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Raffle Application

Steps

1. Raffle Application This section is complete This section is incomplete
2. Applicant Information This section is complete This section is incomplete
3. Officers / Directors This section is complete This section is incomplete
4. Operators / Advertisers This section is complete This section is incomplete
5. Financial Obligations This section is complete This section is incomplete
6. Raffle Location This section is complete This section is incomplete
7. Required Attachments This section is complete This section is incomplete
8. Signature Agreement This section is complete This section is incomplete

Raffle Application

GLYNN COUNTY SHERIFF OFFICE RAFFLE APPLICATION
Please fill out the application information in order to obtain a raffle license.
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Applicant Information

Name of Applicant
Home Address
City
State
ZIP Code
Phone Number
Fax Number
Email Address
Name of Entity, Organization, Corporation
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Officers / Directors

Please provide the names and home addresses of the officers of the organization and the names and home addresses of the directors or other persons similarly situated with the organization.
Name
Title
Address
City
State
Zip Code
Name
Title
Address
City
State
Zip Code
Name
Title
Address
City
State
Zip Code
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Operators / Advertisers

Please provide the names and home addresses of each person who will be operating, advertising or promoting the raffle.
Name
Address
City
State
Zip Code
Name
Address
City
State
Zip Code
Name
Address
City
State
Zip Code
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Financial Obligations

Please provide the names and home addresses of each person, organization or other legal entity that will act as surety for the applicant or to which the applicant is financially indebted or to which any financial obligation is owed by the applicant.
Name
Address
City
State
Zip Code
Name
Address
City
State
Zip Code
Name
Address
City
State
Zip Code
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Raffle Location

Please provide the location at which the Raffle will be conducted. If the premises is leased, a copy of the lease or rental agreement must be attached
Address
City
State
Zip Code
Rental / Lease Information
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Required Attachments

Coversheet of the Organization's Letterhead is required stating the date of the raffle, what will be raffle, and the location of the raffle.
File Upload
Letter from Internal Revenue Service certifying federal tax exemption status
File Upload
Letter from Georgia Department of Revenue certifying state tax exemption status
File Upload
Criminal History/background check for each individual for any person(s) listed in this application
File Upload
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Signature Agreement

Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature
Date
Date

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1. Receive an email copy of this form.
Email address

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Raffle Application

Steps

Raffle Application

Applicant Information

Officers / Directors

Operators / Advertisers

Financial Obligations

Raffle Location

Required Attachments

Signature Agreement

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