61 Pa. Code § 901.191 - License application form
(a)
The Department will proscribe the license application form for eligible
organizations. Licensing authorities may obtain the form from the
Department.
(b) The form is
available to eligible organizations through the licensing
authorities.
(c) The license
application form must contain, at a minimum, the following information:
(1) The name of the organization.
(2) The type of organization.
(3) The address of the
organization.
(4) Incorporation
information.
(5) The name of the
municipality where the applicant will maintain its licensed premises.
(6) The eligible organization's licensed
premises.
(7) The eligible
organization's operating day and week.
(8) The names, addresses and telephone
numbers of the officers of the organization.
(9) Partnership information.
(10) A list of shareholders owning 10% or
more of outstanding stock.
(11) The
names and addresses of persons who will be responsible for the operation of
games of chance, including eligible organization employees, bar personnel,
auxiliary group members and other persons who will obtain the games of chance
and coordinate their use.
(12) A
statement under oath in the form of an affidavit, affirmed by the executive
officer or secretary of the eligible organization, stating the following:
(i) A person 17 years of age or younger will
not be permitted by the eligible organization to operate or play games of
chance.
(ii) The facility in which
games of chance are to be played has adequate means of ingress and egress and
adequate sanitary facilities available in the area and meets Department of
Health and other local or Federal sanitary requirements.
(iii) The eligible organization is the owner
of the premises upon which the games of chance are played or, if it is not, the
eligible organization is not leasing the premises from the owner thereof under
an oral agreement, nor is it leasing the premises from the owner thereof under
a written agreement at a rental which is determined by the amount of receipts
realized from the playing of games of chance or by the number of people
attending, except that an eligible organization may lease a location or
premises for a banquet where a per head charge is applied in connection with
the serving of a meal.
(13) A copy of a corporate applicant articles
of incorporation and bylaws; or, if not a corporation, a copy of bylaws and
other documents which set out the organizational structure and
purpose.
(14) A copy of a nonprofit
charitable applicant's Internal Revenue Service tax exemption letter if one has
been obtained and a copy of other documents indicating the eligible
organization is a nonprofit charitable organization.
(15) The details and copies of the lease,
rental or other arrangements between the applicant and the owner of premises
upon which the games of chance will be conducted, if the premises are not owned
by the eligible organization.
(16)
The names, addresses, dates of birth and the Social Security numbers of each
paid employee, auxiliary group member or agent who will be involved with the
activities for which the license is sought.
(17) Other documents as identified in the
application materials.
(18) The
type of license applied for and a list of all types of games of chance to be
operated by the eligible organization.
(19) A list of distributors of games of
chance with whom the eligible organization does business.
(20) A list of the eligible organization's
auxiliary groups that will operate games of chance under the eligible
organization's license.
Notes
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