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HomeMy WebLinkAbout1988 BINGO PERMITS V S 4 I September 10, 1967 1 1 stroller of Public Accounts Texas Com Bob BullocL Bingo Division Austin, TX 3 Dear Mr. Bullex:k: This letter is to certify that the following Charities and Commercial Lessor have subrnitted to the Denton Police Department, as the appropriate joverning lxxly, ropies of their application as recluirecl by the Bingo Cabling Act. , Charities: Denton Humane Suciety Mayliill-Coo lx•r Creek Volunteer Fire Dept. Roanoke Volunteer Fire Dept. Argyle Volunteer Fire Dept. i Commercial Lessor: 0 Texstar Bingo, Inc. Sincerely, r'''c:yae«~ n I c. F' 0 1 1 ~1111iy.--~~ p NTON,~ i t C11T µp}ihGEfiS fF f i i ~ I f, f i E, 1, NO TEXAS APPLICATION OWv "?J4) FOR COVAERCIAL LICENSE TO LEASE BINGO PREMISES NOTE: A saparsle appbcebort must be filed for w h k)cwow to be knad. a oo NOT wYi rE IN srlaea Mews • uSE AW tN5MCMis • rvpE 01 P"T I la" nee of op" t I Fa CarV~S Use DrOy ' k TEXSTAR BINGO, INC. M""'rt A ■ ssrtq Address El R do ■ 05100 100 MAPLE coty ■ sm6 Z coft czm dano0 dry I ■ • DENTON X1 ' 16201 p K ps ■ sltab DENTON ~T r» f rd nndrl Was6r owe m ' 1 817 / 566-5517 j owe" Enter you txuiess tolepflale rxrrber - - - - - - - - - - - - - - ' p R as ■ 01185 3, hftgo how your b6SWOM b owned (check 0* me type) - - - - - - ❑ I • k,&A W ❑ _ • P.Y00 wIj* ~0~ II z s -Toss ca,p~+b^ ❑ e • FW90 Cvpwabm ❑ e • 00w (spwol ; - e t~ 0 ower+le %ps - 4. Enter you Federd Employer's Idrr*rcabw Number, d any ■ 1 P P L I E , F ❑ ~ 1- ~ ~ luoslen eeaa a d sole awr*r, enter yOV SocW Security Narber 2 1 1 t I t 1 l t ■ LL L 0 0 I L31 ~--1 t 1 I_ t t l l 56mr,I6ry „s+ e dew O Enisr your taspryer weber for rape trq erh Tow tax or ypr Too$ II tt p PLO a a" IypO z Vendor 106 &VAIOn Mr tW, I you row hers of ever had err i 1 L I 1 I l I ! I 1 1 Too or0 419 ¢ 0. fl you business Is a torpmftrl a copy of the ArWa of hoapw*bm must be tied wfth Otis Cara owls w appepUat trtdcow the type of oorporabm ❑ P • from ❑ N - Nortyrofa ■ ( t s saw never 6040 Q 7. If you bustress is a oorporstion enter the state of incorporation, the dwUr or C.0 A. number and dets. D R •01807 06 6r6t■ T6W c= w C,OA ro , two Del Yew lsds 6saup , aI LgJB_RJ n1 t ■ pK11 add X s`_TK.J ■~'i11 61 6191 91 LU&LaLfj L Darpor6esl a.• j h a. N you we a so* mwio, enter C1e foo wtnp inlarnstion Li M ~ yft*~ yeses Xw Mt TaA. ea.7 00nr1r10 qte .l`~ ~ 1 1 I I-I I 1 1 I. l .J ■ lJ 1{f1 e `CRY Slele ZIP ccd6 e„d,. w•• 0006 rd Mrdr) I ± L-Li aL_--~ ■ Dole co Rod L Is H Seri s❑ M ❑ F ■ l I I I 1-J I 1 64"0 orer>t 9. EMN Ce klawkn in$ m stion fa ONE person w1q may be oattwW &Wg buelnM hpes for records or 0 R ttt s 41007 trl w"Mi0n. +snle fWt AM rMlds how I O s L RUSSELL ELVIN F. Lu-j a ~&L 61 01 1 51 018 13 ~ s , lean ui mar z RT. 1 BOX 29 t ■ Sley 01106 more l;1M 0080 rd MIW f ARGYLE x 76226 817 1455-2242 . L_-- I e s owe a er* Race L KFi1iE ■ L_1 Seri ■ ®M ❑ F s 10 11 12 15 131 8 , -c w-I1 ~ TEXAS APPLICATION FOR COMMERCIAL LICENSE TO LEASE BINGO PREMISES APPLIES FOR ' Do not write in shaded Tess Pape 2. Legal name of applicant TEXSTAR BINGO. INC. Taxpayer number ■ 1 1 1 1 1 1 1 1 1 1• I I Fa Compeaws V10 Cti1y 10. Nww of berm, ot rRrrr qnw er Cwte'e ■ 1 TEXSTAR BINGO ❑ Itaa a .~'j 014191 I A00•w fm dot' ereer ► O. sole or rw ley. / Lamson ■ 1 100 MAPLE I FL cs COY ~ Sue. zr code ~ OIL nurar 01300 ■ 1 DENTON I■ LIIXJ ■ I 16201 I I DENTON [ a[ 1 1 1 1 1 cmk* ocas O 11. Is ft ba60n aside r* city tabu of the oily named in mom 104 nR Yes ❑ No ■ l I 12. Is Mti3 bcatlon owed or lease04 0" LM Law Mo. Vey Yew ■ Li J Racine code (ry 13. M owned, enter 1M date you acquired this bcation- - - - - a[ I I 1 q2 11. 0 Wood, enbr tfw name and address of lessor and attach a of ■ 01610 copy or Moo copy d Ya► Was ~ ❑ a IM I SAFEWAY STORES INCORPORATED 1 p [ Addwee ■ 1 I I [ 4TH b JACKSON STS. 1 [Lcoaal easel suft aE I I CRY 1 OAKLAND I J 1 94660 I I OAKLAND I r3 PL " bosom is M s ~ ot Leoeaae aer■d 15. What Is the rnwdrnim sestirq cap" for birW? - - - _ - - - - - - LJ - - - - - - - 540 J • I I 1 - °'e"'e I a - towed am* soft Peyrr" d Of repu'nd fee mwf be "mM*d wth tW W6catw. a[ 1 1 1 . L tww lee Is based on your amud prow lease recWs. 'Gross few race{;"' an the htaf race** from 0 cansa0 u r orgarwzab" hekoft, but not finned fo, &W M farlfab aredpaymanta for W&M, fodVw, seedy seMces, arc. al I Uclow rvraer Mar a YKW proas hw recoos wd be your awk ate o (p-= krase roc" Act V* 12 months kl6owiq this apple- ■ LI 1 I I [ cation. it bole an*" Z j . Your ran- elm and amount d lee wtr be kund in a t" in the kx"wkra. I I I I [ I MORE THAN Q++w aeped9 I IS. Erw tta amot" d your L vvA gross Men roots - - - _ - - - - Is 90.00 UM" closs I . { I t I 1 I { ! ' 084 Um" to Iraem■a■1 17. Frwar your lbert- bow - - - - - - - - U 1$ 1' 00000 I ❑ fti as ■ am OroM Mew wage ' I I IS. List al orgnlxab" whlrh pten b lea- the bcation in nom 10 to conduce baego games. A copy of the base agrvs ■ [ I [ I I I I I nark for each <Ygarltza5m 6tsd must be anaded. Worse lk Nome of organization Organizatbn's ango Umnse him ■ Ll I I i j I L,eellee care Mayhill-Cooper Creek Volunteer Fir4 I I I I I I I I I I Dept. aLi Argyle Volunteer Fire Dept. I I I I I t 1 1 1 1 1 1 Pw"wgreaeree I Roanoke Volunteer Fire Dept I Q rr w I 1. 1 1 1 1 1 1! l_ I1 1 1 1 1 1 1 1 1 1 1 1 ~ I l l l l l i l! I l l 1. I 1 1 k I I 1 I 1~-~,J i [ I l l l l l l l l l l i i i II V .f ~.M-71a1 dd EW.6a7r1I TEXAS AFPLICATION FOR COMMERCIAL LICENSE TO LEASE BINGO PREMISES Page 3 0 r j Nmeof apr:xana, Texstar Bingo, Inc. i i 19. AFFIDAVIT OF RESPONSG RY VWv. the urnrersiyned, dedar0 1Mt. except as noted below: • no person wW In riffs appicadon or its supplem m Irs ever been oomicW t i a felony, crim" baud, or a aim* of more[ turpitude; • no person with over 10% htrW in the appicant's business is eM w mauled of related in the het degree to a person oonvided o (a WIMY, of*W fraud or a trim of mar hfpiude; • no pubic officer has eny kwvW or other ;Merest, dad or hdredt other as owner or fewer of the premises wfyn birW wa be played; • M pLtk officer is a partrw, officer, director, sloddroldw. or employee or the applicant, • no person with over 101/6 Wterrst In the appicav's business is either married or related h tM rrsi degree b a pubic officer. r Erospbon-expah i i I~ I I/We, tutMr csniry that copies d this appication have beer, Bent to Denton PO1 ice Debt . ? W and riot ywe m In d respects ft real W party In hireg h the leased premises, that V/ve are rat ecbV as n tndsdosed agent or mates for as real W stem mer" h tlq appicsbm and any stlachmenta are WA and cared to ft best of Party In hterrsl and that in myla+ krpwfedge and held. t_ f4ar was d Crrnr, prtrer or dktir sa owr Dr*+r n ale= GHa Q t IRussell, Fti_vin F. I hetfe Swum to and aubsaEed beta. me, a e At S Notary Pubic, on this the day of t. / 19 olk/ eo on Ndry ft"C ell sign 0 Irt+t tin of Dartrr or oracr Prtrir or Macr pry ~ n~ > , u ! I Sworn to and aubeatmd before rm, a Notary Pubic. on this Me day of 19 E my o w"alon evir" Notary rue fl ,ts algrio I I i 1 i I Pre omm n.,er o. na,e the I►rror Ibabt n,re. per I~ 124 Iz 8E 3" TEXAS SUPPLEMENT TO BINGO LICENSE ' Use the supplement to provide additional information req amend or renew a go rirmse, uested in the apptcatan for a bvgo Iitense or n the request to bin (Please enter 'pate of birth' as month, day, year. Examples: for 'Jarwary 15, 1950' enter do , 1 , 1 5 . 5 . 0 i ; ' PLEASE READ INSTRUCTIONS for 'December 5, 1955- enter L 1 , 2 0. S S Sl.) ' WRITE ONLY IN WHITE SPACES PLOT ■ 19399 I ka„e CO kua. nok* 2. Tuplanar nwrb.Applied for LTgmtar Bingo, Inc. J I •J t i 11 i,,, t i ' 7 karne Rasr, Ent, nid?e i*AM 4 -50cW UM4 rMnlEer - S DrW$ kww ro. suft .(Russell, Elvin F. I L4,6131-) 6 0 510 8 31.10424846 J LiX t ,a.ne a • t r, i, ■ Rt. 1 Box 29 Lrty stre Zip Cage 7 pMV,e IAra cane d w•IDe.I ■l Arpyle . T X a ( 76226 _J'8[817 / 455•-2242 l att,r: Cau •Ljfsex ■OM ❑f t3.o.rde.e,'■J0i1t2j513t81 11. Poskion (Dwk of *pacaw boxes) ❑ of • sots owner [3 02 • Partrrer 40 N • o1r•cdor 19101 • auoet n OS • Shretntder 0 oT • opermor 0 00 • Worker • C ' 3 twne M1+ft. tart, nrdla retry 4. soea SwuritY M,row S. OrMr'a ka,r ro: Sqy ■ Leftwich, James W. dMq aeIey, - j9 4 5 8 3t41.12,11419J. 0066126E j,T X ■1 3135 Spur Trail 1 Gr State ZiP C+rx J ■ ~ Dallas ph" Wra robe J8T X • 75234 1.J 2 14 / 247-4198 J I woe Cau • U e. s<x ■ EM ❑F io. Date to en, ■ Li 7 0 2 3 0 11. poft'.9 (c4wa a# &PPIcaut boxes) • 0 01 • Sde ow w r ~ 01 • arcs O oz • ParYter Y] w • Oircbr, ; . n 03 • 5hareh6der p 07 • Opsata p as - worf,er • s wine aw. tit, ~.am►;rr~ cot ~ 4. social seority Mxnbs a. Drhoer•d kwu ro. soete ~l ch~rnmm Texa.; E I.J 5, 518,-, 1, 2,•1 91 6, 21 1J.~03206049 I~ T X I •L 9355 Sunny Brook ofy Sr,;e zw- Cone 1 ■ I Da L 1 g $ 7 Pnax 1,4N COW ! Iwn.Ml I ■J ■ 75220 1 1214 / 363-6665 J e. wn LcAu_j ~ e ■ U s. so, • L' M L,! r 10. Date of b:r, ■ J 0, 610, 21 2 0 I1. Poston ecwck at rkarr Mutts boxes! ■ N] is - So* ~ 0 0 07 02 - opera w a W w 03 r Dli ad • lJ V a • other o ' kama Ra+t flu. Adm. iIGd7) d. Soc+f Satarty kuras ( a. DrAar'. Tgri.a re. sun Mae L __j CM Sure Zw Cede . 7 Pnple l4ee cow d rrrnpr•1 e. R.oa ■ U e sex • UM Fs ID. Date or kith • L ....ter... f1. Postw (Cte .a evAcaw* boxes) 0001 0 01 • arcer • Sd• owner t7 0: • Partrtet 003 , ~br ❑ 05 • Sheretiolder 0 07 - t)pamicir 11 Oe • wo*w • I ,'sat st TEXAS APPLICATION FOR LICENSE TO CONDUCT SWW I i Do n0f wr40 in SUded Leas ' PIMP read ownFFfft arrana • TYPE OR PR1Ne Fcr ^N'~a V" Orgy ~ yl ~\r\yy / r Yr` 4(sn..r..~f•, Mae) Q FL a 0„07 a vr no n/ ~`i ws+ y Sw Zp c. Q vt 00 7(o ao~ try mde a s %A bm ness telephon. """°e'- - j A*+.,tp. r.I Enployw's Idew6f 4bm (FEp No. (M &V) . LUG i 1 I A 1 d I a 12i s i f u O Yea ar"nizatim now have ■ i tas.yyer nurnbar for reportng Eir,9o ar I er.rw eoaa Q~ Idr,d"x Nurttpe' YES ti~ H -YEs', enter rrxr> Texas tax or ■ Taw Vendor r LL -0 LO-L-0 LL 4. Type of non p vM a gm iz■tlan ! ' r f I f 1 + Gowan s4iky a ❑ 1 „ ❑ ! • s~aa. 11 a • FraNrn. • Yc4aaer Fin Dot C3 L O$ • om20 i W i . Vow" fW A's rarerne' ory a:aW a/r'«a0 h Me 11.5. QWVae1? YES No ■ 0 typ 9 Q S. b the 019.rtJzation aff"ed Mth a state or r&bwW orWkabm? YES ❑ NO c"" Code I n 'YES; sneer a» nm* of ft orwizotim rd to Plate or n 6w , adtYSSa. Wan meter.n,nery { t s- Q R a . o,.oo j OW MWW W4p 6. (0aa Mrs or9 *Sbcn now haw ■ Sol (C) exwrom tram V* Y,temd Reven,e SerHoe7 i . YES z Q R 17 . 49100 M f YES, .ttach ■ oopy d the IRS R,inp or deten„ir,ebm Wrier on pour .xenpt ata". DPran.un to" - No Star teat r. ,tar w COA no 1b. Day Yew ■ L~ L J 7. M m a?r,ization Is ■ corporation enter; W i A ooOY of Yw ArticWa W • ~ ~ 71 1 I~t i i , . w-11t11,~] 1 ~ W'c 1 h0orporation must be fled w8h Me ap*' bOn • U0W" we f tf hs aryerization Is not a owmatim. dzs~v ft mew of or9■Nzation and SL6V .vlderce d or D.. Of oryr+krC of i°or` A I f I W. Dry yew - I t L.1 I , 8. Hunter d acw. rr WbW j In good stanan0 in Wa orp■nizatlon, i oe'+9o .n. am 9. Type of 'Kanog appyd for ® 3 , Armw El 4 . Twr mfV Q K w ■ 19101 I wkrN PPpan~•1~ appkabm ` fo. w~ to "Art o CUV the %p g r. . enter Ne dble you nrr Pa..e.d ewt Me i I Z i. binyo cen+ea--------------- 1 9 ~ O 11. D.y{s) of the W09k and time(s) 90nm ,H W ` E Fkv try rome Y (>4V ^a exceed tour have h a y 24• h0Lr § •LJ.f rq1 D,# , ILt_f Huw~ g X l! 50 M `j 39,10 flr34a I 2 .l 1 i 1 f~ •LJ.t t 1, r ■U ■LJ uL_Lt r tj aU ■1 I I t l aL) at 1I- _1__L_ 0LJ 12 . tf ft Is an appkation for Wrap " I mW. enter ft date VA. oey yaw m of V* temp°rrYPT4------------------------ L-L I I LAL-Lj tf tH. rb" O that W *4 MOAC@ a rVim game, enter fhe day My R f 'Tw AP; 117.3 sal TEXAS APPLICATION FOR LICENSE TO CONDUCT BINGO • 00 not write in snadoe areas L Name d cwuation b LA Wl- I Page 2. O _ Ta>,payer nlxrlber a L' 1! 1 1 1 1 I F 13. t+■n. or cmmm Vt ■ S • ~1L 1 For fp mogo.I Uf. Crop i L T~ Warm as pa' orpnu6or 1vs~ aUS.f rid rp. a W. +W OPT~^. Bo. v M;, Iwh ~a.) d PL ■ ?1]00 fQ- Clock ram _N ■ F'~11J 14. Is fhb 1Q+Oa g ba,;«, nee, ft «r tt,»it, a n,• coy named in Item 137 EZ~<s ❑ No 15, ■ U 11■rr d btaeon K Mid1 po(rt~~on pyy~{~. _ ,k~ _q I i • r r 1 1 V 'I p\ o • LL. _ W Aaesu ,o„ Aot ror PO mg d n..1 .a.., G!F I 0 PL 06 • 01610 O ■ 1~ QL~~_ ~ OP Coa. Ltoo1lbn~.o. F ■ ■ f _74 r e Y1 L52 _I ■ lo=om c 16. b this bation hsidd ft ONY Ems of re . t f , I ah nertfed in nom 157 YES NO 17. b C1e button { ddleront from 7e bcaGvl of ❑ K Co • olfop + } yclr arganizationi S ❑ NO If 'YES; o qWn wfy. tao'•n nwD■ L&er- c I O L f coi•p eo4 , 'a How B "1 bcation Ov*o ed by your ctWilation7 t a u ow, IV o•Am* Rwne 19 eat: 20 b") Q M Awed, ft" RWM 21 and 22 &a* ■ •.r f■ wo i 9. Merv co oMr Of kaod V>~%111!11 tassa'o WVIVW ro. ■ O 1 1 I pofea PL 06 I o A ~ic0 PP1 1 fP~~ h 1.~1n)TG ~ 1`J t • 20, `.e+s° amount per °oasip' L- p You mwf artech a copy d the ease apsvtw* wdh this gopkat*7. • Alp _ i'qs buQaf eKap ❑ K Is ■ atat 3 21, mo dW dd wn.~ lie. f trR..sp w. ap Yew ya eopie It1• p4ylrlg boatton7 LL- Lawftm call 22. Yrh■t b 7r rt+axlrtK,rr1 seattrq up" for bhpo7 S To ■ U i Loom + - I Canty ■ ~L--L-j E J / 23. E11ter IIr name of the W" fde ■ctJve mernbep who wil be p T&Vy MW M08 for r'h`i"' must SO tilts applicat on In Item 27, and this oonaq YoL' btf190 g& T" and ■ Ll- 1 / kw"*' Ust r» ran" Of a, oafs member who we be op member a lwne apper on Qa■wa..+ bc~.a I I *4 your ¢ ~yapya.. entara on the form A?•121, Teas Sup tKOiytlerk To BkW ingp • L~J I I v< I{ oC mar" AAW. yst maaoE hEie) ~►ho btral r Led" &Pcwd ocawo l ■ h~l ■ lsf_ / ~ OWN a7 r;mil •A+nwr mv"w Awe t"~---1 • U s. < . ❑ AR Q f . [o 1~1 ~I ~f 0 11 ..>I ■ o a 1 t I M AP-117+ TEXAS APPLICATION 0 tna,.. worst FOR LICENSE TO CONDUCT BINGO • Do not write n shaded areas Page 9. Name of agawatiori -11u .i -~N t'•f• Taxpayer nVFOW ■ t , , f i f 1 i Fa 0mr9traar'6 Obe Ph I Z 24. List Vie names d al persons who w'e work and receive cwrpertiwbn as cashed, ushers and caaers at You bew games. Lhe Me appicaWn suppler ent (AP•124). Provide ALL requested nlamabon far each person fisted. O FL pe a wm z 25. a. Estimated warty LOW gross receipts (fie down o*) 4 9 O b. Taxexr-Vw - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2.500 Q c. Estimated quarterly bingo reoe0s &A*W to tax (kam a mews Ram 0) - - - _ 6 600 d Amount of bond required (1lukp* Ram c by .02 (2N or by .04 (e%) I C50 0 ' O yro' b* Msdiction has adapted the bcef fax.) - - - - - - - - - - - - LL Z NOTE: • I bm d r late tlae fW, Vw rxt nom a repuyed QQO • I bW Y fff#g'LI3■d, wtad Nt Carpeoeer'a 00rce @ Type of bad L-I • Not raasw ® • cash ❑ • sa" bond ❑ . A"wrrrrx d sarhps accor+t ❑ PL oe a 491 o3 26, PrpTwR of the required ~oense in must be subrOvO '.,In ttis apps AbM ■ Fr w ' TeM223g kense in • Fee br a Wrporry icerse to cordut orgy one oomsion is $25, Tamporry ILWUL ' Arwal tense fee • Fee for an wed krr.,e Is based on your oWweon's ankW gross reovols. You kww 2 S utZ day and wroth of fee wl be found in a tWe n the mvucb 4. Antra U Enter tie amoiM of yar esbinated orwei gross reoelpts - - - - - - IS 00, 000 •00 Enter your kmw aria Liortse tee - - - - I $ umm Clio o1 000,00J U ■ 21. We, the urdersigr*d, dative that Cx orWosbon OWWIed above to a bone We rfonproM OWMIior4 Owl ws We active mernbers of the orp-dabort, that we wi be responsibie for oonductri brio gores and for fang ■F required re- F rrm norrred turd in sowderlce wkh the Vwlsiorto of the Texas Brio ErW*V Act, and that d net pooeeds droved front brio 0 YES d No I gyros wit be used for dunfabie purposes as defined in Cie law. We krVier Cetus CrM no person named in"appl• cm5m or as ouppientent has ever been corrvicted of a Oak", gs riWig offense. alrrtind fraud or a afrre of moral hxpf• tads. We hrlw certify tftat copies of Cis appkation have been sox to and Clot ON statements I { in tfis appka5m end any alteeNrients are Yue and correct to Cd best of our knowledge and bekf. j I tr.a co ,~p T°■ o.r ~ hereL.9'-11- 87 o.ta thre/ = r`' ~j NOTICE To AMMAtS t~[ A Tans Uoarna b Caedua Brut cm ory be "md to a quaffed, ra-,V , d+am■bre wgariunon r you vcW Is aare■d a' , a dagrWad mrribm d you group musL be oreeent at each and every WW game Orted uwp to korw Tits krw ttirriol be add, rente4 aaraflill or aaai0'r■d to any over vow or Indrld,el, You grail must irrirtah a WV ~I 1t,. decM 9 aoooux for depots of till bhgo Irocaada and pgmrrt of al bk%W upenw YOU mrnl keep ■aarm reoads of ' oes I am opanwe Ixtcaaa they an kOied to &AM by the Stals CarO VAK, Fable k r oide by ft wavrlona ol Cr %V0 Em"V Act oa/d Kkied Ir burrs of tt" appkation to rerocalon of ails sores and airtinal promailion. 'r L ft udralvr4 dodo that I am ft P*W d ft orWas5on and none read and we abide by ft above ststwwk Swom k and xlbeatited before me. a Notary Pubk, on Cn the _/J- day of ~19 L_ hh mnergtela+ 1w" NMl Sw a om to and s+bwibed bet" me, a Notary Pubk, on Cis the day of .t9 LL_ . My w in* expirse kAmy "we sign '19 here Fired endV O. Mme mW u be naoap eurer tats O "~•~AD „e 7 ~ ,Rer FtMJr L TEXAS SUPPLEMENT TO BINGO LICENSE Use the supplement to provide additional information requested in the application for a bingo license or in the request to amend or renew a W go hoeme. • (Please enter 'Date of Wh' as month, day, year. Exampks: for 'Jwwary 15, 1950• enter I 1 , S , 5 , Ot; PLEASE READ )NSTRUCTAM for •Decer7Zer 5, 1955' erger t 1 . 2 . 0. 5. S . $1.) • WRRE ONLY IN WN1TE SPACES PLOT a 49M 1. Name a SWW* imber 2. TAXPW na 60 • >f. N" A", &It aailtse hriar) 4 Sad seevinr 1Mortor S. Ih'M~r'a 10kM M $tah S 6) r l l~~ 3"h1 }L I.lalStS'I1''l';rt`i~w~N I0ILaL5571~yAj - wn,. aose,s Cay _t State ZW CcdF 7 Ptv (Area Cade A nnn0e; " .l ~r_ti i~~ l.W:1'1C•?v1 I.~4/71 -sc, - S 9 Rao* .i lau9.sex aQY tv r 10O■udbM P,1 ..t~a.:J',Iv1 •.•s.. 11. Posbm jD*0p!A*pk•+ab b0m) 2001 • Soto owner 0 Of - pu a a 0 00 • O nc*r ~ u 01,• offer ❑ 0! • Stwd+ofder 7 • OPKWW vra • VIA:" qe ' a. N`m. 900 W R04A hW • S e. SOcW 5ecvity Wife / r, Ickti■~ fto ~ stilly ~ ■11'Yr~ -CtZi (J'MO J I■IjI Q-I-t1111'rl(.;I' q`17 yi~1l.~jdl e. rbme adsna Cny slate ZIP Code 7 PpY IA'e1 co& a n, mbrC .I DErsS c rl I ■L~~ .I `!4-,~ 1 I:■tS')`[/ - /c',~,~/ I I FLWO a U 9. sea a Le DF to. ow of a I~ I~' 1 ! rZl S it' I 11. PoOtim Xhm*'apyfcaDM b"W) ■ 0 01 • Sole owner 0 RaOw , 0 +~f 001 - 015W 0 05 • Share Mier Q'07 • OW& Cd!s '1~lurl!r y a • S Name aAA.-W 0Yadla ids 'SDOW Se"ty Wfty / S. Ork*'V kwm no..~~., ! Stab I I,c) LLSy ?t ,n_T~fl~DJ■I! Ie:111% L~I /.I IS•I1; Cty State ZIP Code 7 PorO fA'e'a coat ! "✓•~1 .I If./L1r A I .L7,)(j a1 7~ao1 I a19171 IM-/IaI S. Iba a W 9. Sat • E~JV ❑F 10 Ode Cif a a a 1 I I I I I y 1(. Posbon (CAM* ar gpka* bwes) a 0 01 - Sole owner ❑ q - Par1Mr ~ , R O 0 01 • oHeer 0 05 • SNv**Idw @ If. OW" ~Ya 1Mor►(r C.% & No" Mk AMC flvdft hito _ Sows Sao" MarbW S Orktf■ Inane ep' I L N i~sw, I I f) 1 I I 1 •ZC~ ,IJCj e,7 i r!✓ ZIP ~e 57 7 1. Vale 3 at 1V ! 7.: 9. Pam u a LJ 9. Sat ■ ❑m EDF 10. 0■11 d bm ■ I I/ i Cl~-~_,.31 . . If. Pos7tfon (ChOC* /M Wpk4bb baz a) ■ Cl 01 • Sob Owner 0 02 • Prctner 0 02 • Oyaeior . t~l u • Officer C3 05 • Stwenolder 047 - oMEW c Workor 6 tit II i I-Mrj) dig TEXAS SUPPLEMENT IO BINGO LICENSE Page 2 L'_ WFOTE ONLY W WMTE SPACES PLO6 ■ 00990 ■ 14 r 9 , , r PLO? ■ 49399 12 Name or km ,ded !Sams as P." 1) 13 Taxpa)er rx IbClt (Same u 0.L n 7) 13 Name a", kv m cRo ollfw) 4 Socw seaway Narber 5 Diner r kerrsc no Stak ■I - i t Ll v'~ I r ' j 51 t'~ 1' G7 Stare ZiP Cole 7 Phc" rAea cW •unDr~ WW■LJtsa ■OM. OF ro.MaaDiri■I~r71/r513i`/I t~ raw ' 1. PoaAloe ~lYarcR yaAod?w bwas) ■ O 01 • Sde qWw.' D91 ftu* ❑ g QiK1or 04 ' Of wit . ❑ 06 • Sf+!d+ONaf 007 (B'61 ►Mxker ~ • 3 ►geia %&K Aral, smams'irtYq - " " t. Soul socu" mAreja . - _ i tkfw7 fosse ro ~ Sisk ~ICFC1~!CY1<Tr)t• ;;f I• ' 7W~: r 7/ 777t f,}I{ $ak ZN Cove 7 Phvre 14ea c''ive a ro.^ia' ~ CI I . LJ a 80 'a [DM QF ,0. Dw% of e*,, ■ I j fj f.~a r j Ls y l 11 PoWb ^ClOO al gprkabb boa t) a O 01 • Sole owner d • Partnw d Dtrecior g/04 OtRcar ❑ OS ' SAaraTwidor - Operebr worker 4c or. ' S. Wme Ras. ArK aiddle kow 1. Sods Sw%M Mrnb r S. DrWo ktess m Sues I ~,I I.I r l l l.I J.L_1 rwn.aafn, ~ Sure ZIP Cole 7 pnprt• rA,ra cove S nx.perr I aW ■I I .I I I awn,, WWaH9.so ■Om ❑l: ,O.Dnea" ■I i I r I I i 11 P06on 000 a1 M~+ble boaeal a D 01 - Sole owner D 02 - Partner ❑ 03 • Di mc6 b i4 : 004ir ❑ 05 - S+w*lc* w ❑ 07 - opwuor or • 1Yorkar •,a novae RVC kit ►r1.b t. Socw SKV" mu't* S. Dnw's korm m ft" ■ L l r, r l l■ L `~INOrnr aesev ~ ~ COY Sure ZIP Cove 7 Prw U,ro cove a'%W'e . / I a. W.WJ.I -j III ` lteayeu'1 se,0 m ❑0, 10. Dow Of ■I i I I I , l f 11 P~>af8on l f of appNeaeli' Doses) a ❑ 01 • Sole owrw D lit partner D Di • Orator 1 r ` o 64'. owner C) os • &*rb)ok* C] IP . opentol W w«t~8r E3 r ILMC ai4 nrdab 4. Sops S@Pjtq Nor", S. OrW6 kwu no.', WU W~Hort%t ad,.,, I . (--1,W W ~ s!a!e DP Cave 7 Prgne iA.ra covr 1 rw+Ce.~ I ■WJ a~-W ■I I } 1 Rant a LJ a. $41 m ❑ i 10.00* at ■ l I r I I it. Postft Xhod r 0goft" boas) . 0 01 • Sole owner Q 02 • Partne d r C] 04 omoor Oo - aor o OS ~ Snaretwider ❑ 01 -Opwebr 01 `'Wo Wort;er 1 I n 'AP'ttr-x &87[5) TEXA? APPLICATION FOR LICENSE TO CONDUCT BINGO + • ftm read rut%Wpons • TYPE OR PRINT ' Do not wrrle in shaded areas r r. N" co wgai Ybw F« Cortploar's On laprer reti40 ■lMayhill-Cooper Creek Volunteer Fire Dept., Inc. ❑FLa ■ ot,cC 2. Claw adareu (Straw s1dm, PO Bcc rvrw ran) ►wtr plaw m 1P. 0. Box 1125 aecra&W 0 FL 09 ■ al tors e' sraa zr coft cov+r carry coa l Denton _J J 17 6 2 0 2 1 1 Denton 1 I F f I _j P^a■ W" com ana rxnlorl • O""~ b tsoe Erna your hainess too KX W rxrnber - - - - - - - - - - - - - - - - - ■ 1 817/38 2 -6103 au 3, Enter your Federal Employer's Idemif=bcn (FEq No. (d any) ■ 17 5 r b i 3i 41 11 11 71 I 17AYfA'0d' Z Does your orgaxxabon now have a laxpeyer r■■nba (or rKo W Bingo or any Texas tax or a Texas Vendor ■ LO 0 0 0 0 weratawn Nurl+eerr ❑ YES ® NO W 'YES', enter mrrlba I I 1 I I L-1 I I I 1 SKarary his" Q ( I I I I I I I I I I I Aadws &4p 4. Type of narprok organ ration D Ras a MM ❑ 1 . Rdpax ❑ x • Aledral ❑ I • FraWnsl © 4 • VokrOer Fre Dept Tax TIp ❑ I • VW*Ww (I+ Ud rkrw' aryrrxarbr clrtred by tM U.S. Capps) ❑ YES ❑ NO ■ 0 1 9 i O Co`ny Wp 4 W S. is ft orpanixation affiated wah a state or national orprization9 ❑ YES ® NO el I 1 1 0 'YES: enter the name of the orgarfzatw and the State OF national adbess. &V0 ausr aurmry a p PL a a Cisco X _ Inw wear eet+p , H D R 11 a Caber 6, Does " orprfzation now Wv a 501 (c) exeTgW hom to knand Ravens Serylos? 1 • YES ❑ 2 • NO O pa &a1a { if -YES: attach a copy 0( the IRS Ding or detwirimbon letter on your exempt atetus. { Sau raua ww or CGt nn Mo. Drr ra. ■ 10, SotO 1 7. If Cher orgxfzation Is a OapOration enter ■ T X ■ 14t 316 13J-11 1 ■ ~L 14i L! 1_Lt ■ U A copy of " Articles of kaorporabw must be food with t ei apps ebm Lb~ 4" d ft organization Is not a oorporatbr desrnDe the rnethal of orgarfzation and M1txTft eYidence o( orga&aftm ■ U M* co *vvuaw Mm Dry YON 1616,11 ft 119,717 1 6. Number of active manbets In good standing in ttfs agenutiorl Zu j Itr+eo C~++e e,,.e I I AS aao N N t Qos.;81E [3P OT ■ plot f 9. Type of loense agpifed la O 3 • arr%A ❑ 4 • Tr.vmq f w Day Y6& Ao**Me vW aft I 10. If d* Is an appintfeon loran &w%4 Ieense, enter the date you l w10 So curtowdxUVft bhp gum - - - - - - - - - - - - - - - - ~1 1 11191 91 11 1 1 1 1 11. Days) of Ifte week and time(s) gangs wtl be played. (Vey not exceed ram hom ki any 24 - Char pwW) F Fred ay rrra Secad ay rrr r/id ay to* 'I Wed 1 6:30~a8:45tx 1 Sat :30pkLr8:45N 1 1Sun q:30pib8•,45,pJ a LJ a l l l I I■ LJ ■ L-I a L-1 1 1 l a LJ ■ LJ ■ l f I i I a L_1 C1 a I I I_j aLJ ■ I I t t I ■LJ ■l_I_I aL-1 l O 12. 9 lift Is an appk*Wn for to,kpaary foerm, enter the date Nor Dry Yew of ow*rlpon"game-_--_------------------- l, i 1 l 11191 H the above temporary gertw wll replaos a reg,la game, enter the day Dry of 9wWAVgangthlisre0sced------------------- r fat V s AP-11 t.s 547J5) TEXAS APPLICATION FOR LICENSE TO CONDUCT BINGO Do not write n shaded vets Name of orparizatxxl ilayhi 11-Cooper Creek VFD aaQe 2. Taxpayer rxrmber ■L i I 1 WnpYO.r r Ufa crh j - 13%wr* or wabon 7-J Qa~~ ~l14ayhill-Cooper Creek VFD Station ~ r0 or a onamror rt~ raSrr ro) K 05 alwo z FM 426 Mi. W. of Grissom Rd., at Mulkey Farm Denton I M 176201 J Denton + LI I ■ 11. Is flis bcabon aside the L J dfy faits va tfie City named In Item 13? ❑YES ®NO a LJ 15. turn co team N rR10 2mw n PYyad auM■w =a ■1 Texstar Bingo, Inc. + . WSJ Addrw, rot MOT ~ P.d. etr w wW mw*) 100 Maple C3 ,t 0e a 01410 cod teu.m y Star ZIP Z ~ Denton 1~! 0 ■ f ■ in[ 76201 J 2enton 'Lacam We U 16. Is O:s bWM nyds Me ■ ~ I ~ O 01f' knS Of the pt1' named in Item 157 En YES ~ NO 1 t7. b ft boadon d}krpt from ft Iocaton of ❑ PL 05 A 01300 your orQarirawn? ® YES El No M 'YES, explain why. ,ocastn ivs % (Station unsuitable for Public meetings IS. Now b fhb 10USM txxrt05ed by your wgwe zation? ' ONCi ' o'" 0 Cawa ww kw" 19 &W 20 N.* EN ~.~~.~~zr.W 22 b** ~ coda ~ 19. lion. of ore. d Iwwd a""I" Waor'I tagq. no. • Texstar Bingo, Inc. I j A0law Awl 1 1 1 1 I , , 1 I ❑ PL Oe ■ etaf0 E X 100 Maple , Denton, TX 76201 I~PP"ce r, 1Omom Uo 0 f ■ LL_L _ 20. Lew amo,m per oomom 1 s 750. Do + f401r0A I19e yov Mum copy of the leas. wow"" with this ;m. • o E .hot baAon ad~q ❑PL is ■ 0102 M4 C" YM 21. What date did you •o~uk• 2+a Lease begins upon issuance of 1 ce~"nse-`J I-1 u f a,,,ad 0 22. WW is ft maxYrx,m see ' a " caps y for bkW? i S ~ O ~ ax++r waea 23. EnW ft name M the boru We actor member who wit be Pltywi y respalsb a for + P %V tax terurra. This member MM °0"d""w f 01 bhp o.rne5 end • W spa ft spPfranpn in ttam 27, and ft member's rums wi appear on your d'e•eaen enam . I KK tw LB!"nrr,ea Of Y dfw nteffibers who w9 be operators on 710 form AXI24. Texas &W*rwA To BnpO it LL- t I j llan.a Rat. a't e.+dah ►a+7 NOV ,bOaA.U ( ~ 1laCrr d ywn mace" n -it* f DOW ■ Cowan Christopher C. 8 ILt I t+ I 1 h LA-6-ju a eorrr no$%," ■ _1_16 18 I'f0 1 9 3 .105459177 I 611' Xf e ■L Rt. 2 Box 1086 + w Par ocx■aE UTY n Srau zr coo. Prx►v lArw ood.,nd uIto I I ■ t.J&J e [ 76201 l a ~17 / 382-61031 p4wy "No D.la d a.e • ~atu Rape C I■ U Sex . Q M ❑ F w[.11 112 1514 61 [I PL 11 . 0 6 i A Pv "7j5i TEXAS APPLICATION FOR LICENSE TO CONDUCT BINGO • Do not write in al a areas Page 3. Name of organization Mayhill-Cooper Creek Volunteer F>' - yK n~ ■ I f i t a t i I I t I > For tamaoe. a Use rkry 0 24. Usl the ranee a N persom who wil work wvl receive compensation as cashiers, ushers and CAW$ at your bingo z games. Use the appication suppkrrwnt (AV•124). Pro-nde ALL requested infamutbn For each person fisted, ❑ K a ■ 00990 Z 25. a. Estinatedquarterty bnpo gross receipts (Whob doers ony) _ _ _ _ _ _ _ _ _ 3 oa SOD, ■ a g C b. Tax ex 2,500 Q c. Estimated quertaly bingo rect'ph sibject to tax (Rem a maws kern b) d. Amaral of bond reamed (MuRipy Item c by .02 (2%) or by .04 d your bad Arfsr ba has adopted the baI tax.) - - - - - - - - - - - - ~ti7_' 6 D_ _ c Z IMOFE ' e hm d b Am Ow S950, Own no bond Is FogWed. Zz ' a Bond Y r*p,Xed, eorxur tM Coromihr's Cftw m Type of b«td ❑ • Nw reQA [4 - Cwa ❑ • &r" bond ❑ . Axww we co wrap wM0 ❑ R 0e ■ Il1Rl f 26. Payment of the requFed kertse fee must be ubm tied with fts eppkat;om s Fu LLJ • Temporary kense fee - Fee W a somMary, kertse to conduct ortty one occasion is M. Taepaay ly ' Arntd kertse fee • Fee for an emwl kww Is base4 on your «peruabon's amid gross rempts. Your kwm 2 S l 8 dots end arrant of fee wit be bud in a tads in the Ir~i". + Enter rate amoutt of you estimated wvwM gross meceiges - - - - - - L 00 I I t t t ErAw your kanse doss - - - J incense lee - - - - 5 10 u°, 6 `t i eteas 27. We, Mo uderspned, dedae that the organization k1m, Red above Is a bone fide ixx qp A orparzaft% that we ar■ • active raw, it* of fo orgw ix■tion. Nat we wiz be rnponsbk for oonducnrtg bingo panes and for frog M rec?L*W to- ►arr.i ~ h" In aoooihm with the provW" of no Texas Bingo ErW*g Act, and Nat as not proceeds derMd from brgo I gams wN be wed f« dwable purposes as derrod n the law. We Arfw dedare Nat noperson natod in Nis appa• ❑ t LS D Cation or its agplerrrmt has aver been awMe W o (a f*ey ga t&V offense, akrinal fraud or a akro of moral uxpl- f tide. W furew oertiN not Copies a Md appkabm hew been sent b Denton Police Dept. and not at stateffw a h thb app8cgon and a are true end ou, b the best of our lafowiedge arld bow. Ifaad row OeY I %n ► 7 i tt►Ign Tate i NOTICE To APPLICANT! - - I A TWe Lbww b Caridud DFrpo cm ory be esued b a grwses0. non•proak Cwrlhde aprruaon a far pray Y g rKSd I a low", a detipw w e0 be of your F** MA be at earn and ewy bi+po fines i~yW ~^p eie tianae. Tfis epees X31 be Mold. nrisQ eawfwrw or asagrwe b arty COW prop or wftfi . Yow group mum awtiati a birw { dwrkk Kom" br dapoee d al bhp proceeds and psyn a of Y birW experwa. You must keep somata words d I r ow Cooeede and 0x1 beeaae ewy are tut ed b auoa by tlw Soh Comploaw. FMre to acids by ties p vAsb m of ow Dino Si*" Ad mid *etod ■w WWws 0f en appacaeon to wooraom of to seeress and airu+af prweawon. k ft ubwWrod, 7 I am of ft orgrftft and few read and *4 abbe by U ebow etalamwrk ~j M ► .t-~ - Sworn b and subeatvd before me, a Notary PLtk, en ft Ne JILL day d ~19 Y1. . My Mi isson -gi No4ry Pu01o 5 I I 19 here►r t~~64 L.y~LiL1Et~.I~.'~ p sworn to and auDeaEed before me, a Notary Pubic on tNa the 11! day of tC' L r,19 . MY wmM*ron expires nxary Punt 119w:►bc«tLl~1~.x~;y~~v~.E f Hid oNOe ewer o. n.nr and naror eao.yt nee. per c f~ ~~p 171 ~ 6 TEXAS SUPPLEMENT TO BINGO LICENSE Use this supplement to provide additional information requested in the appjication for a bingo License or in the request to amend or renew a bklgo 6cense. (Please erRer 'Dale o( birth- as month, day, year. Exarnpks: for 'January 15, 1950' enter 10 . 1 . 1 S 5 0t; • PLEASE READ INSMCDONS for 'December 5, 1955• enter L 1 , 2. 0, 5 , 5 St.) _ I WRITE ONLY IN WHITE SPACES PLOT ■ 44399 1. Narv d karue hoiaer 2. Taxpayer nunper Mayhill-Cooper Creek Volunteer Fire Dept., Inc 1 J Name Rm, IWA nwdit .rw) 4- vo# secvq f'tkt.er•s kwm no, state •LCowan, Christopher C. 114 6 6 6 8j. 0 1 9 3 5459177 1. Hwoe a0oess I t 1 I I I t • e ■ Rt. 21 Box 1086 I (-Ay Slate IV Code 7 Phq rAta 0004 a rw+,Oty} .[Denton _J ■L?❑ • X 76201 1 •1817 /382-6103 I e. Hate C U tr . Sex a u ❑F 10. pea a tits . 11 i a 12 i 5 14 ,6 1 ® } 11. Postion (Check at adpdcawe foxes) ■ Q 01 - Sde owner D 02 • Partner Q 03 . Director C!F 0! • ter w ❑ 05 • %Wwvkw p 07 • operator G 00 . Workw • L -J `fo ' 7 Name ILW bell, 00ft Wind 4. sold sewky NuniEer S. 6%0 6'kv 10. Stall f • Glenn, Brian P. J . L4 6 12 1.11 14 1• 5 17 I6 17 1 09859621 Iii r t a Lane address ~ ■IRt. 2, Box 1144 I CA7 su,e 20 Code 7 PIK" races code a nw+br' ■IDenton 1 ■)T LX~ ■ 7b201 •[817 /565 0393 I ' s Race I C i a U s. sex ■ ®v ❑ F 10. Deis a bM ■ 10 17 10 14 16 i 9 I 11. Position (Greek M goprc■DN boxes) ■ D 09 : Vwebowrw a d 02 • O 0 03 • oiorc , r • C Oi • alkar p 07 • Operator 0S . Y4orker LJ 4rc ' s, kettle Rasa, lraf, nica4 kwia) 4. socW security NAlto S. DrWs ke tw no. SIAM I Dillard, Charles R. _J 14 5 9. 3 5 2 7 7 1 1 1 10039862 let 'X t I 10 Hunters Creek Rd. 4 c*y sate I,P eoae 7 Phone rata code a rvftbe) 1 1 ,1 Denton ■ ■ L76205 I 01817 / 382-9634 1 s. taxes C _f . U sex ■ ®u ❑ r 10. one of e+m a 10 12 2 14 6 5 ~ 11. PUspam peso of goyuteple foxes) ■ ❑ 01 • sale owner d 02 • F*tnar a C3 01 • atscar q 05 - shrelrobw ❑ 07 • operator 0a9 . ow~w ' a L_J ' o. kwo p;1n. Ark midv Mica) 4. loci. `f` 500+M W0168 s. t?lver's ksrse ro. sat i ,rbBeadle. Robert M. 1 j4 S b 3 9 7 8 5 5j 103428702 I.XJ i •n adbess • t 1 , I . *L1321 Hozinsto { ' slate Iw cote 7 Pna,e lave code a r4mw 1 i •I Denton I• T X ■1 76201 j81817-1387-6285 s. Aeca W I ■ Lf s, sex ■ ❑X u ❑F 10. Do* a am . 1 0 2_L6 L5J 11. POWW p wk a+7 4ppNCaaV boxes) ■ 01 • Sole owner 0 02 • P■ tw 0 04 • olfioer C3 o2 • WOAW o os • srwlal,deer ❑ a . op«a1« ~ of • worker ' cit i ii 'w -0114- II i "C.`4P.1243 •o. Its I U'31 TEXAS SUPPLEMENT TO SING-0 LICENSE Page 2 ■ 9 PL41 a 49399 WRITE ONLY IN WHITE SPACES PLO6 a 00990 ■ A U I I I V N K d fceme toter !Same as kem ry 13 Tarpary runts S"* as Rem 7i 1Mayhill-Cooper Creak Volunteer Fire Dept., Inc. I I I 1 1 1 1 1 1 1 ' 3 Nw* (Las7. twit mrddk wwfaij 4 SOCW Se ANY ?axnDer S Drrvef s kense m Stare ,1Moehlman, Timothy L. J 11416 161-12 ,5 17 13 ,8 ,3 05624867 ~aJ { Ion! adYK3 .1116 Country Side Dr. I Crty swe 21P Com 7 Pna'e'A'ea cow• S ""twi MI Denton IMIT X a 1 76201 I .1817 / 566-0985 I a. FMU I w I w U t, see . Q u ❑ F 10, wn a bm ■ [0 16 11 15 16 11 1 11. Position (Cr>ack 0 oppocawo boxes) ■ ❑ 01 - Sole 0wmr ❑ 02 • Partner ❑ 03 - Diectar [dc 04 - Officer ❑ 05 • Shar**1d+• • ❑ 07. Operaw ❑ 06 • Worker • L___I I k CA 1 ' 3.. karts haft, fiat, mdit Ytw 4. Sold Swat Mxralr S. Orlrer'r low" mo Stall e IMcCurley, Vincent L. I0[4,6131•12I5,•12191019~0 I07236097 .tr XI r dyne ad*m ~IRt. 2 Box 1144 I Cer Stele ZIP Code 7 Ph" 4Are+ rope 3 rkffV! o y a1 Denton I T X 0 1 76201 1 0,1817 L56500393 1 1. Neon I w I ■ U t, sea ■ ©Al ❑ F 10, DIM d " ■ if 11 12 17 16 12 1 11. po"m (Check or appocow bores) a ❑ 01 - $de owner ❑ 02 - Prtrror 0 03 • Director 4 ❑ 04 - Of w ❑ OS - "Ooider ❑ 07 • Operator IN 00 • Workr • CL-J IC 3. Norm A*x &K mdear AW 4. socw Se"Ity w ree S, O*W'e fame ro. Stall a 9 6 6 1,14 b 16 7 1 I61 ■106404378 } T X~ f [Hopkins, C. Rodney 1 . ? Poo aaoKa ojDenton #70 SDMHP I { Gty Sure ZrP co* 7 Phare (A,ea Cale 3 r ,tei ; l al Denton I T4 J 76201 :J,1817 / 387-1495 1 i 01 I r o. Nora I w I ■ U a. sex e Elm ❑ F t o. Dme of e+rvr a 10 17 11 13 15 12 1 11. Pos?ft Pk* as fop U&N bursa) a ❑ 01 - Sole owner ❑ 02 - Partner ❑ OS • Dredar ❑ 04 - OFIA00 0 OS - Shareholder ❑ 07 - Opaawr Ok - worker ' u c4c t 3. Name mat k'K~ m&* hklaf) 4. sold Sttvt3 1kmMr S. OnwY kw%54 no stall I Amador, Jeff 1. 4 6 0, 16 17 1-12 16 15 12 1 .L11 _194830 e r X I ,11001 Manhattan Dr. 1 Gry Stwo ZP Code 7 Pror* rkea cocr 6 rvmbe) i ,lDenton I MIT X ■ 1 76201 1 ■{817 /387-2384 } . • FIKa I w I a U a. se, a x[] M❑ F 10. D.ca d nro, a 1015 10 17 16 i 8 I 11, Posiom, P** N ppkea* Dora) ■ ❑ Ot - Sole owner ❑ 02 Partrlw - - ❑ 03 - Direaa I N • Opber E3 os - S W*j0j6V ❑ 07 . openly a • worker • O f • 2. Norm "K Kral. mid* kkW 4. sold Sow" Wftw s. Orsr'a fares no, staff Correa Patricia 4 5 5 5 3 6 2 0 5 04330720 I 1T X' k , I I■ I I 11.11 I'll l 1 1■ L. ~al l l' i. 411P. 0. Box 24055 _ 1 MI Denton _i a [XJ a 1 zP76204 j 1817 382 98 1 1 1 a P m i w I a U a. sR•. a to M' F 10.0810 d"oil 1 11 161616 11, `Position (ChscA as sAomc- bores) ■ ❑ 01 • Sole 0wrw Q 02 • Partner Q 03 - DnCW a LJ ❑ 04 • Officer ❑ 03 - Shorowwor ❑ 07 - operator Q N - Worker i l 1 =AP-124 2 ~pti , ee s, T EXAS SUPPLEMENT TO BINGO LICENSE L amend or rwt IjWo~ elJtonai information rested in the app~caton for a t~'n4o Icense or in the request to ' (Please enter 'Date d as month, day, year. Examples. tor 'Ja r PLEi1SE RFAD WSTRUCTJONS nY 15, 1950 enter I 0 , 1 , 1 . 5 S 0, ; WRTE ONLY IN WHITE SPACES for 'Decembers f955' enter 1 1 , 2 0 5 S Sf.~ f I Namc of faxtse Adder PLO? ■ 493" Mayhill-Cooper Creek Volunteer Fire Dept., Inc. aTUp"m_"W ' N•n, Res+, M,t "dit p•~,ryl I • i I r , , , I Womack2 Stephanie r, + scars. r S Unw's ac,rr, ro. sae, Z arta~t„ 1.~4r6,11.19 2,•,1,5,1,71., ,106286298 -T TLxJ 2114 Nob F1ill Carrollton suet trpc~ I I R+o"a JA m coot A ft^b,/ I la T X .(75006 I'.L214 1416-6937 S. Race L W _I • u 9. sex n [lM 0 ` F to.Oft of am,112451 ~ 1 I. POS&M (Ch tt at *pVA* boxes) a D 01 • Sde owner D 09 • officer ❑ OS - Sh~ D 07 07 - P■rt~ 0 03.7 oRclor a Nam, ItW Mat ia+ed. D operator 0; as - Works ' yuc He 1 a I Jason 4. s«ir s.c, n weed, - e: caw a'IaA1, rot ~ taost~s _Ia14,6r7i•,6, 9,•.41314 2 13270570 2626 W. Prairie Apt # 66 • ,IT X . i Denton $r` I'P Co* 7 prwnt rtiea cow L>,,*o.•, I ■ T X .1 76205 ■L8 / 387-2233 J a. Ran l w i■U9.s.x ■ XIM f OF to. tea. of am . 0 9 2 2 6 8 11. Payibon (V wk ai Vp6tabAe Dora a 1 of 5y* Owner O Ot • Pryw rr ' r l+! C3 04 • of how • 3' Na" OT • oplfettf [J il. • ti'YOfit91 - f t 4II G-pt btl. 1f1OA, iWian Cot ■ Garnet, John e' $0°'s`aaej we to Stele a rant ao6t:s . 14 1410 3 6 4 r I ,1 11 I• 4403641110. K~ 3108 Heather Lane j Denton S,.t tip code LL -J 7 r~ tart cow a rl'°"' ! Race Cain ' r •LL-~ .1 76204 I.L817 138 9 2-7374 ■L.J9.l~x.Qw ❑F 10. wt.at birch .0 3 1 1 38 r." r + F 11. Posihpn Mhwk tl *PkAw 17 Cl 01 • offer boxes) . , p y - • p D9 Sf elowner D 02 Partner a. Nam, rcpt iat n`datr wit) C3 n ' Overetor 06 wCON l-j ~ObIAf SoA1 E I.IIR so" s.a,e, w,o., e. orNWA aorr,e nor. uo ' A 11 7r LIP-340S11 Y j~ sire z6p CO f Pno'y rArer cow A nunMt.l I •f r,-TAI • I ( o!t~ J I l 4 1 ~ 66 •5'g cg ' rt .f Lo- . U1. 9e„ ■ • I.; ❑41 Ej~F 10. Dtts CC S~ r ' o ~11. Po,kion 1CIMCA M ~pPlCadle bocq t~ • ~0~ ~ w~({ ~2~ wool • Sde on*w i~, l1 f + Q 0! . Omer 13 1 •!7 OS • S+wetrolder C3 Or ft . p~ d ft • Dreitai ' y 01 Warw • LJ € y) d r' 4a x. .w r - yk. K f 1 fi'"f C O . iprt 186,11 TEXAS SUPPLEMENT TO BINGO LICENSE Use the sippleawt to prcnde additional informat on requested in the apo awn for a Mingo rcense or in the request to amend or renew a bingo kense. ¢ {Please eater 'Dale of bath' as month, day, year. Examples: for 'Jarwary 15, 19517' enter 10 . . 1 . 5, 5 . 01; lt3 • PLEASE READ INSTRUCTIONS for 'December 5, 1955' enter 11 , 2 , 0 , 5 , 5 . 51. j c • WRITE ONLY W WHITE SPACES PL07 ■ 493" 1. Horn of fc 0 - War Z. Ts NW nxrder IMayhill-Cooper Creek Volunteer Fire Dept., Inc.1 .I I I ~_1 1 I I t I • 3. h*ft (tall, fiat most hW 4 -socw sew" NumWr S tkieer's kerm no. SttN { ,1 Womack, Stephanie G. 1@1411611j-19121-11t51117 [ ,106286298 QT X i . !bin ad7n, ,12114 Nob Hill 1 coy stale ZIP Code 7 Rule Weer code 6 %0'rW) l Carrollton I , T X ,175006 _J,1214 / 416-6937 1 Asa I W a LJt + se. . El u X 1 I , ❑ F 10, owed e:m . l 1 I 1 12 , 415 11 I 11. Position 1Chwh at' App6Cable boxes) 6001 • $ob owner ❑ 02 • PMner 0 03 ~ Doctor ❑ 01 • Officer [3 05 • Rwerglder ❑ 07 • opmwr moo • Woks ' LJ 3 N.M (toff. fit. 0") s, SooW Segsity knb& d [WWI leeUi ia. ; Site Helal, Jason 1,[4,6,71•,619,•,4,3,4,21,113270570 1 T X 12626 W. Prairie, Apt # 66 1 Cd1' state ZIP Cod 7 Plo (Arm cede A A~) i j ■IDenton I. T X ,1 76205 1,1817 /387-2233 I a Po+oe I W i. U Y sex r ❑IX Y ❑ F 1 o. Deb d" . 1019 12 12 16 , 81 % 11. Poslnal (ChecR at IppI boxes . y.r 1 ) ❑ 01 • Sale dMMr [3 02 • P.rbW p 09 Dretft ; 1 0 01 • offcer ❑ 05 • Sfleretoder ❑ 07 • opirw as wakr cot • 3 h" a4vt tpf, Pid* kAW Soar Seo^ Nurnber s. DrivWS soerw ro. Stare !1 Garnet, John 1 14,4101-1316 1.14 11 11 11 1 ~1 4403641111- Horne Horne addrew ,[3108 Heather Lane Ur Sate Zip code 7 Ph" [A," cod, 1 +w^be•t ,[Denton 1 WITIXI aI 76204 11817 1382-7374 1 s p Cau C ❑ 10 3 11 1I3 8 Am u. u 4.s.x • M F 1a. Deb d Di41 a ! f 11. Posibw (K;new IN Aopk" cars:) ■ ❑ 01 • sob ae+w 1302 • 6artrw . C3 0$ , otOcW { , L .J ❑ 01 MW ❑ as • slweholder C] or • open" WWW R { 3. Nrne Ra>G arer, mtdde held) t. Sold tioeady Ri'tbb• 11ohw N.. sa" . R0*UA)30AJ ELLA J.141SQ1•{11S,0117,S7le Ila.B'i0SSII.~r J. .1 ao S s. t~u~dstl f~~; Cnr E- 0. ` state ZW code ? Prone I"& code 6 r obr, .l N I.Lri~J.1 70.201 I.I?Rl ~6G•SYc$ 3. Race 1 J e U 1. Sex M 1z F 10. Deb of DYIh • 1 181 I l Col % 11. Position PwA so ypAciow boxes/ a ❑ 01 . Sole owns ❑ 02 • Partner 0 6$ • 61reclar'_ LJ ❑ 04 • otfalr [3 a • &w* *"w ❑ 07 • Operabr a Walter qt , L _ . AP-1 17-2 TEXAS APPLICATION : IFer t:a>1sl FOR LfCENSE TO CONDUCT BWGO • Pkese read rnstwons • TYPE OR PAINT 00 not w Ae in tn+de0 areas For Cargdlr'a Use Or+h am i 1, r4ma d orperv+txrr I A1es1r telti0 [I PL a . o1100 ` e I Aro } a Vn} tmtaar T'i rP T}EnP k4e!~ pPOna ro lllf 2. K%& Ad*V" mrwr Wdw. P0. Bow now rm") I P 0 Box 984 ❑ PL 09 a 01185 • 5„r, LP Cade Cvur" Carar ao0e . I Argyle I . TIXJ 61 76226 PI +I~ ■ ordm and rumor I ~J f31~ 7~ 464-7643 OWN" Enter you pusness telephone wnber_ _ _ • - _ _ _ - - - - - - - - - a 0 Li 17rna+ea 000 I Enter Y00.9 Federal Empeyer's Identification (FEI) No. (M ■ ~ Taxes tax or a Texas Venda • 0 0 0 0 Does your agrizatia now have a taxpayer rxrr bar for reporting Bingo ry P benVc■Wn MV*wl DYES ❑ No n -YET, enter nlxnbw s2 1 31 -1 7i 31 41 91 01 81 71 s,mc, M*V F I 1 I I I 1 1 I t I 1 I M010 sr.9 4 4. Type of non proTrl aperalbon ❑ R a ■ ozno O9 I ❑ S .Rya ❑ ! • AM6uf ❑ 5 • Fraternal © 8 - Vckntaer Fra Daq. W a Vewrr M Old wma by me U.S. C*Vrm? El YES ■ i_ j O ❑ • rarerar■' aWnTdbn ❑ No cvurty code CC 5. 1s this orgenfz■bon afiated with a state or rledoew or9arizabon7 ❑ YES © NO I l~ Q If -YES,' eraet the name of 714 orgartizalan and the state or MtiaSd address. ❑ K 00 ■ 01400 1 Ww mw sew" maw 901o* 1- p PL 1e ■ 09108 1 traa•+MP• 6. Does tM arpenkaion now have a 501 (c) exWVWn tram the Memel Revenue Serote4❑ 1 . YES © 2 • W3 M 'YES; attach a copy d the IRS Ruirq or dakrrrination Naar on yar exempt etlthrs. r7rgr ■ I . i Sasa Tsar fietsr or COA ni, kb. Dar Yssr wic . ■I 1 1 1 1 1 I.I I i l I Is 1 I 1 . ~ „tee ,loa j j 7. if ft arparlizabon is . aarpa&dbrt «ttar: _ _ . L1 1 1 1 L1 II, A oopy of the AmAs. a hwPor■ m mst be tied wiM tM ag"nebon s LJ ! b INS orpaNz■tla1 Is not a 0apa■tia1, desabe the mefwd of apenwtion r+d oie arprom of aprimebm. DQa»al tlotl.+t+r Fie! lMilAs VA pry Yaw I TS)LINS ST*1! F:tM MARS110 AI ~J 11,916131 i 1 e. MatD■r d active members In good stan6rV in the arp•matim 30 I e+qo or*• t►sr i 9. Type of k" appsed fa ® 2 - Amid ❑ 4 • Ternpary 0Q. R S S-100 hs r } . ar Yaw Nev+a+aa cart ear #it `I ,a mo } 10. 0 ft b on appketbn lot an artrxral kense, enter the data you I,, f wish 10 start OW46P*V the bhgo go * - - - - - - - - - - - - - - - - L1t ,9 Il A 1 9 7 ■ 11 w9 be flayed. (May nce exceed far how i 24 - period) I F t1. da) of the r m and rule(s) fiam•s 5soona ar Trra day r" l Tu£ 121:bD b hLI l_ 1 IA to } I CCp •U ■I 1 1 1J ■U ■LJ ■l 1 1 1 1 aU ■LJ ■1 1 1 I I •U Z • ~ I l 1 3■LJ ■l 1 1 l f■(J ■t 1 I L I. U 1 Va. Der Yaw 12. If Ws is an appkatfon la tenpxary Seense, enter tl,e do* 4 9 Z of ft tsrnporrygart+e-----•------------------ Der 0 7n above larrtporary gems wi replace a nag" parrs, enter to day of ft repderWm OWisreptaced 3 1 i i i. i i I r lip, 1s do "=AP-1171 mi, ee7rsl TEXAS APPLICATION FOR LICENSE TO CONDUCT BINGO Do not write in shaded areas Name of orprizaWn Argyle Volunteer Fire Dept. Page 2. Taxpayer numb ■ L I I r I 1 t 11 Name a somem For Cmpsaew's Uu aH X Argyle Volunteer Fire D fduton ebt. ❑Atoe ■ ot7oo J Pttyrer eadreas a ymf orpr+neon rape mwt aid M r dr.amru. Nor P.D. 901, v nrr nx,r. no.J ■ ( P . 0. Box 984 n,~tr 0 stw tP codre -tea iy--~ • C I oodrr ■ L Argyle j ■ T X . 1 76226 1 1 Denton ~ . l < OMAXL cc 14. Is t is bcation hside to aty writs of the city named in nom 13? Q YES ❑ NO ■ U O _ coft 1 5. Nsnr d butlorr M ~ prrr rs pryed ■ 1 I f 1 ■f Texstar Bingo, Inc. i Address Mo ACi er6r I.O. pat a ,vr roue) t ■ 100 Maple I ❑ ftioa . a,uo loaeon nutter CRY Soft p ■ l Denton ■ T X J, 76ZIP cod@ 201 J Denton Lawson 1 a f WJ i~ 10. Is M bcation insWo tx city writs of the ay named inum 15? Z YEs ❑ NO l 0 R 06 a 01700 (7 17. Is Ihls bcatlon drlfr(ent from the location of your orgaiyus m? Q YES 010 H -YES, explain wry. tee Z No facility large enough to handle Bingo Games oica"Maee,I r 101. Mow Is M toc■ton cont7oied by your oryenhabm? I~ct+oa~ ❑ Own Of Ow'rled, rare ftu re end 2O bW) ® Lapse at rested. lase tams 2r &W 22 bb* • U wee 19. ,dress of o«rr of ersd prrrens Lessor's i-u-ww to. Texstar Bingo, Inc. R■1 I I I I I I I I I i 1 ❑nae ■ 01410 I ftM .i ED F J2 I.0i0ea011 fxertr 1 100 Maple, Denton, TX 76201 i tao.,y 20. !asap ■rt,ar,t l l „ I 4 Per Omasim [s 7 50.00 1 f You muef aum ■ copy d )M leas apr■wrWi Wkh Na qpp, t)arr. •iepboeta es,rp 'r, { I - 'i Q K is a eelpe 1 - t W. Dq vsr 1 ` fig CO 21 ~.easeginsilpon~issbua ce of license Lf i : °w° Jl = 22. Whol Is the mv-kmn :e+rrq 'W" Ior tyY,pe? i mot' aadeUfted 23. Er,tar the rare of ails bons fide ■om member oft wo be vvnrey resporr■Die br oondACuV yms. blrgo 9rnn and a W WV tax rob", This me -60 must eiprl 7,b appicatbn In Item 27, and thy member a nine we appear cn year boom . woerae. W Br ranee of d other membxs who wd be openta7 on ire form AP-124, 'r■xas Supplrrr,t TO Bhpo a LL-"-LJ 0 [Jeer!,,' Fwfeq boron ff k weer of r.sre u M n+«rar ■r aap E'-"L" 01 J 1 D I}r a! Price, James R. D"m re a s bsnw 14 stsm 1J i ~ l I t 1 1 CROCRY • 1~ba ,17 Ig Ilr7 I_ nT~ f .100885228 1 • ~V! I I I ! L 135 Bartonvi11e J LOW op"Mol CRY suds zr Caps Fnon y4ee doer pro rarreer) l LL~ ~ ■1 Argyle ■LXJ ■1 76226 ■ Al7IG9]-24771 Wmn so. Dew a tlsft C3 PL „ . aw Race L Cau l ■ H Sex ■ ® M ❑ F ■ l 01 81015 S 6 a e I r; r; ■ r r r i f O ~"1CA AP-1174 tpw~ earst FOR LICTEXAS ENSE TO CO~NDUCTT BINGO L } Do not write in shaded areas Page 3. Name Of ag+yzatiar Argil P rn111ntnpr Flre I)PRt_._ Taxpayer number ■ L r i 0 24. List V* names of as persons who wi work and rece ve Fa roecasr's L)&@ 0* t - games. llse the appscatm campensadas as cashiers, ushers and caters at your bhgo f kPOltmerlt (AP-121 Provide ALL requested nkmrabon for each perw tsted. f 0 it Oe • WeBO z 25. A. Estimated gwrtertp Dingo gross receipts (,Vpa@ d A&s ortly) - - - - f -2 00 D. Tax r' ■ i 9 nrpbon - 2,500 C. Estioved quart" birW receipts ubtW 10 tax (item a milks item bJ _ _ _ 7 . OvlbO d. ArwwA of bond requVed (uugpy hem c by .02 (2%) of by .04 (4N r 2 yn,r kcal brLSdabn has adopted the bed lex.) _ _ _ - - - - NOTE: ' 1 ern d is Aw Ow $M, tarn m h»C b 99Lw0a. - - - - . t] ' X txd b M*w-, wow die 7 cwi'toAl/'! ON'iec t m Type a bord ❑ . rkt ngnirad ® - cash Ej - Suety bond ❑ . Assonrnt of "vkV acaoux O Ft as ■ te1Rf ( 26. Payment Of ew Mq*od k&Ya lee mw be sutxrltied with ft appkatcxt IJ W - T■ e^ l k*-" tea - Fee for a WrporM kw" b Conduct ■ Foe I WLL 0* . Y oocastm is L25. r. f N ' Amu d lease lee - Fee nor an amud Tr"p0 a based on yox 1 {i class rW amourt Of ka wi be 1andnl a t" in the RRyy s anrxrl Dross roceipts. Yar icerlss 2 r ] 2 s f{j Emer eta wra" of yar asanrted air"d gross r,Cpq, - - - - - - $ 3 001 c Oo 10 -1-- -LJ Enter your kera• doss Ll~J Lbense ke t 2000 . -00 LA W%@ dace 7. We, the undwtiRled, dectw OW M CrQ•rrzaticrt identfied aDow Y It bons We a U ~ Memters of a* anon, Out we wi be raporlsnbfe br condoms bingo gemea " anon' M 1 we are provlebrls of Ote Texas Bingo EnabkV Act, and OW d net ~q bkW ►q. sun rcehed Own wo be AW'Orq p u *IVW in Ote law. We furlfw dedre V* no person rwrAd h el a Sp* 13 M E3 No 2 bde. Convicted 0(a Dan bhD alerne, aLrr 11 Mud or a cY119 of magi turpL { We hglhw w* eut oopres Of etq W aWn have been writ k Denton Pot ice De t . ; i _ and 01st d fl aternenls in ris appk4tw and any attadmer%s we true and correct to the best of our knowledge and betty. alrr a xuaon Tom Date I ap.,kn nca To Arouciwra hue ,~o f' -3~ 4''f A Texas Lkeru r ton _o MMO oem 0* be Weed 10 ■ , , a roan.., a dW9rrrd mr 60 co yes grxq at wed ind aDarluaon, r yar wow is g anrd brip dod. ar kw" CAN drt,D n wr a,ppy of or "NQ'°°'°'"p cow a0w ,r. Year ono a mwiYxtaim bhp 1 1 bhP quotas f end •rperwa beaueeay are Mod m wet W, ~ v & moat k p by to p A*m of rr ftW En "V Ad ooua ktpW ar WWI d we volcaoeon b rape o, of to locree a 4 ai rr to p~s~1j d • t 0 L er ur0/er mK dente rw I am to heed W 1ne orDer7Runem arld rule tad aro we save by trr .Dove etas•rrrt 1 ;/t I i ~ Swan b and'Aft,"'eid before me, a u7 Pubic, on - 31 my omreseron uptee day of t 19 $ 7 _9-24- 19 88 he~ra0 rrie P t singer Swom to and subscribed before nv, a Notary Pubic, on ft day of St ,19 87 My owrrVaegn "was 1~aet /aeee 9-24- t9 88 . bg , ` Fla pries Hoar .o. 11Nr ,nor nw7D~ neo+p 1xnDer tare 4 AA 124 2 TEXAS SUPPLEMENT TO BINGO LICENSE f Use this supplement to provide additional informaton requested in the application for a Urlgo license or in the request to amend or renew a dingo ,;terse. • {Please enter -Date d bkth' as month, day, year. Examples: for 'January 15, 1950- enter 10 , 1 , 1 , 5 . 5_OI for 'December 5, 1955- enter 1 1 2 0 55 . S I PLEASE READ INSTRUCTIONS • WWE ONLY W WHITE SPACES PLOT ■ 44194 l Z. Tvp"w rwxttbar 1 Nanwe d ktwe Adder Argyle Volunteer Fire Dept. 1 111 12 i3 i- 17 ,3,4,9 ,0,8 i7 I • 7 Nrtte astir. W, md* or") t -cowl ° ky mriber S. DrMr's kttroe rt0. Sub 4,4,9,-1910 r, 715101 J, 06730343 eT X , Ta lor• Patrick K. 6 tb^e a"esx I ■I sox 922 tar State ZIP code i Prvrt (kom cooe 6 n,ma+l @I Argyle I ■ T X ,l 76226 I'.J817 1 464-3196' ~ 1. Raoi' I cau, I ■ U 9 set a ®u ❑ F 1o. ovw of b v, • 1019 11 1915 i 2 i 11. Positort (CheeA M apvlksbb box") s ❑ 61 • Sole oww ❑ 42 • PxVw ❑ 03 • Director , lJ 11,001 • oftker ❑ OS • Sherefgldee all • operator ❑ O< • worker cot • J Name ft w &Ii. ewdde kw4o 4. soar sew" Ntmtw tt DrKI kww la.. stale, 3 ■iHcn 1 v,Richard J I■14r6i0i•16,0,•12,4,5,7 ,103047220 {,T X - 6. tbme aobnt [f Stale ZIP Cod 7 Phme rA.~x case a ne++ov1 • px ,89 1 ,~J , 1 76226 I ,1817 1464-3666 I i y t I I . l A~t~ ; e. Race L,-j a U 6. Sex ■ [Z M ._I F 10. Data d Dirk, s I V 111LL41.~L9J 11. Positon (Cheek ell eppresb4 boxes) ■ ❑ 01 • Sc* ovnlfx ❑ 02 - Pertrler O 0! r 1 9 1 i ! 91 04 - ()Ikv ❑ 05 • V wd1dder V 07 • opertlor 004- W060 ck 1 S Name Rar, lieu. 'MI ixyis7 4. soew Sewity Mxnlrer S. Drwar's kw m m stals , ~ . eT X ■{Fnnl v_-arad W I■141 6t1ti7)Br10 1512)4I■ 09060205 6 wm s0o I - t ' ■LRox 52r Gihhnnc Rd - 1 1 a;e stele ZIP code 7 PWV IAta code a amor) ■ i .YO.,1 p 1■Llj-IJ .1 76226 I ,1817 1 464-3702 1. Rao I rAl l~--s • U 9. Sax e N ❑ F 10. Dated" ■ 10 1 41 i 7 1.6 1 1 1 11. Po6lion rSOO $1 *r9ceDk born) ■ O 01 • Sob owner ❑ 02 - Partw O W OteC10f t . a • ❑ 05 - Sherefntder 1107 • Operator Q M . YVorker ■ c I officer s. Nam ¢asr, Iht eiddN k449 4 Seal Ssaxky Wader S. Dews karts rt0. Stw Edward T. __j ,14,6,11.1411,• 4 1 9 4 0108941364 I T X ■ it I. Nome aeres+ ' ■Y2 Hickory Hill Rd. --J Gr stare 21P code ~ PnvY iAre coo a ,vro"l • 1Lr )L e I, T X■ 1 76226 J ,1817 1464-3669 J J 1F.X* !-C-put. ■LJi.sew ■~Xm ❑F to. coots co "ellili0i8i6ill 11. Position (checA to 4vilk4bb boxes) ■ ❑ of • Sde owner ❑ 02 - Partner O 03 • DiecbF 9) 04 • officer ❑ 05 • SNV*x der XXO7 • operator C7 06 • worter , I ' :L `-WiR121 3 . dte. earn, ~ O TEXAS SUPPLEMENT TO BINGO LICENSE Page 2 l! 1 WARE ONLY IN WHITE SPACES PLO6 ■ 00990 ■ L4 f 9 , 1 l PL07 a 49399 u Name d hcv se hi (Sane u Nam 1) 13 Ta.payer nome• rsa+v a, Rem 21 Ar yle Volunteer Fire Dept a f 12 13 1- 17 13 14 19 ,0 18 17 1 • J Name (Lest. lrsf. m„d+e na a7 a Socyl Securcy NtxnOer 5 6Ners kertde no Stale I afDowiwl6s, Michael J. in L 4L6 , 1 ~4 14~ ehbt+eess l•,7,0,6,21,~0114839b le X •1835 Hyatt f I City Stale ZIP Code 7 P"V ia:ea UYY d M1n*tr:•, j Lewisville la '1X 75067 j 11817 455-2307 f e au L Cau a LJ a. se, ■ Elm ❑F 10. Ow of e:rt ■ I 0 18 2 13 15 12 f 11. Position (CAaea a7 *pk" Darn) all 01 • Sow owner 0 02 • Putney 0 03 • Diri 1 04 oftio r 005 • SfweAOi6er [>S 07 - operawr 19 06 - Worker a ' • 3. Narl» OAK OrK aurae rWy 4. Sow secialtp la+nCr s. Orfrar's acaroe no. sale = a Robert I in L 1 181•13 14 j514 4 7 a ~ 06192720 Ie T X~ i, .1115 Brazier Dr. i I t State Zip Code 7 PTpne f0i tale d ,moss r ajArgy1e J 11T X e( 76226 la 817 464-7421 - '1 a. f4a Cau ■U 11. Sox arL^1M ❑F IQ dtr., a~ I I I j 1 I t i 11. 00111 lei al +K 1 Sys bar") a p 01 • Sow owner p 02 - Par4xr iii ❑ M, • 0lfcer p OS • Stwaftober 6 07 r *O~erskx f as Water • 1., A4rr a fliet W M d* 0*10 a. $o ro, • ~ I 1r stew { r8*rena, Patricia j a [415 151,15 13 1•16 12 10 15 1, J04330720 f e f X J H" s LP. 0. Box 24055 A ~ State zw code 7 Pnone tti ea coot d M1mLr:i Denton f MIT X al 76204 f x1817 / 382-9891 I e. as Cau S L J O . SO a ❑M E ]F 10, Dw of bM ■ L l 11 11 16 6 16 f s 11. P'01ii (CM0 at Vp ahls boxes) a D 01 • Sole owner ❑ 02 • P~ D W • Dirsebr i. 0 04 • 0L9er p 05 - vwen0tder p 07 - • L-J } Werala IN 01 • worker Cot • 3. Nsne "sL• ft, pidle a1riii l sail sxvrey harts S. DAw'e ketosis ro. S1au LWomack, Steahanie C. l a (416 111.1912 1.11 15 117 1,106286298 feT X wr+adm „12114 Nob Hill Gb Sleie ZV Code 1 +'*,tre ,Ara cone d ft-,, ,lCarrollton J T X . 75006 -j aL214 1416-6937 I i ( a.R.o►' Cau. .QM QF 10. Da* dUM ■f1,1121415 it f I 11. Poe7Gon )Chad at appacei boxes) • p 01 • sae owner p 02 • Partner p 03 - Diedor p 41S • Sflerdlolder C) 07 • Dpei p 01 OfOcer 000 •1Morker • L J I I 3. firrM Ital. Fr,l, ■,d>♦a hfieQ a, s0e111 se*voy Mmdr S, orw~er'a kensa no. Sta4 twela elsa Jason .1416 171'16 19 ,4 13 14F2J ■113270570 _f e}~ ,[2626 W. Prairie. A t 6 ` cty Stale In Coop 7 Pnoe rATa cock d ' Its r .Denton I a [I- XJ , L 76205 J .1817 1387-2211 _J PAW I Call 1 a L-J'. sox a ®M ❑ F 10. ow at bm a 10 : 9 12 12 16 1 R 11. Position (C WO 0 applk&* boxes) @001 • Sole owner p 02 • Patytw p 03 • DFecw p 04 , Moor p 05 • st raNokler p 07 • Operator p 00 • Wvkr ' LJ ck t I TEXAS APPLICATION Q.`;, ~ eaTlsi FOR LICENSE TO CONDUCT BINGO ■ Pfeasa read butr&;Ms TYPE DR PRIM Do net w-ae 0 shaded areas For C rc*o r'e Wo Orly ' 1. Nary d orgr.:eern Merr eelwp . Roanoke Volunteer Fire Dept. C7 PL 04 a o11oo 2. ma" edeeu (strew aodra& P.0 so., ru•N row) Mmr* °"PM re . i P 0 Box 714 1 O PI LM a 01195 C Swe zr cow CDU ty ea.y ooa. Roanoke 4■ , 76262 Denton ■I I , 1 Pnorb low Code .d nnibd 817 /491-2301 or.r.elw _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Enter yar Dusirless telephone lxr Da----------------- a ■I l I Federal s Identification (FEq No. M anyJ • 71 51 -1 11 21 21 91 7i 71 Iueroa oDde EmW 1 0' Does ym organization now have a wpw roTbw for rega" Bingo or on Texas tax or a Texas Vendor ■ 0 0 0 0 t z 0 Identification thndafr ❑ YES ❑ NO If -YES'. ~ monter L i 1 1 1 I I Seodday wev Q I I I 1 1 I I 1 1 I I I Amos 80,9 V 4. Type of MW OM orq&*Vb r1 f3 R 0I ■ OM 1 • /+alPa+s ! . Medoel El s - frebmel a 4 • Vakn9ear Fre Debt Tex Type { tZy} El e • Vetrw fb W■ nfw"I WW*tanan oWS&vd by Ne uS, Carparf? ❑ YES ❑ NO ■ ey Code i D Cu CC 5, is rib organization aM W*d wtM1 a state or naDorW organization? ❑ YES ® NO I ■ i i l mmw > M -YES,' arse( the rwne of to organization rd Ina state or nzbOnw addross. enpo a"""ny 6a. ❑AM ■ msm X ftw ..er sek4 F, ❑ PL 15 ■ 49100 6. Does ft organization now Ira a 501 (4 OxWO n from ON Int" Revwu* SeMca7 ❑ t - YES ® 2 - NO 1?yereulorl ! M 'YES; Ittach I ODpy of ft IRS RLkV or dotarR"bm letter on your exempt A&WS- . W Stab Tan dwW Of 00+1 ro, Mo. Day I Year ISQtC 7. M o" orgarrzatbn is a wpooft onW..- - aI I 1 I a I 1 1 1 1 1 1 ■ <~.1~L_J L'_J-L..J ■ L.J I A Copy Cl Ste Artkia of hcorpontion must be fled wMn Mrs applcOm umm N9e 4 d Mrs organization Is not a Corporation. desoribs tna meM+od of orgeniuCOr1 and vAm Dee or~ pooftn Crgenzafion ■ U W. Dy Ytr 1 Li 3T* ~14E MAR4NAU i k3tcd. ■l , , 1 i ,q 0. Nunter of oc" na-bms in good mwxt g in M1b orowtzatim ~ 25 E t at" tiro *m 3 I r1 pa sxJ ni rs.BL ❑ K w • mot ~t f 4. Type of lcanse ■CPeed for ©1 . hrxnl ❑ 4 • Temporary mo Day x, ynr powwad ow dim i 10. M ttrs b an ^v&mWn tar an vnW kense, enter Me dale you E 1 { r4 wbn b start OY*c V ft t*W 90 r1•s - - - - _ - - - - - - - - - - - LI 1 1 1 9 i tI O 11. D+Yfs) of Mw week W time(s) games wi be pbyod, (May rgt ercaed kw han in any 24 • how period) # Tme ti FM day TV* second oty rql r" do 05A w f-UF~E(a3~%t to $yS- ki~o Mbgy (S FIQ3 ■I I I 1 1 sLJ aLJ ■1 11 1 I aU aLJ ■l 1 1 1 1 ■LD U. al I! l I*L-J ■L 1~J■ U ■ I 1 1 1 t.1 _I 1 z Day Yew i 12. M Mrs V n Ippkeom kr temporary icalee, enter Vw dole - - - E t of " bmporry We - - - - - - - - - - - - V n s 1 9 m A s i.tc, I ~APPAouaa.7 M M» obm tenlponry germ wM rept*x a fog" game, enter ft day dtMfog" g■rravwtisreplaced i j r AP-1 17-3 TEXAS APPLICATION FOR LICENSE TO CONDUCT BINGO L • Do not wfAe in shaded areas Page 2. Nerve of orperr ern Roanoke_Volunreer Fire_nppt. Taxpayer rxxnow .I + t t , t t 13. Nmr co >ot m, tar cwovl 'a the @y lRoanoke Volunteer Fire Dept. ED m PL04 ■ o17oc A'TIW @d*m at 7v%r Ql~iLlft Alan !Loaf and ro, a ar.rnonr, tar P.O. aba or ivar role ro,) lmtn nna. ~ P r I 01. 0. Box 714 1 a L -L--J ~ F saw ZIP coaa oalaxy coo i a lRoanoke 1 0 1 T, X1 a L 76262 1 1 Denton ■ r+pa 11. Is Cis k=tb hside the oty inks of the city permed In txm IV Q YES ❑ NO ■ U Wirdw mdf 15, NO" of w9kn 0 *tkh pmw an O&W ■ L I I ! 1 ■I Texstar Bingo, Inc. 1 /a0aw 0 _MOT arrir P.O. Bar or real raft) 100 Maple 1 r.,m: 01610 ch suv zr coot _Xj p ■ Denton I■ Lj ■1 76201 1 (Denton 1 ■ 4" !Qj 1e. Is Cp batim hsid■ the city kNb of the city named in item 154 X YES ❑ NO ■ J ❑ R OS ■ 01700 17. Is Ctis batiorl dtbwfM from 0» location of your orprizatim? [X YES ❑ NO M -YES,' ex;AW why 1eLrm lu" ; I Station unsuitable for Public Meetings f Cj* WOa, t l I ~ ~ . LuJ f 1i. Mow Is rtis bcalbn oofwoied by your orpmom? ICyoa El owl or o.naa "v ft m it ra v brut) Q usam tr reaw, bnv r er s7 re 22 eb q • U coo x ! I t l 1 ■ I ' . t 4, tarns d awr of lewd AaR~aw t.raoh lorpayar rn. . , , ! T xstar Bingo, Inc. I■ L, _ 1 1 1 1 1 I 1 1 1 I❑ Ry ■ 01" ~ p1 Q P ~ i e D P~ laaaon ea1■ar 1100 Maple, Denton. TX 76201 I ■I 1 1 1 1 1 uussefl4ge 20. `.ease .marl` pw oocasion Is 750.00 ! . ILJ You MM aCacA a Dopy of the bw a rearnwlt wth the #ppAcsta - Ikpe bw ton wrap ❑ R is ■ ulna wb, DW Ywr 21. Wet data dd you aog49 the pt■ytq Imeft 7 ~w Lease begins upon issuance of license ■ Li a_tnwd 0 22. What Is Cr naxharn me" OW" for brW? I Sam / *Oft . 23. Eller e1. Iw71e Dr n» ea,.110■ acnw menDw w1w w11 to pf4rlriy rsspom6M W oaxklcirq yor bkW p■rrre ■nd a [ MV tax nmTW Tfis m ,da must sips hits eppiaticn In Poem 27, w4 fib nen0e i rww wN appear on your Ofrsaroaean baserI farm. Ust ft nwrm of ei oCw nwT6" who 1 a tie operators on Me form AP. 121. Texas SuppMmal! To Bnpo ■ Uomem.' P4" Oeeeon ~ Nw■ M1mK wK awns k*M Nwev co "M w a" No f" 1 I }4 1 ■ t1~ .aa..e ! FSP r_kPtt . 1.1 d j J ! 1 1 1 1 1 1 1 1 F ■ ~ ~Drr ir'a k*w no. Ro kue+a " I -I 11 71 § ?1•t q 7 0 3 7 a1 0020066 I SIT, X ■ 1J t.aw ..mat ■ I P. 0. Box 184 1 eaarr, °l' stow zr Cox ftm cj~vm wad w rurta ■ I I I 1 I ! Z *I Roanoke I ■ IILXJ ■ 1 76262 1 .[817 30-16891 miry ap■.ar OW Of can C7 `race I cau I . L cex a 0 m ❑ F ■ 10 6 12 15 14 10 I `111 ■ am i i i V O ~ ~rrsl FOR LICTEXAS ENSE TO CO DUCT BINW L ' 00 not Write in shaded areas I Gape 3. } Nam or organization goanoke Volunteer Fire Dept. Taxpayer number •L__L_ I r , , r , For carpfwg UN {I Z 24. List the names d al persons who WE work " receive compensation as ceowers, ushers and callers at your Dingo { - parries. Use the appboation umpoerrrent (AP-724). Provide ALL requested nlomhation for eacrt person fisted. ❑ PL Oe a wm f 1 O 25. a. Estimated Quartery bingo gross receipts rwnob doers t 9 b. Tax exempben - - - - - - Q a Estfrrtsted quarterly bingo recepts stbpet to rrt (item a mirwa dam D) o e. ATqu MY kCW rtt Of bond reqLArad fMt*py Naar, r Rom o by .02 (r%) or by .tie r•x) r adop(udtherxattax.) _ goo, 2 NOTE' 'I item d Al Mss Marl SM. Mw no Dr.d At rkAvd. Z ' I Dad N rp~ted. C~ the C,,Tftra9sr's Orfiae. Type of bond ❑ • Not mqL* d Z - Can ❑ - &ny bond ❑ • Aas wmw t at w&v moms t ❑ FL os m a•ws 26. Payment of the required license lee must be submitted with 'tee appbcabon. a Fee ' 7oThpoary bcense lee • Fee for a lanporary bcense b oonOLCt only one occasion is $25. Tarrpvary t1J ' Amuat boars* lee • Fee for an arrual low" is based on your apWzabon's at^* gross receipts. Your kense 1,1 VZl dams and rrowt of fee wi be found In a tabie h " nshxbpna. 2 6 Araxrtr Enter the amount of your estimated wvkW gross recepts 3 0O, 00 ( ooJ t I I f Enter yaw fieerw doss - - - Lkerse ra. _ _ _ _ La a b O :00 ux+.e dw 7• W, er udxsipnea, Ceder. 1W the orpenaation identified • active merrbers d the above is a Dona ride non-profit «psrwzati that an orpenizabon, that we wh7 be resportstle for oonductirp pin9o 9ashas end rot MV d d requYa d ro- ►exrw reotk•C tints in aooadanc•"the provisions of the Texas Bingo ErWft Ad, and that M net pr eds der! °0 Mom gams wM be used for dwttabla puroosas as dented h the Inv. We hxVw declare the: no person need In ttwa~ ap* ❑ m ❑ NO cation We. Or b supplement has ever been WrMcted of a felony, gambhtp offense, arntinal fraud or a opts of moral turpi. We hrvw cw* that copies of flea VWffbon M" Dean sent b Denton Police Dept. r and that M atatema p IM fhb apocabon end any attadrnents am true and oared to the best of our knowWpe and belief. Hmd of orgw4g m ~ tee ow h% h 1'/ c ~ nee ~ / - / • ._1 7 j C - ~I o r7s A Tom lhrm b Condit Bahpo can orgy be rw,W tog qudflad, rg WDK ohreapa orgWzmtlpt Its tax group Y pan40 QW a kwm a deslD+Med mnnbr d Far W** at each and wary WW Demo Wfed u" aws karoe. Pis oplodch for w cam be soK am aooaxx CaDoea of ad or assigned b any ofer pap or ohRvlOvai. Yaw group ftM n " fah a bkW lo prooada ant •xp post l of ad bhp prDCee I OW POP I a of ad bingo axpanw. You mwt koap Samna reoada of dn9o the h as'r9o Ad ax1d ~y an a490 b soda by u.a SWe Cary ftW. Faan b abide by ft WWdiau of b el>JW fir aigrers of to V*Ww a revoaeon of the ker" and atmaf prwahuaort h k ttr vdrYptsd, dedara fat I am fits head of tt» orper>iza7w rd twit read and w! a" by fir aWm atasrnr>t. w t Shan Ward kJbwbed beforo nW a Nary Pubk on Oft ft-y- (38y of- ,19 ~L , f by OWW* sion .V4*w Notary P bk ,79 . +fisrs► ~ i Swwn b and sub%rbed before nw, a NoWy PLW on Ows the Cey of t t9 . My oonrrwssio I wQ**s Notary Pttik _ T- 4-~q ,19 nee►_ ftl~~c~Cr~~ F7ra rHa,e rt. b. O. erne ra meow ftow F"Y" h 19 TEXAS SUPPLEMENT TO BINGO LICENSE Use this supplement to provide additional information requested in the appfcaticn for a bingo license or in the request to amend or renew a oirgo license. • {Please eater `Ow'e of birth' as month, day. year. Examples: la "January 15, 1950" enter 10 , 1 , 1 , 5 . 5 • PLEASE READ INSTRUCTIONS for -N--tuber 5, r953" enter 1 1 , 2 , 0 . S . 5 . 51.) t • WRITE ONLY IN WHITE SPACES PLOT . 49399 ' i. Plerry a ~Canae fWlJer - Tapayer IRlrlLer (Roanoke Volunteer Fire Dept. } a 7I ,5,_~1~2 12 19 17 17 19, } • 3. --N" 484 &A e,dCA triag . 4.:ww Sear" N,n,Wr 5. DrW6 to no. - Sit% Beckett, Lloyd J. j 111- " 6121'16161 • 71013 ~LO?006_6~LIX I ewn+e eoaess NIP. 0. Box 184 422 Front St. Cey 5144 ZW Cooe 7 PhQ 'Al" code a rvnPer) Roanoke } •LTLJ 81 76262 f 8~ 17 1430-1689 J a Rxo~ Cau a Lj t, See OEM ❑F ,o. Dale of hill . 0 t 5 12 514 10 it. Position Dock am app4cabb bo.ea) ■ 0 01 - Sob owner 0 02 - Partner O 03 DY•tior LJ Ck01 • Officer C) Os - Shwelloider 07 - Operator 01 worker' yc 3 Namt Rae, kmt if dole M,leQ e. Socid seii IMr»er c5rww$*A"'ria Scott ,LBeckett, Naoma E. I@1415131.14181.19,31010, 00450950 utr ix e None eoae,s 4 ,!P. 0. Box 184 422 Front St. } Gtr state ZIP Cone 7 Ph" Ix•ee cane a m tern 41Roanoke J , T X 81 76262 E01817 /430-1689., f e a.a Cau • L J tr. se.. ❑ u ❑ F to. t7ete a " • 10 19 12 16 13 14 If. Ppsibm ICAOO aI apphe" bores) • 0 01 • sole owner 0 02 • Pander : 003 Qr CW CX04 • Officer ❑ 05 • Shwehi 0 07 - OperNOr 606 : worker a CA 3 Hang ,Yore. Lx, eii hw a. socw 5ft'w* lamber - S. Driver's ko no. su" }Caftin• Phyliss 91416171-13,5111121615 09336848 }eT X .Wane ,oar„ 1 P 0 Box 31 407 Lamar } I t City sta4 ZIP CO* 7 Pha Wee code a nlmoe•I I r o kq_ I. T X 76262 If tl cau i •U 9 1 sacs . sa • ❑M ❑ X P 10. Dar of era .I 1 l 1 I i l it PookQn Khftk ON Vpksbk beaes) • 0 Ot - SOW owrw [3 02 , P•rlnet~ s ,1t, to in C 0 _ 0 os . snr*dder 0 07 • Ow" 3, Nww gAK AMC nrd - ht" e. SoeW SeD.Ay NurBY ; S. taMii~hind ro. ` Srb . I 'i~RlakPte a Donna }■l416ili•i718r19L 7 6 ,]05803013 IT X 1.7 F, bone roars, - l eL M N. oak P. 0. Box 472 e,q Sure zp coos 7 Phone rAree cork a n tuber, IiLRoannke -j L11 76262 •{$17 1 430-1784 J' is. Raa LrJ t • LJe. see • ❑u' I F 10, Dar of Liar . I I 1 I 1 } r 11. Po~ (Choo dl ep ikaDN bola) ■ 0 01 • We owner - M 02 • Partner d W • Dlr w 0 01 • Officer 0 0S • Sfwehdder t7 07 - Owalor (ga wor w, i 1 - r w I `'>r ~n.leta 4: r~ r-05r3,' TEXAS SUPPLEMENT TO BINGO LICENSE Page 2. 1 WRITE ONLY IN Wh7E SPACES r 12 rlame a PLO6 ■ 00994 r r 4 9, kerne caber f5xne ,.Ism rl -----~J "07 ■ 44349 Roanoke %olunteer Fire De t. 13 Ta.payer ,sa,,,, 12) 3 hia v (L r.-u. nMda+e +nrury • I IShook, L. J a. Sowr Sec," rA,npe s Draer s Icertse +--L LJ Sisk . ••OTe aODK1 I. L4, 5~__~ __01•,1 19 1•,4 ,2 19 ,8 • 07212435 X ■lP. 0. Box 466 130 B. t Cl, Jo Lane ,LRoanoke Stair rQ coae fa'N LOOT a r4•nO1y, 1 r T X a 7b262 r PhDY J pm au 11. pojRd PWO a a e. s« OM ❑F as oa or nrin . (0 I 1 i0 6 b 6 1 r+ors+j r d 0f' So4 ' /y p 009w, -1 0 02 4" 93 ~ NrrM,.IkI±f. lwsC •~k ~ 4 ~ ~dOf d w1 ~ ' ■ U t { rno, Tommy br>;+r ■ stir+i rio, ; - stiu a+r- ■ 62.58.8704 ;01576117 ~JX a 120 Oak Lane P. 0. Box 583 Oty a Roanoke stale zv ~POe r. Prase raa cxr ! nmoa., I . . T X • L 76262 e. ""0' 1 'au J , U Y. ux r ❑xw _j it PoalNon tcfvo So ❑F ,o. DoW a 0 1 0 7 4 0 Q~.e+. [nxerJ • CJ 01 • sole owner CY 04 • OHkar d O 02 • P&tnw d 03 • 05 - el,older d 07 • Operata° • I • J. wme fast Ai>t, ~L+7 to 00 • worker - ~ Scott Gar a. soar j . S Dr,t■r'e f'unae ro. stare 1 Hot I m 416 15 1.13 ,1 1.,4 17 17 ,2 f • 08651062 1 a Rt. 2 Box 142-0 X t cRr Roanoke suit nP Cc'* _ 4, COO& -f r T X r 76?.h2~~ aaa Cau a U a r it P,oeryfM lCllp~k d I. Sex a C7x ►1 ❑P ,O We of 6+/, y 0 04 4opriKo LoxezJ r qq : sok vow CJ 02 . pnher L7 . RLR in a✓ia, 06 She0er q n . ~a Oa wo her a LJ a. Socia+ sea.~r tR„ber , (Watson Steven R. S D*W'll e" S i S, Here acbna . L~J 4 9 1-11 9 0 5 9 E P. 0. Box 1044 6 r 06485271 l,~XJ' 701 Pecan E CRY l Roanoke $1re zIP Cow J : cow a nv^war I w P tea r ~ T X 6262 91 17 4 i a oe ~ Cau - . , 3 ■ 8 9465 ! t1. Potippn Q 9S ' 0~ ❑ ,o. DW a ern . 0 72 8 15 18 • fi aJ r 0 of, Sob 04a16f E C3~01 • OM1ner d ad, Slrral,oWe( d 02 . bu"r [7 00 • mecio • o kri+e Rant fiear. mdA. titef 0 ,01 DPW _j I )7 o1 • wcew- *L a.r > tk S ~ : f..0rfrery b;ti.'ro ' ' r•O~r! aOYK1 - .~ati J . L~.J e~L! ■ F, IIP eoae'- r Pnvk rti-ea cone d n~..,h., f~ i Pace UL Ln a U sex a l D M D10. De4WLin eta a 11, ?pyDpl PCnelo ,lopfcab~► DoxeaJ , ■ d01F . Sde owner C] OZ • owber 0 os St&udder. C7 er . Pact<,~ nos . oscfo, , ~ Ct a • wak« 1~1 O. F4,?,ern TEXAS SUPPLEMENT TO BINGO LICENSE Use this supplement to prcvide ad6tional information requested n the application for a dngo license or in the request to amend or renew a birW license. (Please enter -Date of birth- as nyWh, day, year. Examples: far -January 15, 1950- enter 10 , i , 1. 5, S • 01; for "December 5, 1955• e7>ter i 1 . 2. 0.5.5, $1.) PLEASE READ INSTRUCTIONS W&7E ONLY IN WHITE SPACES PLOT a 49M t. Nr+r of kierKe holler 2. Tas,,-oyw error . jRoanoke Volunteer Fire Dept. r , I'■ L I I I I I l l I I t I • 3 Haar JEW, &W, rWae ixb+7 4.-SOW Sanxey Meter S Oehe"e Ica■a a0. - StMa ' . I ICorrea Patricia 04330720 . IT X~; ' I■I4,515 %513,"16,2,O15I■( Mprrie ed6na Ile ■Lp. 0. Box 24055 Cry State ZIP Code 7 Pnov 1Aw code t rvloe.l ■I Denton I ■ T X '■1 76204 I'o[817 / 382-9891 I I U #.s.. ■❑u x _ e. AI cau ■ +c. ❑ r ta. o.w of late, ■ I 1 1 1 I 1 16 l b 16 1 11. Position (check of *Pk" bores) ■ 0 01 - Sow owner ❑ 02 Parfier 05 4Ptecfw 5 - E eu. 2 , 0 01 • Officer " ❑ OS • Shareholder O 07 • Operilor YVOrlcer JCA • J Haer ftad, 4eK midde 1rww' a- $ocial ref' NAber ti. 45rr+ar'i "roie6i'iq.' S4y' 4~Kke Stephanie G. I■(41611,"19,2,-,1,5,1,71.(06286298 I T X ■ 1 2114 Nob Hill CM S1a1e ZIP code 7 Php ,Ana code A ty..•,pa.) . a[ Carrollton _ l ■ T X ■L75006 I,I214 1416-6937 J c Pane I Cau I ■ U a. se, ■ Elm ® F i o. Dew or etn ■ I .1 , 112 J 41 51 1j »,•t ; 7r 4,i1 11. P*Ww (Cheek W Avl5cabia boxes) ■ p 01 - Saw owner ❑ 04 • Officer p 05 • Shareholder 0 07 • operator C3 Q~ 3 Hama jLw, Mal, mo* raW 4. social sewey Mrtw S. fl,wi 46erlee riOp sub I! 1 =l uelal - Tacon 141 61 7,-i 6 i 9 ,•]4 i 3 i 4 i 2 f, 13270570 I T X } stone aosn 1 2626 W, PrA_ irte.A _ 66 '17, , Cly Stale Zip Code 7 ph" (bea code a rv^me') f; ,,l I M id r)pntnn 1 ■~l-X ■1 76205 yI817t / 387-2233 I t I cA11 I•Us Sa`■(10 u ❑F to ow orbaY, ■I01912,21618I' hti-T~f!:~t;LlyO 11. Poe1WrA xm;ock of *A*Abla belies) ■ ❑ 01 • Sole owneh O CA Pttn w~r'T°11~,.L7 F! •zC ~~f f ^ ~ r~~a} ltj f to 04'. ollber.. ❑ O6 t+de►old■f o of ~,operrior r' Z] a`•, wart, • ►qc j a !Nano - 1KYI! 4.SoCrl SeaA!' *nbe! d' i IctrMe Ito.. • k~ P ra John I, 14, 4, 0,-, 3, 6,- 4 1 1 1 440364111 0 K 13108 Heather Lane ~j I~ cA, ,p!~y A~• ~~.•J Denton I ST X zi792 4 708PI IAYJOL `/3/4 n a ,tso. 1 Cau~ P U s. se: ■ QY ❑r to Dow of Ert ■ { O 1 3 f 11 11 3 8 I . t t r 11. Postion (cheat aI rpp!kAble boxes] ■ O 01'• Sde owner [102 • Pars~ r. C] Ol. Oricta ' ;tr O 04 : Officer p 0 - Snarerlokw ❑ 07 • Opar+!or o1 SAfl 11r * ' Yp _ 1 r q. IEk. 1 d!`,~ TEXAS SUPPLEMENT TO BINGO LICENSE Pace 2 ■ WR)TE ONLY IN WN(7F SPACES PL06 . com . l4 19 1 I I PLOT ■ 49399 v Name of Ikltcf! N.Yjer (same as Ram 1) 73 TaAww ember isame as Rem 71 1 I I I I I 1 f I , l • 7 Name flasf, Grsr. mddh n447 1. some Secwy Nanber 5. deans kem no Slate I 3A+M~S AAA) Er S1)4) E+2S I,l 4 G l I I SIG Iafo141J.IOTors3or le r'x No Y 3099 I . City State zip C-oe 7 RI ,Area code a ~beri bfayioAJ Iri ?IlI 7Cao9. _j 191,7 ~ 9-G6 cii, I 0. Rau J■ U l s■a r❑ M ❑ F 10. AM of bias ■ I I I I I I ! 11. poe7don (CMc1r sIa ppQreDM hoop) • ❑ Ot • Sde oidaer r: ❑ 02 : Partner 03 ❑ Dredor a . o ffoer O 05 • S+lereho"r" 6111i opdretor ;t*,. wont4 , I _ t;pc 3. tartte "34 lost, M60 mo. + `Sodf sKurry ma" ; S. DAMOS 61 no: Staf■ ILItbme adorns 11. I I I I'1 I E'I I 1 1 I I Jai { ~I C117 54te 2W Code 7 Pt,ou lNe+ code a n.mnrl JrW ■I I,l I a P." ~J n U s~ Sal I❑ u ❑ F 10. Data d hi0 . I I I r I I 11. Pusrtiori p)lao aI tpyk■be bons) • 0 01 - Sae owner ❑ 02 • ParlrMr ❑ 03 • Qitactar O 04 • oft w p OS.• Stla &Wder ❑ 07 • OWIWr p 00 • Worker ■ LJ Cie N•tw Bast. lrsf. RYddf■ Y+tYIJ 4. Soots! Sena■y IM+Oee - 5. dint's kim do. Slow I all I I •I I I'E I I 1 101 LW I i1NOm..ddnd ■ I. uY Slate Z6P Cade 7 Pfwee r7es code a rWm ) l Roca,. a U I.~ sea r❑ M ❑ F 10, dW of " r l t I I ~J l 1I F0ettlan IGMCA al eppkaeb DORS■) ■ ❑ 01 • Sole away ❑ 02 • Partner ❑ 03 - onew a LJ ❑ 14 , otftoer 0 OS • Shardvidw p 07 •Operator ❑ 00 • Worker ya 3. me" gig &K R~dalir k1bal) 4. SO" Senalty Nil e■i S. Or1w'e la+rs■ no. St■u I rI Y I L I I I'I I I 1 I, ~_~eW IEI Iatr nano I IT j ~ stale ZIP Cock 7 Pt+ox iAxa cod d ntmtperl I l' I . u• 0•'aat l a ❑M l-ls to 0w of d tA' a l I I I I I f 11+ Poehm +t poRU)' a to 01 Sde'owner ❑ Oe Prrtnw fl O~ a, OF+atOr 1:, 0 04 - I 9fCoer ` 'o os srwt;:,t;ltiet t] 07 o►1a o a • Worker 7 Nrne A pC lost, m dls. lrliol) k Social 3* 1ry lAartWr ` 5. Dr Owi kern r stat■ i 1 I ,1 I I I'I I 1'E I I I I a! L~.J',.; State ZIP Code 7 Phone rhea code a ?w4cx+J ► . W . l I .I___~ I ' I.IUM 9"'.❑M OF 10 Dee ofaI I I I I I I I I. Poelotl (Chant 0 ~fo~3CaD 1r bor4e) . d H SoM owner C] 02 PaAner ❑ 03 • DFtlclor 0.64 i5to r' ❑ 06 St4*x'* p 07 • 0*06r b a • Worker • LJ ex I T I I 1 l } L t f 1 {S } s Ic F a' i i Fl 1~ f i