Form GC-317 "Application to Request the Disbursement of Games of Chance Net Proceeds" - New York

What Is Form GC-317?

This is a legal form that was released by the New York State Gaming Commission - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2017;
  • The latest edition provided by the New York State Gaming Commission;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form GC-317 by clicking the link below or browse more documents and templates provided by the New York State Gaming Commission.

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Download Form GC-317 "Application to Request the Disbursement of Games of Chance Net Proceeds" - New York

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GC-317: Application to Request the Disbursement
of Games of Chance Net Proceeds
__________________________________________________________________________________________________________
1)
Name of Organization: _______________________________________________________________
2)
Mailing Address: ____________________________________________________________________
3)
Phone Number: ____________________________
4)
Games of Chance ID Number: _________________
5)
Name and address of officer(s) responsible for use of proceeds:
______________________________
__________________________ ____________________________
(Print Name)
(Print Title)
(Home Address)
____________________________________________
___________________________________
______________
(City, Town or Village)
(State)
(Zip Code)
______________________________
__________________________
___________________________
(Print Name)
(Print Title)
(Home Address)
____________________________________________
___________________________________
______________
(City, Town or Village)
(State)
(Zip Code)
________________________________________________________________________________________________
6)
Amount of disbursement for which permission is sought: $______________________
7)
Describe purpose for which the proceeds will be used: _________________________________________
_____________________________________________________________________________________
8)
Total unexpended balance in Games of Chance Account(s): $___________________________
Provide a copy of your most recent bank statements. (Note: Include all related savings accounts and CDs)
9)
Amount realized from the conduct of Games of Chance during the past calendar year:$_____
Page 1 of 2
One Broadway Center, P.O. Box 7500, Schenectady, NY 12301-7500
GC-317 (Rev. 7/2017)
www.gaming.ny.gov
GC-317: Application to Request the Disbursement
of Games of Chance Net Proceeds
__________________________________________________________________________________________________________
1)
Name of Organization: _______________________________________________________________
2)
Mailing Address: ____________________________________________________________________
3)
Phone Number: ____________________________
4)
Games of Chance ID Number: _________________
5)
Name and address of officer(s) responsible for use of proceeds:
______________________________
__________________________ ____________________________
(Print Name)
(Print Title)
(Home Address)
____________________________________________
___________________________________
______________
(City, Town or Village)
(State)
(Zip Code)
______________________________
__________________________
___________________________
(Print Name)
(Print Title)
(Home Address)
____________________________________________
___________________________________
______________
(City, Town or Village)
(State)
(Zip Code)
________________________________________________________________________________________________
6)
Amount of disbursement for which permission is sought: $______________________
7)
Describe purpose for which the proceeds will be used: _________________________________________
_____________________________________________________________________________________
8)
Total unexpended balance in Games of Chance Account(s): $___________________________
Provide a copy of your most recent bank statements. (Note: Include all related savings accounts and CDs)
9)
Amount realized from the conduct of Games of Chance during the past calendar year:$_____
Page 1 of 2
One Broadway Center, P.O. Box 7500, Schenectady, NY 12301-7500
GC-317 (Rev. 7/2017)
www.gaming.ny.gov
10) Have you used Games of Chance proceeds for this purpose in the past? _____
If so, how much: $___________
11) Has a previous application been filed for this or any other expenditure? ______
If yes, provide a copy of all NYS Gaming Commission approval letters for the last four years.
12) List other sources of income and amounts per year: __________________________________
______________________________________________________________________________
13) Will any of the money you propose to spend be used to erect, equip, maintain or renovate a bar or bar
room?
___________________________________________________________________________________
14) Have you solicited bids for the proposed project? __________ (If yes, submit copies of at least two bids.)
15) If proceeds are to be used for building repairs or new construction, give location of premises where repairs
or
construction
will
be
done.
.
____________________________________________________________________________________
16) Does organization have title to its premises? _______ If not, furnish name of owner. _________
17) Has any real property of the organization been sold? _________
17a) If so, for how much and what disposition was made of the proceeds? ____________________________
____________________________________________________________________________________
18) List other mortgages or conditional sales contracts outstanding against this property. _______________
____________________________________________________________________________________
I hereby swear (or affirm) that I have read and am familiar with Commission Rule 4624.21 and that the
information and statements contained herein have been examined by me and to the best of my knowledge and
belief are true, correct and complete.
________________________________ ______________________________ _______________________________
(Signature)
(Print Name)
(Title)
_________________
________________________________
______________________________________
(Date)
(Phone Number)
(Email Address)
Page 2 of 2
One Broadway Center, P.O. Box 7500, Schenectady, NY 12301-7500
GC-317 (Rev. 7/2017)
www.gaming.ny.gov
Page of 2