 4wnar'abinga IlaiiNr umbah ' ~0Vt l~olL1,MbtkS C( IA~ fJlii~5 O Addren of owneT 01111 al and hunt bar or P.O. Rox; city, ato to, rip co") Nana pardelandar - month L -,7 3aoo, 0 j 11, Enter your organization's Sederal Cmployer'a ldonfllloali VEll No. (it any) 17, Does your lrgenizatlon now have a taxpilyo1rfl-VI bar I eporting any Toxet tax or U js 2 D 0 } Taxes Vendor ltfentlfloationNurnbarl d' VUS s-NOll"Y[g",enttrnumbar ' as 18, Number of eollvo members In goodNfnding inihis orgarllzellon I_.18o J quill i l I t ,E e API 17.3 (Rov. I.ea/3) TEXAS APPLICATION 9Do not Milo In shaded areas FOR LICENSE TO CONDUCT &INQO Page 2. rl+N ameoIor g nlon TA-- 6 r Code a PLOS ftoode ~100 1 9 ~ 7 bepoilEOde x~t(1r~ ~lmoV~A+IIQ address (8tree~OJdr j _L ~~..rn Nouto 0 -Su7 1 croe litre ,i,).-_ A--- city -sw _ Stalo / 10 TYPO of non.protlterganlaston ~ e • Zi ~1J I ;I(ViL_ -J 1 • Fill Lrj2 • Medical e 93'- Prolornal 4. Volunteer Fire Dept, 6 • Veterans pe lhlr ve7rr mhe; ,r/anlrall,n chartered by the U.S. Canorenf rr'~.~~ YES NO) El LJ 17.bthis organization ef}Illtied wllhastate arnational orgaalsatlon7 YES ~I " N 7 II yes", enter the ems ofyfha organlre lion nd Ina rteIa or nallonal address, e D{ -~D1L+LL1?41~ e~lj 00 l1c,i1 48,Dots in It organization new hgvoa 601 (0) exahnptlon from the Insernsil Revenue Sorvlce Y.Yos N Nod fJ / - if "YES", ettacha copy of the IRS flultnei or daierminatlon letter on your exempt alarm, Stela . roxesoherter of COA no Dete 19 !f lhU organlsetfon b aoorpamllan anlerl 'A copy of the AFlfolos of Incoiporalion on el eL- - e I _ J 2(,1} this prganfratl must be filed with this application, I'M acorporotlon.doscribo the method of or0anlraton end cubmft tvldonaeof oraanhetlon, Date at organisation 21,Enter the llama of g Iwna fide active "liner Who will bb primarily responsible for c indualhig your bilel' member must 3111n ihfs application Ir 90 el end ng fax relutm. This "am 29, and this memher's name will appear on your littlest. List die names of,, ail other' "Who will be operinto it on the oppocailon supplement IPOrm AP -124). members Nameand nurnbet. of year, as an active member ~j 3oelel9eourlty Number D'rluer'a]NeM1w (Scare ne.) Homo addrert _ tally _l-! _.-,Y!s~ LJ~ 01 r_t=~s~.1 1 {7~'Z'LS r,7 r ~1. ~D 1J~0 fJ 0 J ( State J -.-J 'L1Y code Phone hlraa coda & nn.) L-70--E ~s zttlo~t ~I LrAJ LTL z D ,I Rene GL- Sex t"l s Deis of birth 7"7+~ 22. Lit the names of elf persons who will work and recmva compensation a$ celhlors, ushers and collars at your ' bingo games, Lie the aPPllcallon su pliment (AP. 6necswedue p 124), Provldt ALL royuotiAd Inforntatlon for each parson listed, e 29 PU't (d`y Of Ina Week and tfinel4 garnet will be pbVa~n (pfa` y not etcenJ lour i s In an 7 ~ U-~J__ p M a Boaond eV'Ume Y hour pert, d) M,j L T~tfd day : Tlme eL IYrt'_ J L,1 e, , I I-_,_,__. J L J .~_~_..e..J t~~•-i~ ~J L._I II lids it en 0151140011 for seen" .eery license, enter the month, day and Urno of (he Manth day Time lempofaty Beme ..n.. - _ - - If the above temporary game will roplACO reBtier BPmA,antgr the day and time of Bay the regular gem, that I n,p aceJ to Coun110011V code ICL/OCl 110M per calandar month - - DI~DgbD tlbN4d1:0) LICyNee rc Meyer humb,r P01MIt number Taxil ea... I License oleo - i e • LJ code 4f1 41 600 TYps 01 band License nvmtaor T. Llcutlo 1teiW-- aL.»s_..1 0 I Otlg, bLN Mel N-No Amount....., Y f L I f av.3•ablz) TEXAS SUPPLEMENT TO J APPLICATION POR LICENSE TO CONbUCT BING TYPE O L--._OF{ PRINT DO NOT WHIZB IN $NA°ED gpEA5 We lhle tupplamanl to provWo addl0ortal information Coquetted by "Tuxas Application for I.Icensn,to conduct Slnou" {Form AP-1171 or r Amend etlon not ment to ground lnvestlyadon, to for elachl n nmo Ih~ tied: itnfuimetlon ranluaspodttorr hfl 00 oporetare at Jttworka is is necessary Clair aocrb net ecU vtly ba'~`ck• ,(Please enter "Dote of birNf"es r lorfllr, Cla), yeor. Examples,' for "Janvary 16, 106tl'enfer ~0 f t 1 t 6, L.iu; arm 11 Y omanIreilvn~ ` - - - for "Doc enlGer 6, 1066° vii let LI 2 6 , 5 t r N~r~ p n~ To~et Llconia to cond/u/ai /urne~o nom er - Ili _ 0 Y 40 N1ti1lA.s _"_1 s~1I,-Ri4G ,r PZ n I,, Ofit3AN xA7'ION ONFIOERS I • Noma (Lail, llrsl, fplddle) Soo &I gestlrltv,NuniB + Home adults" `CITY Stale ZIP coda Phone (Aron code A rru) i Name 11,dri liell Aiddr.J' r."i 8eclel8rcurlrvNumbar.:, Title a ~ Nomaaddtels ,.151 '--City Stale 1 zip coc, -~A. Pliene (Area code a no.! L,-J I 1 t L t. 'z Nome (Leal, IlriL mlddlr)" "al to Secur lty Number Tltfi , ;i Home aJdta 1, City state ~ rt, I I I I Stets ZIP coda Phone (Arta code d nc,J -i~ L--- j 11' IN(40 OPERATORS- Cdtar the nantos of all bona fide notlyo nloMbers who will bo con(luoting bingo games, I Nems (4ast, flrel, mrdrfle) Number of yam as on eatlva member Secret Security Number ;;Oms _(•OpQ + _ Ditva,'eltcanral8(aedna.J l 1j 1 3 5 ~y tr r t i~r No)me eddrdu q I Clty YS ' ~ i ~al..j gD.,3 Wt3T2{ri~_V-`f e"' 1~ Soato Zip node Phone Arta code r~i o.! 11 Fteas. upJ M Sex I 'F{ ' ' A:.J t I'nJ LG~~'rl) J L0/3P7- /7s 7_J Ntrerdred by the Texas !tope) bneht of Public alefyl 0 bola of birth L1 ~•Z,~.Z,~~ L~`?-~ 7 "I NygC~ii (Lott, flril, middle) Number of years at an eatlva member ;A r r rr:1 LY,Q~'~r oaolel Security Number bNver'a lleenae (8fafod na,J Y - -1 J 6 Nomeaddiaa Olt raa T LP 3 Zt lz$~J~?_?~/~1 f~yyy~.0 f 11.:.J L_3 state zip code Phon. / rea coda d nv.l ..117 ~Y! 41{~ l_ t itnit I Hue.t(G Saw I~M note of birth-` ` ' i4 , „ fneeulrad by Ilse Trxat haparurl am df Pub 11 a 8a/aIYJ ~L+-.-1_`f6 Namel~~if, /In 1, mlddfeJ IJumbor al yeeflet en eatlvanumbar B , ' t E I Oolel security NUrttWr ' Otlvar's llcan ea f8fafrdno,J __.IUYri._lit~ ryry 1 Ili, I Home Aodedii 12i-2_-LLT 0 I 1117suJ L1Q~~S.~_QaIJ 1 L7 d L htrt City aTt'e'10 Zip cede + I ~ppho~ne (Area rode d nu.J - Reoe sex bl q9 1 (SteufredLr(heTexdltlehortrhon~ iljlbb~rd8, 151) Dote ofbhth LV, J Sa y t l x' ni+l~ahlfial,fnlddfiJ Nw bar of Vast: 511 "r{ W1 ~ n r / v. ~ active member f Iiealrl BOCUrItY Number,.... ~bYr`iv,-trtellcinra/i~CF6Jtalr~na ) t~ WWY a address oil ~l_~ vrtJ ~J~ O 1 117 0 LLG 2 y`~yJ If n ~~~o n ~ ~r~ ,c u { Sletay Zrp node IPIOnyo r~oyc code d~n~oa ~Ltrl~-J.t(.xto ~ ~'41,.•CC'11_.._.~ I~_.t'~1 ' i~ Fi 2_ O~ .1 LS~L/.~1i•3~l-~.IJ f lease 'i ~-i`-' 1 A "ro lltegulrrd by the T1Ped tlopartmehl of 11"bi11c SJa! ty) °ate of birth ' Nitme (LaahI4N, m1dd1e1 Number of yren of an cat va ins mar 8dolet 9aa NcV Number. VA* ' 'tJ °r ver a ItaaA~e76fe t~f it ' Nome address L_-ra , CI Slate Zip code t 1l0•~~~,~ I Phone (trm coda d Flu, t Ewa L~,r '.,LW 7- psi , b I th °.1-.SL4Jr~.. Sew' 'I...Jr data of liar k i I Nayuirald Dy fhe TaNai Ursix ~;7M ianl of ArBlle balofyl LO l zl I I~ ~J Name (L,itl, llrrl, Htfddla ,J . Number el ybrl it en eblNa member ofc -t' - ~$1 ~y Social BeaWltY~yNumbN' 't7tlvar'e lteMNf81el6w,) ' P~,Qi~'.Y?_ V,YU ;HaN & J i O lrv ~s r red code 7 LM-1- Sfe;e lp Ooda Phbn f red code d no ) tif~_~! I I J Ln ''.fSJ I~~ gyp/ ! ~ry~ /,t ~w~lUr'_ oauotf rth' Ifl ~ -1~ f/.. ` I.~tC. a212'"Zl.{J1 ` .a-.._ ale f..`J ~alYMrt'daifr:°.. i i i N I KNIGHT'S OF COLUMUS 4771 UNION, TX ADDITIONAL BINGO OPEMTORS ` i /l Hartman, Cugene Martin 25 SS 450-64-7277 (X4339445 818 Stanley Denton, 1X 76201 817/382-5295 Caue, M 11-18-40 Jones, Paul Ronald 12 SS 05832-5021 TX06929983 1409 Windsor Denton, IX 76201 817/3.47-4943 Cauc. M 12/19/40 Soi.leau, Marion Joseph Jr 3 SS 433-60-6748 7X10618019 2113 Emerson Denton, 'IX 76201 817/382-8896 Cauc, M 06-27-44 i Stocker, larnest Eugene 26 SS 455,68-1553 7X01559937 Rt, 1 Krum, 7X 76249 817/482-3411 Cauc. M 10-06-40 Wehous, Raymond Herman 25 SS 505-48-6277 7'X08587327 607 Magnolia Denton, TX 76201. 817/382-8826 Cauc, M 10-0428 Poir& James Louis 6 SS 460-70-1676 7X05135093 3801 Hampton Denton, IX 76201 817/387-3759 Cauc, M 0426-44 i M~ a f i i N t i a I I f END ID F 1 k FIL F-- t r