Transcription of LICENSED CHARITABLE GAMING FACILITY …
{{id}} {{{paragraph}}}
Example: air traffic controller
LICENSED CHARITABLE GAMING FACILITY …
Reviewed By:CG-FAC11/13 Quarter: 1 __ 2 __ 3 __ 4 __ (check one)Calendar Year: _____ FACILITY NAME: _____ license NO. FAC-_____ LICENSEE NAME: _____ MAILING ADDRESS (Licensee): _____ LOCATION OF FACILITY : Street Address: _____ City: _____ County: _____ Under penalty of perjury, I declare that I have examined this report, including any accompanying schedules and attachments, and to the best of my knowledge and belief it is a true, correct, and complete report.
Organization Name Organization License # Total Rent Owed During Quarter Total Rent Paid During Quarter Rent Due 30 Days Past Due 60 Days Past Due
Loading..
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document: