info@dc.gov
Office of the Chief Technology Officer, Washington, DC, US
Application Type
Date of Application
Organization Information
Full Name
Full Address
Is the member in charge 18 years of age or older?
Is the deputy member in charge 18 years of age or older?
Is the member 18 years of age or older?
RAFFLE Class of License (MARK ONE)
BINGO Class of License (MARK ONE)
*NOTE: Fee for qualifying senior citizen groups is $10. (Class D Recreational Bingo for Senior Citizen groups will be issued as regular bingo license only)
MONTE CARLO Class of License (MARK ONE)
Applicant is making application as a senior citizen group.
Applicant is incorporated as a non-profit group since:
Principal activity of applicant organization
Date / Time of Event
Prize Information
LIST TWENTY ACTIVE MEMBERS OF THE APPLICANT ORGANIZATION, (TEN IF SENIOR CITIZENS GROUP).Â
Member 1
Member 2
Member 3
Member 4
Member 5
Member 6
Member 7
Member 8
Member 9
Member 10
Member 11
Member 12
Member 13
Member 14
Member 15
Member 16
Member 17
Member 18
Member 19
Member 20
If prize is donated, submit letter from donor stating that the item is an irrevocable gift to the organization.
Item 1
Item 2
Item 3
Item 4
Item 5
Item 6
Item 7
Item 8
Item 9
Item 10
Certificate of good standing from the D.C. Department of Consumer and Regulatory Affairs (DCRA).
Copy of Applicants constitution articles or bylaws.
A copy of the applicants tax exempt status (IRS or D.C. Finance and Revenue letter of determination).
List of prizes.
Surety Bond of Aggregated Prize Value or Provide Confirmation Letter From Donors
Proof of use of venue ex: One of the following: Copy of Certificate of Occupancy, Copy of Rental Agreement, or Letter of Approval From Building Administrator.
A copy of the agreement with the licensed supplier (if applicable).
A list of games to be played at the event (if applicable).
House rules (if applicable).
Sample ticket (if applicable).
