Form Gc-2b - Application For Games Of Chance License - New York Division Of Charitable Gaming

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Division of Charitable Gaming
GC-2B Application for Games of Chance License
Name of Organization: _______________________________________________________________________
Games of Chance Identification Number: ____________________________
Date: __________________
SCHEDULE 5:DATES, HOURS AND RENT OF ALL LICENSE PERIODS TO BE HELD
(NOT APPLICABLE FOR BELL JAR GAMES)
DATE
HOURS
RENT
____/_____/_____
________:_________am/pm - ________:_________am/pm
$ ___________________
____/_____/_____
________:_________am/pm - ________:_________am/pm
$ ___________________
____/_____/_____
________:_________am/pm - ________:_________am/pm
$ ___________________
____/_____/_____
________:_________am/pm - ________:_________am/pm
$ ___________________
____/_____/_____
________:_________am/pm - ________:_________am/pm
$ ___________________
____/_____/_____
________:_________am/pm - ________:_________am/pm
$ ___________________
____/_____/_____
________:_________am/pm - ________:_________am/pm
$ ___________________
____/_____/_____
________:_________am/pm - ________:_________am/pm
$ ___________________
____/_____/_____
________:_________am/pm - ________:_________am/pm
$ ___________________
____/_____/_____
________:_________am/pm - ________:_________am/pm
$ ___________________
_________________________________________________________________________________________________
RAFFLES
DATE
HOURS
PRIZES
(Cash or Fair
Market Value of Merchandise)
____/_____/_____
________:_________am/pm - ________:_________am/pm
$ ___________________
____/_____/_____
________:_________am/pm - ________:_________am/pm
$ ___________________
____/_____/_____
________:_________am/pm - ________:_________am/pm
$ ___________________
____/_____/_____
________:_________am/pm - ________:_________am/pm
$ ___________________
____/_____/_____
________:_________am/pm - ________:_________am/pm
$ ___________________
____/_____/_____
________:_________am/pm - ________:_________am/pm
$ ___________________
SCHEDULE 6:
EXPENSES
List items of expense to be incurred, and the names and addresses of vendors.
ITEM OF EXPENSE
VENDOR NAME
ADDRESS
STATE
ZIP
____________________ ________________________ ___________________________________ _______ ________
____________________ ________________________ ___________________________________ _______ ________
____________________ ________________________ ___________________________________ _______ ________
____________________ ________________________ ___________________________________ _______ ________
____________________ ________________________ ___________________________________ _______ ________
Page 1 of 2
GC-2B (Rev. 2/2014)

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