DESERT VALLEY OASIS DBA MESA ARIZONA ACRES, LLC REDACTED.PDF

Applicant's Name (as shown on page 1)
\I\ 1\04, t,& r:1"2,01/\,k, APPLICATION FOR BINGO LICENSE.
15 List the name(s) of the person(s) who will serve as assistants. If applying as a qualified organization, each person must be a
member or new member of the applicant. Except for "Class A" licensees, each person must submit an affidavit.
16 Street address of he physical z location where bingo will played:
73 —026
17 Indicate the time on each respective day that bingo will be played:
SUN MON TUE WED THUR FRI SAT
,
• a.m. • a.m. ...1 • a.m. • a.m. 1111 a.m. • a.m. Darn.
, Rpm , Rpm , f. '1)(2 ,pm , , MI p m ,Rpm I Rpm I
18 List dates of proposed game cancellation if any:
19 Indicate the type of premises where bingo will be played. Check one box:
a a Neither rent nor mortgage will be paid from bingo funds.
b (71 Rented or leased. Attach rental affidavit and copy of rental agreement.
Landlord's Name Address — Number and Street, Rural Rt., Apt. No.
Telephone Number (with area code) City State ZIP Code
c fl Owned solely by the organization. Attach copy of mortgage, deed of trust, purchase agreement, escrow agreement, or
other related document:
Holder of Mortgage Address — Number and Street, Rural Rt., Apt. No.
Telephone Number (with area code) City State ZIP Code
d ID Owned jointly with other organization. Attach copy of mortgage, deed of trust, purchase agreement, escrow agreement, or
other related document:
1) Holder of Mortgage Address — Number and Street, Rural Rt., Apt. No.
Telephone Number (with area code) City State ZIP Code
2) Co-Owner Holder: Address — Number and Street, Rural Rt., Apt. No.
Telephone Number (with area code) City State ZIP Code
3) Co-Owner Holder: Address — Number and Street, Rural Rt., Apt. No.
---I
Telephone Number (with area code) City State ZIP Code
Continued on page
ADOR 10334 (1114) Arizona Form 833 Page 3 of E
Previous 71-1010 (4/06)

Applicant's Name (as shown on page 1)
QX264( Dobii3 &\3&, .1)Vyi .20k eX651 APPUCATION FOR BINGO LCI:
20 List bingo licensees who are or will be conducting bingo in the same premises as you and those licensees located within 1,000
feet of your premises:
20a Name 20b Name
Address — Number and Street, Rural Rt., Apt. No. Address — Number and Street, Rural Rt., Apt. No.
City State ZIP Code City State ZIP Code
21 Expected bingo expenses:
a Mortgage: per month
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
b Rent: sAl per El month El hour El occasion
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
c Janitorial Services: $, f't , per o month El hour o occasion
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
d Accounting Services: 5, Ai / /4 , per o month i:1 hour El occasion
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
e Security Services: , per El month El hour El occasion
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
f Bingo Supplies: 4:2-",per
Address — Number and Street, Rural Rt., Apt. No.
3/0 / AC, /Zed
City State ZIP Code
NOR_Ar Og 73069
Line 21 continues on page 5
ADOR 10334 (1/14) Arizona Form 833 Page 4 of 5
Previous 71-1010 (4/06)