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CHARITABLE ORGANIZATION LICENSE APPLICATION

Page 1 of 15 FOR OFFICIAL USE ONLY: $25 Fee Paid Commonwealth of Kentucky Public Protection Cabinet DEPARTMENT OF CHARITABLE GAMING Form CG-1 2018 CHARITABLE ORGANIZATION LICENSE APPLICATION A COMPLETE APPLICATION MUST BE RECEIVED AT LEAST 60 DAYS PRIOR TO THE INTENDED START OF GAMING OR BEFORE THE EXPIRATION OF YOUR CURRENT LICENSE . GENERAL ORGANIZATION INFORMATION * Information provided in this section may be available to the public on the Department s website. 1. ORGANIZATION s Federal Employer Identification No. Expiration date: 2. ORGANIZATION s Name: ORG- Mailing Address: City: State: Zip Code: Telephone: ( ) Email Address: Web Address: 3.

Page 4 of 15 10b. Provide details below of how the organization spent money toward its charitable purpose. Examples include: personnel expenses, mortgage or building payments, office equipment, supplies, utilities,

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