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Home My WebLink About1992 1 i BINGO PERMITS 1992 e r.ne TEXAS REQUEST eeq TO AMEND/RENEW LICENSE TO CON"JUCT BINGO e rlease fbad fhef uctona i Type of OrMI Do not wnre, In shaded areas 1y, 11 ~y II I Nameoforgami2albn Tax a ernumber 11 1310,01 o.I~;Y 13 I. Type of faquait C7 A • Amendment K R • P~nowal M 2. Name of organlzallon (use the name shown onn~~your license) _ I III fi-p K S - ~ O O (exss, 2 0 Box q nyi at mule number) 7 Mallij address (Street r # } 4 4. Cly Stela ZIPcode Ccunty )I) irk ra N I ■f 1A 11111914410 a! I- pD/'Q4~_. 5 Enter daytime telephone number of contact person . . . . 1 Phone ~yf4' f tndlviduai'a name to contact _ V 40#*_ /1r M7 Day Year g y II ; e Iw~sh to slartcpionducln9 for henbnmo under your our Work 6 ensleense, enterih• dale you 7.1] CHECK THIS BOX IF THERE rS A CHANGE OF DAY(S) AND TIME(S) GAMES WILL BE PLC YED (Enter the entire now Schedule), First day Tama Second day Time Third day Time M, to M.~ _ M to . M I M. to M.1 t BOX IF CHANGE 11 YOUCCONDUCT YOUR MEETINGS AND PRINCIPLE BUSIINES3 NCIPLE t USINt99 LOCAtIQN A60RES9 AT WHICH kf a Name of location I Physical address of your organltatlon (Use street anJ no. or (Jlr rolione, NOT PC, Box or rural joule no.) F Coy state ZIPcWUe County 21 . _ I ■1 1 _I 01 l _I1_(_J L Dooime phone number far above locatiom I x Is this locallon Inside the ctfy limits of the cly named In Item 87 f I YES I 1 No + How is this location controlled by yourorganlzallonJ7 (I own I_I Lease What Is the maximum Seating capacity for bingos I I I' I CHECK THrS BOX IF THERE IS ACHANGE OF LOCATION AT WHIr,H GAMES WILL BE PLAYED. s g. Reason Ibr chsnplnq playing 1ocsUon r 10. Name of new location Ir Addross (Do not enter P.O. Box or firs! route) I I )try Slate ZIP code cnunty 11. is this location Inside the city limits of the clry named In Item 107 1 1 YES L) NO t;) Ilow is this focatlon corlrolled by your orggnlzation7 1.1 Own pl owned, leave items 16. 11 and 18 blank) f I Lease (If leased, lerive hams 14 and 15 Ulan ,j 17 Is Ines location different from the IocaUon of your organlraliorl7 i I YES 1 NO II -YES,' explen why. ° °q TEXAS REQUEST TO AMENf Agi LICENSE TO CONOUCt BINGO [a Please read Insfruclione 0 Type Of PAnf i I)o not wdre In shaded areaA Narnecforganitallon Taxpayer number i Mc. Day yea? 14 What date did you acquire the pieying loco lion? . I ~ J -L _ i - J-.-I J 15. What Is the maximum seating cepaclly fa bingo? fe Name of over er of leaser) promisee Lessors taxpayer number i _ I■ I I I. I__ I_ I I. I. i_ I _J 1 Address City, ST. Zip Code 1 17 . Has your lease agreement changed in emeurtf or condlllons7 ❑ Y ES L 3 NO 7 is lhis lease based on attendance?.... . E] YES L-I NO I Is this lease for a one year period?...., (J YES C7 NO j Is this lease amount ralr and reasonable to your opinion? 1-1 YES U NO r Is this lease signed by moth parties? (J YES L) NO IS . Lease amount per occasion, fnciudlrig al expenses paid to the lessor In cornecli + wilh the use of the remises Ls .00 J "i You must arach a copy of the lease egreemenl with this application, sealing capacity _ -77 19. 1.1 CHECK THIS BOX IF THERE IS AN ADDITION OF OFFICERS, DIRECTORS, WORKERS AND/OR SECONDARY s OPERATORS (workers such as cashiers, ushers, carers). • Complete 'Texas Supplement to Bingo Lkensa' (B-AP-124) and return It with this request. 20. I 1 CHECK THIS BOX IF THERE IS ACHANGE OF PRIMARY BINGO OPERATOR. II the name W the member prlmarlly fesponalble for conducting gamos is being changed, enter the Information requested for the new operator. Tr is Informatlon Is required for a criminal activity bcckgrouhd Investlgallom. Name (Last, First, mIJ11a Initial) Number of years as an active member Social Socurlty Number D,Iver'I licensa no Sta' ■i I I )•I I__i•!__I I 1 -lrl_ _■~_J Iloins Address ■I ~ t r City Stale ZIP cods Phone (Area code and number) Dale of birth t Race IN Sex ■IfM f I f ■~.L ~_!__~_E.I 21. Has there boon ony change In the dedication of net proceeds? (-1 YES JIQ NO Explain any thengoa made. 22 AMENDMENT Irfe. It you requested to charge In Items 7, W or 20 you Trust submit a Ise of $25 (payable to the STATE TREASURr.rt) upon clearance of this request, Return your current license, and a new Ikense will be issued to you, Keep a copy of the Ikense for your records, You CANNOT change locu7+on or days and Vrmla of games until this request has been approved AND yov scan a your new Ikense. if you make Mose Changes at Iha time of renewal, the $25, 00 Ame,rdmenf tae Is not required RENEWAL FEE- If you are requesting a renewal of s current Ikense to conduct bingo, you must submit a remawal fee (payable to the A STATE tnPASURFR) with this request. The renewal fee Is based on rho annual gross scalp's that you reported for the pravlous year. Enter 14Informal'Mn requeeled below from the renewal nclks, and ATTACH YOUR RENEWAL NOTICE I Naw ?tense class l New Ikense fee 001 `J _ rxa. I r 4 saint TEXAS F1EOUEST TO AMENDMENEW LICENSE TO CONDUCT BINGO + Please tad Msfnx7 o/n, r type nr P im r Do not wrrfe in shaded, `\e49 Name oforpanltetion L~y►+c Q ~I Taxpayer number 23. AFFIDAVIT OF RESPONSIBILITY We, the undersigned, declare that the organhellon IdenlAVMCrgRrYSabMII rilftri profit orpanlasi on, thatwl ere Active members of the orpanhal on, that we will be responsible for conducting bingo games And for ffflnq •A required rotums to accordance with the provisions of the Texas Bingo Enabling Act and the Tual Atcohok Beverage Commiselon nA^4 that alt net proceeds dedvod from bingo games will be used for charitable purposes es dellnod In the law, and that no person named In Ihla appGcefton or Its supplement has ever been convicted or a felony, gambling offense, crfminal fraud at a crime of morel turpitude. t We Wdher coil/ry thct c.~o+plAa of INS toque at have be on sent to (entm the home of tho local governing body In your ers100) I ___-----_.-__-----__--___.-----endtire Iail at atements In this application end any altachmenU era true and correcl to the best of our knov.,ledge and t X7e11. Officer of the aegnnirattan (Cannot be the primary operator) Title Dale sign here Sworn to and subscribed before me, a Notary Public. an INsthe - dayat--- t My commission expires Notary PubPc - sign 19 here Primary operator Tate Dole sign herill Sworn 10 and subeorlbedbefore me.oNotary Puhlle,onthlsthe____,1Q --day N- -I1I-OH Mylco^mmbsybn expires Notary Public r-eS~ J 9here IAA TABLE OF ANNUAL LICENSE FEES r _ CLASS ANNUAL ORUSS REC_ErPTE __LICENSE FEE_ A- $25,000 or less $100 B 25,00t through 150,000 200 C 50,001 through 75900 300 D 75001 through 100,000 400 E 100,001 through 150,090 600 F 150.00I th ough 290.00 900 0 200,001 through 250,000 1,200 N 250,001 through 300,000 1.500 I 500,001 through 400,000 2,000 - J more than 5490.000..- - 2,500- - Nole At the end of each annual lkenso porhM, N>e ornounl of your Iofaf gross recelpfs reported lot the preceding podr wilrbo reviewod Any detrcierrcy Nibs lee pald la thAt period musl be raid prior Id renewal Any excess M lee paid wlN be credited, (Section 13(e)r Texas Bingo En*MV Art) Pepe 4 oll PAGF. 1 TEXAS ALCOAOIIC BEVERAGE COMMISSION BINGO LICENSE RENEWAL NOTICE Date: February 12, 1992 TAXPAYER: 30006893447 Districts 06-Dallas REnt 02 ELKS LODGE 2446 PO BOX 1961 DENTON. TX 762021646 1 Your annual Bingo Conductor license will expire 03-31-92. In order to renew your license, you must complete this notice, the enclosed renewal application, and a supplement. To assist you, we are enclosing a print-out of your current license Information. Please submit any necessary changes to your license on the accompanying renewal application form. Use the esilosed TEXAS SUPPLEMENT TO IPPLICATICN FOR BINGO LICENSE to list new names or positions associated with your license. Your total renewal fee is computed as follows; New license class F New license fee $ 900.00 Credit from fast year's license $ 0.00 TOTAL RENEWAL FEE $ 900.00 To Insure sufficient time to complete the approval process, your enforce- ment field office must receive your renewal application, supplement, this notice and payment for the total renewal fee at least 30 days prior to the expiration date on your current license. If your license expires without receipt of the renewal forme, you will be unable to conduct bingo genies or bingo related business. If you have any questions or need assistance, call your TABC enforcement field office. 1 IMPORTANT { Thie RENEWAL NOTICE with your renewal application, supplement and fee MUST be delivered to your enforcement field office. It will be forwarded to Austin ONLY upon receiving clearance from that office. , I PACE 2 Taxpaye, Numbers 30006893447 Listed below is the information we reflect as current for your Bingo license. Any changes to this information must be made on the enclosed renewal application. Mailing Addresst PO BOX 1981 DENTON, TX 762011646 Your Bingo games art played at the following timest WEDNESDAY from 06130 P.M. to 10:30 P.M. SATURDA" from 06130 P.M. to 10130 P,M. Playing Locations ELKS LODGE 2446 LOCATION #t 00001 228 EAST OAK STREET DENTON, TX 76201 You own this location. This location was acquired by your organization on 07-10-1974. The seating capacity of this location Is 100. The primary operator lot PEERS, ARCHIE Home Addreast BOX 316 SSNt 474180228 KRUM, TX 762490000 DL Qt 03788427 - TX Phone nbrt 817-482-6389 facet W Sext F DOBt 04-20-1922 Ih I~ { I i PAGE : 3 Taxpayer Number: 30006893447 Listed below are the active individuals and their current positions associated with your Bingo license, To add an individual and their position(s), you MUST rsmplete form B-AP-124, Texas Supplement to Bingo License. To delete an individual and/or position, write "DELETE" in the column next to the appropriate position(s). To correct an Individual's address and/or phone number, make the correction directly on the list. This attachment must have two different notarized sigr.stures - one by an ` officer of the organization and one by the primary operator if you are I` renewing a license to conduct. If you are o lessor, manufacturer, or distributor, two different notarized signatures are required, unless you are a sole ow:;sr. 1NDIVID?!AL LIST: (1) DEKUEHN, VERA M Home Addresst 807 RYAN RD SSN: 131286610 DENTON, TX 762050000 DL h 04212478 - TX Phone nbr: 817-387-9946 Races W Sext F DOB: 07-13-1936 Positton(s)t WORKER (2) ROBY, 7AYID G Home Address: 700 DEL DRIVE SSN: 379640550 DENTON, TX 762010000 DL #s 13194014 - TX Phone nbr: 817-382-1715 Races W Sext M D08t 12-14-1953 Potation(s): WORKER (3) THOMPSON, TOMMIE 8 Home Addresst 2415 BOWLING GREEN SSN: 449609267 DENTON, TX 762010000 DL #1 04693928 - TX Phone nbrs 817-382-3118 Races W Sext F DOB: 03-07-1940 Position(s): WORKER (4) FLOWERS, WILLIAM D Home Address: 2328 KtNGST')N TRACE SSN: 450804090 UENTON, TX 762010000 DL #1 05671249 - TX Phone nbr: 817-387-6925 Pace: W Sext M DOB: 06-15-1948 Position(s): WORKER (5) KRUEGEP, JEFF L Home Address: 1001 EDINBURG SSNt 451113450 DENTON, TX 76201 DL 4: 08455243 - TX Phone nbrt 817-566-5608 Racer W Sex: M DOB: 10-23-1959 Position(s;t WORKER (6) LANDERS, ROY Home Addresst 1005 CARROLL ST SSN: 451109381 DENTON, TX 762010000 DL #'s 01417714 - TX Phone nbrt 817-382-6854 Races Sext DOB: 02-18-1911 Position(s)t OFFICER 40-kLKfC' (7) PEERS, MAX INE A PAGE : 4 Home Address: BOX 576 SSNs 454325640 KRUM, TX 762490000 DL ns 04443374 - iX Phons nbrf 000-000-0000 Pecs: W Sex: F DOB: 04-02-1925 Posltlon(s)s WORKER (8) WATKINS, BILLIE Home Address AT P2 ROYAL OAKS EST SSNS 456366125 DENTON, TX 762010000 D1. #s Oo373541 - TX Phone nbr 817-382-5518 r Positicn(s)t DIRECTOR Racas W Sexs F DOB: 09-23-1930 (9) EWING, OEOAGE C Homn Address: 6016 HARRISON WAY SSNt 456644164 WATAUGA, TX 761480000 DL 03604108 - TX Phone nbr: 817-498-6096 Races W Sexs M DOBt 07-12-1943 Position(s): WORKER (10) HOPKINS, LINDA Home Addreset BOX 1624 SSNS 462768855 DEN7ON, TX 762020000 DL is 06930251 - TX Phone nbrf 817-382-6641 Races W Sexs F DOB: 07-17-1946 Position(s)! DIRECTOR WORKER -v- (11) MUNDY, BILL B Home Address: 3328 DUNES SSNt 463528272 DENTON, TX 762010000 DL #1 03435110 - tX Phone nbrf A17-387-1777 Races W Sext H DOBr 07-01-1937 Position(s)! WORKER (12) MUNDY, WANDA J Home Addrelst 3328 DUNES SSN: 466500987 DENTON, TX 762010000 DL b 04163495 - TX Phone nbr: 817-387-1777 Races W Sex: F DOB: 09-10-1937 Position(s): WORKER (13) PEERS, ARCHIE Home Addresst BDX 576 SSN: 414180228 KRUM, TX 762490000 DL (2t 03788427 - TX Phone nbrf 817-482-6389 Races W Sexs F DOSS 04-20-1922 Position(s): DIRECTOR _ PRI OPER OPERATOR WORKER (14) DOWNEY, FRANCIS 1J Home Address: BOX 1247 SSNS 482202644 DENTON, 1X 762020000 DL Ot 07358659 - TX Phone nbrf 000-000-0000 Rece: W Sexs M DOB: 10-11-1925 Position(s): DIRECTOR _ OPERATOR WORKER W (15) SEATON, ELDON 1 t LJ'L R k PAGE S ,s Home Address 2 SSNS 509324767 DENTGN, TX 762010000 DL //s 07712279 - 1X Phone nbr: 817-3$2-3109 Racer Sexs DOBr *~a+ahtk r Position(s)t WORKER (16) KRUEGER, GLENNA Homo Addressr PO BOX 442 SSNS 310344621 SANGER, TX 762660000 DL #s 07024755 - TX Phone nbrs 817-458-3925 Position(s)t WORKER Races W Sexr F Wes 06-03-1933 j i i i PAGE t 6 AFf,IDAVIT OF RESPONSIBILITY We certify that the attached list of indi-+iduals and posttions is current and correct as submitted. We declare that no person named on this list has ever been convicted of a felony, gambling offense, criminal fraud or o crime of moral turpitude. OFFICER OF THE ORGANIZATION/APPLICANT (other than primary operator) Sign heret - Title! Date: Sworn to and subscribed before me, a Notary Public, on this the day of My commission espirest 19__._ Notary Public (sign here)- 1 PRINARY OPERATOR/OFFICER i Sign here: A-24. T{tlet _ Date1 + Sworn to and subscribed before me, a Notary Public, on this the ,1Q day of M , 19~ Hy commission expires: Notary Public (sign here): Ab_1 IMPORTANT This RENEWAL NOTICE with your renewal application, supplement and fee MUST be delivered to your enforcement field office. It will be forwarded to Austin ONLY upon receiving clearance from that office. END O F Li FILE