DREAMLAND VILLA REDACTED.PDF

Applicants Name (as shown on page 1)
DREAMLAND VILLA COMMUNITY CLUB 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.
15a Name 15b Name
CVn Mundav Mary Seamandel
15c Name 15d Name
Earl Munday Jim Doherty
16e Name 15f Name
15g Name 15h Name
16 Street address of the physical location where bingo will be played:
6159 E. University Dr.. Mesa. AZ 85205
17 Indicate the time on each respective day that bingo will be played:
SUN MON TUE WED THUR FRI SAT
Dam. Dam. Dam. Dam. Dam. • a.m. Dam.
1 ,Dp.m. 1...1 -3 ,114p m 1 iljp m , . p m . , • p m i • p m . , p m
18 List dates of proposed game cancellation if any:
N/A
19 Indicate the type of premises where bingo will be played. Check one box:
El Neither rent nor mortgage will be paid from bingo funds.
b CI 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 a 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.
N (4
Telephone Number (with area code) City State ZIP Code
d ri Owned jointly with other organization. Attach cony 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.
iN1 IA
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 RL, Apt. No.
Telephone Number (with area code) City State ZIP Code
Continued on page 4 4

Applicant's Name (as shown on page 1)
DREAMLAND VILLA COMMUNITY CLUB APPLICATION FOR BINGO LICENSE
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
N/A N/A
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 Mortoaoe: $1 0.00 , per month
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
b Rent: $ 0.00 , per CI month CI hour CI occasion
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
c Janitorial Services: $10 00 , per £71 month J hour El occasion
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
d Accounting Services: si_O_QQ , per CI month CI hour CI occasion
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
e Security Services: $,CLOC) per 11 month J hour 71 occasion
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
f Bingo Supplies: $ 250.00 , per month
Payable to Address — Number and Street, Rural Rt., Apt. No.
Cactus Bingo Supply 3210 E Roeser Rd.. Suite #15
Telephone number (with area code) City State ZIP Code
(602) 268-2848 Phoenix AZ 8504030
Line 21 continues on page 5

Applicant's Name (as shown on page 1)
DREAMLAND VILLA COMMUNITY CLUB APPLICATION FOR BINGO LICENSE
21 Expected Bingo Expenses, continued...
g Maximum prize payout per occasion: $, 3.000.00 ,. Attach game schedule that lists individual prize amounts.
Paid to Address — Number and Street, Rural Rt., Apt. No.
Winners at Location 6159 E. Universtity
Telephone number (with area code) City State ZIP Code
(262) 853 -7725 Mesa AZ 85205
h Utility Expenses:
Electric (payable to) Address - Number and Street, Rural Rt., Apt. No.
NA
Account Number Monthly Amount City State ZIP Code
$
Gas (payable to) Address — Number and Street, Rural Rt., Apt. No.
NA
Account Number Monthly Amount City State ZIP Code
$
Water (payable to) Address — Number and Street, Rural Rt., Apt. No.
NA
Account Number Monthly Amount City State ZIP Code
$
Trash Removal (payable to) Address — Number and Street, Rural Rt., Apt. No.
NA
Account Number Monthly Amount City State ZIP Code
$
22 Briefly state the specific projected use of net proceeds from games of bingo:
Financial support of facilities, activities, and entertainment programs at Farnsworth Hall, one of two community
centers in Dreamland Villa.
I, Jim Seamandel , under penalty of perjury and upon oath, declare that I am duly authorized to sign
and file this application. I hereby swear or confirm that I have read the foregoing application and know the contents thereof and that
all information provided has been fully, accurately, and truthfully completed to the best of my knowledge.
(f) 0)Ol Manager
DATE TITLE
Please mail to: Arizona Department of Revenue, PO Box 29019, Phoenix, AZ 85038-9019
rr (602) 716-7801

Arizona Form 832 Endorsement by Local Governing Body Bingo
FOR OFFICIAL USE ONLY PURSUANT TO A.R.S. § 5-404.A
• License Applicants: Complete lines 2, 3, and 4. Submit with entire license package to local governing body.
• Local Governing Body: Complete and return with license package to the Department of Revenue Bingo Section.
n Date License Number
New Application Change of Location June 3. 2015 07-336-B
From (Name of local governing body)
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
Address (number and street, PO Box) 88
City State ZIP Code
Phone No. (with area code)
*1 This is to certify that on la hearing was conducted pursuant to Arizona Revised Statute, Title 5,
Chapter 4, in the matter of:
0 Application for a bingo license by the following applicant.
0 Application for a bingo license location transfer.
2 Applicant's Name
DREAMLAND VILLA COMMUNITY CLUB
3 Location/Address where games will be conducted: City State ZIP Code
6159 E University Dr Mesa - 85205
4 Fill in the time on the days games will be played:
SUN MON TUE WED THUR FRI SAT
Oa.m. Dam. Dam. N a.m. Dam. • a.m. • a.m.
1 , •Pm :1-3 .013 in . i Op rn . , OP m , E3p m , t OP m t -10P.m,
5 Background investigations:
0 have 0 have not been conducted on all individuals listed in the Bingo License Application.
6 Recommendation for the application: 0 Approved 0 Disapproved
7 Specific reasons for disapproval are hereby listed pursuant to § 5-404.1:
This endorsement must be signed by a delegated authority of the local governing body.
PRINTED NAME
SIGNATURE DATE TITLE
Please mail to: Arizona Department of Revenue, PO Box 29019, Phoenix, AZ 85038-9019
ADOR 10326 (1/14) Tr (602) 716-7801
71Ann9 minm








DREAMLAND VILLA BINGO
6159 E. University, Mesa, AZ 85206
Monday: Games Start at 1 p.m.
You must be 18 years of age to play Bingo. You are not allowed to split packs. You must Bingo on the last number called. Once the caller starts to
call the next number or letter of the next ball, no previous Bingo will be honored and the game shall continue. You must use a dauber to mark your
cards. Please be considerate of the other players. Loud talking or disruptive behavior will not be tolerated. Please silence your cell phones. P4
GOOD LUCK AND HAVE FUN?
GAME 1 SPECIAL GAME 8
Betty Boop ip Picnic Table (as shown)
70, 80, or 90% payout In Gray Boarder
11.11111. $100.00
UWE.
GAME 2 GAME 9
X-mas Tree (as shown) Elm Lazy E (as shown)
Blue Border ini Olive Border
=I
$100.00 $100.00
GAME 3 GAME 10
4 Corners Any Regular Bingo
Orange Border Brown Boarder
$100.00 $100.00
GAME 4 GAME 11
' Anchor (as Shown) Wild #4 Corner Triangle (4 combinations)
Green Border Red Boarder
$100.00 $100.00
GAME 12
Champagne Glass (as shown) Wild #5
Yellow Border Purple Border
NM $100.00 $100.00
11111
GAME 6 SPECIAL GAME 13
Small Diamond & 4 Corners Pot of Gold —Coverall
N•'
Pink Border Yellow Solid
MEI $100.00 80/20
EMI
1/ 2 18/ 33/ 51/ 61/ SPECIAL GAME 7
19 34 52 62 Double Action
4/5 20/21 35/36 53/54 63/64 Coverall
Color Orange
6/7 22/23 free 55156 65/66
70/30
8/9 24/25 39/40 57/58 67/68
10/11 26/27 41/42 60/49 69/70
INTERMISSION

DREAMLAND VILLA BINGO
6159 E. University, Mesa, AZ 85206
Monday: Games Start at 1 p.m.
You must be 18 years of age to play Bingo. You are not allowed to split packs. You must Bingo on the last number called. Once the caller starts to
call the next number or letter of the next ball, no previous Bingo will be honored and the game shall continue. You must use a dauber to mark your
cards. Please be considerate of the other players. Loud talking or disruptive behavior will not be tolerated. Please silence your cell phones. P3
GOOD LUCK AND HAVE FUNI
GAME 1 SPECIAL GAME 8
Betty Boop ODD/EVEN Coverall
• 70, 80, or 90% payout = 50/50
111/
MIMI
GAME 2 GAME 9
Hangman's Knot Double Bingo
Blue Border Diagonal and Straight Line
$100.00 Gray Boarder
• $100.00
GAME 3 GAME 10
Lucky Seven (as shown) Top OR Bottom T
Orange Border Olive Border
$100.00 $100.00
GAME 4 GAME 11
Corner Stamp & a Line (No diagonal) Crazy Small Kite (all ways)
Green Border Brown Boarder
Ell Swam° $100.00
EMI
GAME 5 GAME 12
9-Pack anywhere Double Stamp from any corneer
III Yellow Border Red Border
EMI $100.00 $100.00
INN
GAME 6 GAME 13
Missing Link Right or left flag (on top only)
Pink Border Purple Border
11111 $100.00 $100.00
111111
1/2 18/ 33/ 51/ 61/ SPECIAL GAME 7 SPECIAL GAME 14
19 34 52 62 Double Action Pot of Gold —Coverall
4/5 20/21 35/36 53/54 63/64 Coverall Yellow Solid
6/7 22/23 free 55/56 65/66 Color Orange 80/20
70/30
8/9 24/25 39/40 57/58 67/68
10/11 26/27 41/42 60/49 69/70
INTERMISSION

DREAMLAND VILLA BINGO
6159 E. University, Mesa, AZ 85206
Monday: Games Start at 1 p.m.
You must be 18 years of age to play Bingo. You are not allowed to split packs. You must Bingo on the last number called. Once the caller starts to
call the next number or letter of the next ball, no previous Bingo will be honored and the game shall continue. You must use a dauber to mark your
cards. Please be considerate of the other players. Loud talking or disruptive behavior will not be tolerated. Please silence your cell phones. P2
GOOD LUCK AND HAVE FUN1
GAME 1 SPECIAL GAME 8
Betty Boop Outside line & 1 opposite Corner
70, 80, or 90% payout Gray Boarder
GAME 2 GAME 9
Goal Post (as shown) Check Mark (as is)
Blue Border Olive Border
$100.00 IIII $100.00
IIII
GAME 3 GAME 10
EINE Heart Double Plus Sign (as shown)
Orange Border • • Brown Boarder
iiii. $100.00 En $100.00
Mill III
GAME 4 GAME 11
Large Diamond Chevron (4 combinations)
Green Border Red Boarder
$100.00 $100.00
GAMES GAME 12
ii um Plus Sign min Regular Bingo OR 4 Corners
• Yellow Border • Purple Border
111111 $100.00 • .
MIME. MIN
GAMES SPECIAL GAME 13
7-11 Wild #7 Pot of Gold —Coverall
Pink Border 11.1111 Yellow Solid
$100.00 MIMI 80/20
Mil
1/2 18/ 33/ 51/ 61/ SPECIAL GAME 7
19 34 52 62 Double Action
4/5 20/21 35/36 53/54 63/64 Coverall
Color Orange
6/7 22/23 free 55/56 65/66
70/30
8/9 24/25 39/40 57/58 67/68
10/11 26/27 41/42 60/49 69/70
INTERMISSION

DREAMLAND VILLA BINGO
6159 E. University, Mesa, AZ 85206
Monday: Games Start at 1 p.m.
You must be 18 years Of age to play Bingo. You are not allowed to split packs. You must Bingo on the last number called. Once the caller starts to
call the next number or letter of the next ball, no previous Bingo will be honored and the game shall continue. You must use a dauber to mark your
cards. Please be considerate of the other players. Loud talking or disruptive behavior will not be tolerated. Please silence your cell phones. P1
GOOD LUCK AND HAVE FUN!
GAME 1 SPECIAL GAME 8
Betty Boop • m ODD/EVEN Coverall
• 70, 80, or 90% payout 1111 ... .111 50/50
II .
111111 1111
GAME 2 GAME 9
Division Sign (as shown) Any Two 3-Corner Brackets
In Blue Border Gray Boarder
1111 $100.00 $100.00
MIN
GAME 3 GAME 10
rn iiim Large Diamond (as shown) Top OR Bottom Line
MI Orange Border Olive Border
1111111111 $100.00 III $100.00
• 111111111 MIN
GAME 4 GAME 11
3 X3 X3 Crazy Arrow (all ways)
Green Border Brown Boarder
$100.00 $100.00
GAME 5 GAME 12
Double Hardway (no free space) 6 Around-the-Corner
Yellow Border II Red Border
$100.00 II MEI $100.00
11 EMI
GAME 6 GAME 13
Stamp & Diagonal • Letter X
Pink Border • Purple Border
$100.00 $100.00
1/2 18/ 33/ 51/ 61/ SPECIAL GAME 7 SPECIA GAME 14
19 34 52 62 Double Action Pot of Gold — Coverall
4/5 20/21 35/36 53/54 63/64 Coverall Yellow Solid
5/7 22/23 free 55/56 65/65 Color Orange 11 80/20
70/30
8/9 24/25 39/40 57/58 67/68 11
10/11 26/27 41/42 60/49 69/70
INTERMISSION