Form LE 7-8_COMB Application for a Bingo-Raffles License - Colorado

Form LE7-8_COMB or the "Application For A Bingo-raffles License" is a form issued by the Colorado Secretary of State.

Download a PDF version of the Form LE7-8_COMB down below or find it on the Colorado Secretary of State Forms website.

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License Number to be issued by
License Fee: $100.00
Department of State:
Make check payable to
“Secretary of State”
_______________________________
1700 Broadway, Ste 200
Date issued: ____________________
Denver, Colorado 80290
APPLICATION FOR A BINGO-RAFFLES LICENSE
This application must be filed with the Secretary of State.
1. Application is for a:
New license.
I have included c
opies of articles, bylaws, charter, rules, constitution, or similar organizational documents that were
dated and executed at least 5 years ago and show membership qualifications and purposes.
I have included
dated items in the organization's name to show organizational continuity (at least one from each of
the past five years.) See instructions for examples.
Renewal. If renewal, most recent year licensed: ______________
2. Name of organization: __________________________________________________________________________________
3. Address:
__________________________________________________________________
Street and /or PO Box
______________________________
___________________ _____________
City
County
ZIP Code
Organizational phone: _________________
Organizational e-mail: ____________________________________________
FEIN: _____________________
4. Type of organization (see instructions)
Religious
Charitable
Labor
Fraternal
Educational
Vol. Firemen's
Veterans
5. Names and addresses of officers or board members of organization:
__________________________________ ________________________ __________________________________________
Name
Title
Address
_______________________________ ____________________ _________________________
City
Zip Code
Phone
__________________________________ ________________________ __________________________________________
Name
Title
Address
_______________________________ ____________________ _________________________
City
Zip Code
Phone
__________________________________ ________________________ __________________________________________
Name
Title
Address
_______________________________ ____________________ _________________________
City
Zip Code
Phone
6. Number of active members in good standing:
____________
LE7-8_COMB
Page 1 of 4
Rev. 5/24/2017
License Number to be issued by
License Fee: $100.00
Department of State:
Make check payable to
“Secretary of State”
_______________________________
1700 Broadway, Ste 200
Date issued: ____________________
Denver, Colorado 80290
APPLICATION FOR A BINGO-RAFFLES LICENSE
This application must be filed with the Secretary of State.
1. Application is for a:
New license.
I have included c
opies of articles, bylaws, charter, rules, constitution, or similar organizational documents that were
dated and executed at least 5 years ago and show membership qualifications and purposes.
I have included
dated items in the organization's name to show organizational continuity (at least one from each of
the past five years.) See instructions for examples.
Renewal. If renewal, most recent year licensed: ______________
2. Name of organization: __________________________________________________________________________________
3. Address:
__________________________________________________________________
Street and /or PO Box
______________________________
___________________ _____________
City
County
ZIP Code
Organizational phone: _________________
Organizational e-mail: ____________________________________________
FEIN: _____________________
4. Type of organization (see instructions)
Religious
Charitable
Labor
Fraternal
Educational
Vol. Firemen's
Veterans
5. Names and addresses of officers or board members of organization:
__________________________________ ________________________ __________________________________________
Name
Title
Address
_______________________________ ____________________ _________________________
City
Zip Code
Phone
__________________________________ ________________________ __________________________________________
Name
Title
Address
_______________________________ ____________________ _________________________
City
Zip Code
Phone
__________________________________ ________________________ __________________________________________
Name
Title
Address
_______________________________ ____________________ _________________________
City
Zip Code
Phone
6. Number of active members in good standing:
____________
LE7-8_COMB
Page 1 of 4
Rev. 5/24/2017
7. a) If a corporation, give date of incorporation: ____________
b) If not a corporation, give date of
organizational founding:
____________
8. State the specific purpose(s) to which the entire net proceeds from games of chance are to be devoted:
9. Applicant intends to hold (mark all that apply):
Bingo
Raffles
Pull tabs
10. a) Address of place where
BINGO is to be conducted: ___________________________________ ______________________ _______________
Street
City
ZIP Code
Day(s) bingo is held: _______________________________________________________________________________
Time(s): ___________________________________________________________
Mark:
Weekly
Monthly
Are premises to be rented to applicant?
Yes
No
If yes, terms of rental: _______________________________________________________________________________
b) Address of place where RAFFLES are to be conducted (physical address MUST be shown before a license is issued):
___________________________________ ______________________ _______________
Street
City
ZIP Code
Date(s) of drawing(s): _________________________________________________________________________________
Time(s): _____________________________________________________________
If day and time are not known at time of application, this office must be notified of day/time at least 2 weeks prior to games and before any
chances are sold.
11. Designate games manager in charge:
Name: ___________________________________________________
Phone: Home _________________
Business _________________
Address:
___________________________________ ______________________ _______________
Street
City
ZIP Code
Certificate number: _______________ E-mail address: __________________________________________
LE7-8_COMB
Page 2 of 4
Rev. 5/24/2017
Games Manager’s Oath
I, ______________________________________, games manager for _____________________________________________,
take oath under penalty of perjury as defined in C.R.S 18-8-503 and punishable by law, that I have read and am familiar with
the provisions of the Colorado constitution, statutes, and rules governing bingo and raffles and will be responsible for the
conduct of all games of chance activities in accord with those provisions and the terms of the bingo-raffle license and that I have
been certified as a games manager by the Sec. of State in accord with C.R.S. 24-21-609(2) .
Signature: _______________________________________________
Date: ____________________
I, ______________________________________, am an authorized individual pursuant to the organizational articles/bylaws to
make this application on behalf of the above-named organization, and the organization is eligible for licensing pursuant to the
provisions of Article XVIII shown above. I have read the referenced constitutional provisions and the laws and rules governing
bingo and raffles and will be responsible for the applicant's compliance with them. No commission, salary, compensation,
reward or recompense will be paid to any person for holding, operating, or conducting games of chance or for assisting therein
except as provided in Title 24, Article 21, Part 6, Colorado Revised Statutes. I solemnly swear, under penalty of perjury as
defined in C.R.S. 18-8-503 and punishable by law, that I have read and know the contents of this application, and all the matters
set forth are true and complete to my knowledge.
Signature: _______________________________________________
Date: ____________________
LE7-8_COMB
Page 3 of 4
Rev. 5/24/2017
Roster of Member in Charge and Members Assisting in Bingo-Raffle Activities
Please complete this roster and attach it to the license application. You may substitute the applicant organization’s membership
mailing list for item 4 by attaching the list to this form.
NOTE: Items 1-3 and the certification must be completed even if a membership list is substituted for item 4.
1. Date: _____________________
2. Name of Organization:
________________________________________________________________________
3. Name of Member in Charge
(Certified Games Manager):
________________________________________________________________________
4. Names of members assisting with bingo-raffle activities:
First Name
Last Name
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Certification
I certify that the individuals shown on this roster and/or the attached list are bona fide, active members of the
applicant organization and will be responsible, if a license is issued, for assisting with the operation of bingo-raffle
activities in accord with law.
Signature of member in charge (games manager): ___________________________________________
Address of games manager: ___________________________________ ______________________ _______________
Street
City
ZIP Code
Phone number of games manager: _____________________________
LE7-8_COMB
Page 4 of 4
Rev. 5/24/2017
Instructions for a Bingo-Raffle License, Roster of Member in Charge and Members Assisting
Please note: Both new and renewal applications must be accompanied by a roster of all bona fide, active
members who will be assisting in your games of chance activities.
New applicants: Attach copies of articles, bylaws, charter, rules, constitution and/or similar
organizational documents, dated and executed at least 5 years ago, showing membership qualifications
and purposes. In addition, attach dated items in the organization's name, at least one from each of the past
five years, to show organizational continuity. Please use bank or audit statements, checks, corporate or
other periodic reports, publications, tax returns, exemption certificates and/or other independent records of
organizational existence.
Note: No new license will be issued without proof of both five years continuous existence and of a
qualified membership engaged in carrying out the objects of your organization during the entire five-year
period. Renewal applications do not need to resubmit proofs.
Section 2: Name of organization must be specific and consistent throughout the application and all
documentation. If the organization is a corporation, LLC, or other entity on file with the Secretary of
State, the name on the application must match the name on file. On a renewal application, name must be
exactly as it appeared on the prior application and license. All name changes must be documented when
applying for a new or renewal license.
Section 4: Designate type of organization applying. Applicant must be one of the seven types of
organizations listed and defined in the bingo-raffles law (see CRS 24-21-602). No additional categories are
allowed.
Section 5: Show all requested information (name, title, addresses and telephone) for each officer/board
member.
Section 6: Show total number of all bona fide, qualified, active members in the applicant organization.
Section 7: Must contain the date of incorporation (7a) and/or date of founding (7b) of applying organization.
Section 8: Must show specific purposes for games of chance proceeds are to be spent. Please be as detailed as
possible when completing this section.
Section 10: All applications must show at least one physical address for the conduct of games of chance. This
address is required to be printed on each license issued. If games location is tentative at time of application
and is changed later, licensee must obtain an address amendment from the Secretary of State. License
amendments are free of charge, but must be requested in writing at least 2 weeks prior to the use of the new
location for any games activity. NOTE: Rental agreements must be filed with the secretary of state on
approved forms before any rental can be authorized. Issuance of a bingo-raffle license does not constitute
rental approval. Submit rental agreement with application or prior to any use of rental premises for games of
chance.
Section 11: Give complete information for member who will have overall supervision and management of
such games, and will be responsible for the holding, operating, and conduct of such games of chance in
accordance with the terms of the license and the provisions of the law.
Note: Games manger must be trained and certified by the secretary of state’s office before assuming any
games management duties, and before any license can be issued. Games manager must be an active bona fide
LE7-8_COMB_HELP
Page 1 of 2
Rev. 5/24/2017

Download Form LE 7-8_COMB Application for a Bingo-Raffles License - Colorado

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