Bingo License Application Redacted

City of Apache Junction — Regular Meeting (2026-11-03)

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REDACTED
Arizona Form 833 Application for Bingo License
* Type or print in black ink and complete all information requested on this form. If you do not, your application will be retumed. Alt
information is subject to verification. If you need more space, attach additional sheets.
* All bingo licenses expire one year from the date of issue. To continue conducting live bingo games, you must renew your license
prior to the expiration date pursuant to A.R.S. §§ 5-403(C) and 5-410.
"Hatileen A Funk Falsification of information
PiU
5	1	14	1	1	2	478	546	204	188	67.375336	Schade
5	1	14	1	1	3	721	600	98	79	73.952095	St
2	1	15	0	0	0	1675	575	627	96	-1	
3	1	15	1	0	0	1675	575	627	96	-1	
4	1	15	1	1	0	1675	575	627	40	-1	
5	1	15	1	1	1	1675	575	197	32	96.280014	contained
5	1	15	1	1	2	1905	575	35	32	96.074638	in
5	1	15	1	1	3	1971	575	75	33	96.074638	this
5	1	15	1	1	4	2076	575	226	40	96.083725	application
4	1	15	1	2	0	1675	630	563	41	-1	
5	1	15	1	2	1	1675	630	224	32	95.547928	constitutes
5	1	15	1	2	2	1910	637	24	25	95.547928	a
5	1	15	1	2	3	1948	630	102	33	96.059845	Class
5	1	15	1	2	4	2064	631	23	32	96.224724	6
5	1	15	1	2	5	2100	630	138	41	96.058990	felony.
2	1	16	0	0	0	2348	494	6	196	-1	
3	1	16	1	0	0	2348	494	6	196	-1	
4	1	16	1	1	0	2348	494	6	196	-1	
5	1	16	1	1	1	2348	494	6	196	95.000000	 
2	1	17	0	0	0	187	676	2165	13	-1	
3	1	17	1	0	0	187	676	2165	13	-1	
4	1	17	1	1	0	187	676	2165	13	-1	
5	1	17	1	1	1	187	676	2165	13	95.000000	 
2	1	18	0	0	0	1101	691	72	25	-1	
3	1	18	1	0	0	1101	691	72	25	-1	
4	1	18	1	1	0	1101	691	72	25	-1	
5	1	18	1	1	1	1101	691	72	25	96.757454	State
2	1	19	0	0	0	200	684	959	101	-1	
3	1	19	1	0	0	200	684	959	101	-1	
4	1	19	1	1	0	200	684	959	101	-1	
5	1	19	1	1	1	200	688	36	25	77.023132	ab
5	1	19	1	1	2	242	687	54	32	86.176376	City
5	1	19	1	1	3	314	684	226	90	93.109505	Thom
5	1	19	1	1	4	549	685	130	100	78.646942	Sor)
5	1	19	1	1	5	1035	723	124	52	61.375519	x
2	1	20	0	0	0	1242	691	135	26	-1	
3	1	20	1	0	0	1242	691	135	26	-1	
4	1	20	1	1	0	1242	691	135	26	-1	
5	1	20	1	1	1	1242	691	50	25	96.471390	ZIP
5	1	20	1	1	2	1302	691	75	26	96.471390	Code
2	1	21	0	0	0	1248	718	225	57	-1	
3	1	21	1	0	0	1248	718	225	57	-1	
4	1	21	1	1	0	1248	718	225	57	-1	
5	1	21	1	1	1	1248	718	225	57	2.220268	tabs
2	1	22	0	0	0	1638	698	701	23	-1	
3	1	22	1	0	0	1638	698	701	23	-1	
4	1	22	1	1	0	1638	698	701	23	-1	
5	1	22	1	1	1	1638	698	133	21	96.106308	REVENUE
5	1	22	1	1	2	1781	698	55	22	95.475349	USE
5	1	22	1	1	3	1846	698	79	22	95.475349	ONLY.
5	1	22	1	1	4	1936	698	39	22	96.701767	DO
5	1	22	1	1	5	1985	698	58	22	95.988731	NOT
5	1	22	1	1	6	2052	698	82	22	96.186073	MARK
5	1	22	1	1	7	2145	699	26	21	95.314445	IN
5	1	22	1	1	8	2181	698	63	23	95.681702	THIS
5	1	22	1	1	9	2253	698	86	22	92.013016	AREA.
2	1	23	0	0	0	1636	726	38	40	-1	
3	1	23	1	0	0	1636	726	38	40	-1	
4	1	23	1	1	0	1636	726	38	40	-1	
5	1	23	1	1	1	1636	726	38	40	57.696693	13
2	1	24	0	0	0	187	772	1413	11	-1	
3	1	24	1	0	0	187	772	1413	11	-1	
4	1	24	1	1	0	187	772	1413	11	-1	
5	1	24	1	1	1	187	772	1413	11	95.000000	 
2	1	25	0	0	0	200	780	562	90	-1	
3	1	25	1	0	0	200	780	562	90	-1	
4	1	25	1	1	0	200	780	562	90	-1	
5	1	25	1	1	1	200	784	33	25	96.135712	3a
5	1	25	1	1	2	241	784	201	27	95.874550	Administrative
5	1	25	1	1	3	452	784	81	27	96.884041	Office
5	1	25	1	1	4	454	780	78	90	48.383148	Uw,
5	1	25	1	1	5	574	785	30	81	40.984074	B
5	1	25	1	1	6	634	780	128	90	58.603218	Rood
2	1	26	0	0	0	259	810	260	61	-1	
3	1	26	1	0	0	259	810	260	61	-1	
4	1	26	1	1	0	259	810	260	61	-1	
5	1	26	1	1	1	259	810	260	61	40.959282	HDs
5	1	26	1	1	2	456	806	64	69	64.381912	Ww
2	1	27	0	0	0	185	871	1415	8	-1	
3	1	27	1	0	0	185	871	1415	8	-1	
4	1	27	1	1	0	185	871	1415	8	-1	
5	1	27	1	1	1	185	871	1415	8	95.000000	 
2	1	28	0	0	0	1100	883	71	26	-1	
3	1	28	1	0	0	1100	883	71	26	-1	
4	1	28	1	1	0	1100	883	71	26	-1	
5	1	28	1	1	1	1100	883	71	26	96.607803	State
2	1	29	0	0	0	1074	910	107	61	-1	
3	1	29	1	0	0	1074	910	107	61	-1	
4	1	29	1	1	0	1074	910	107	61	-1	
5	1	29	1	1	1	1074	910	107	61	60.411903	fz
2	1	30	0	0	0	198	881	578	95	-1	
3	1	30	1	0	0	198	881	578	88	-1	
4	1	30	1	1	0	198	881	98	32	-1	
5	1	30	1	1	1	198	881	36	23	92.027878	3b
5	1	30	1	1	2	271	882	25	31	73.054474	Gity
4	1	30	1	2	0	371	883	405	93	-1	
5	1	30	1	2	1	371	883	405	93	34.988480	esunctren
2	1	31	0	0	0	1242	883	133	26	-1	
3	1	31	1	0	0	1242	883	133	26	-1	
4	1	31	1	1	0	1242	883	133	26	-1	
5	1	31	1	1	1	1242	885	48	24	96.030960	ZIP
5	1	31	1	1	2	1300	883	75	26	95.975677	Code
2	1	32	0	0	0	1235	910	226	65	-1	
3	1	32	1	0	0	1235	910	226	65	-1	
4	1	32	1	1	0	1235	910	226	65	-1	
5	1	32	1	1	1	1235	910	226	65	23.899469	25148
2	1	33	0	0	0	185	967	1415	8	-1	
3	1	33	1	0	0	185	967	1415	8	-1	
4	1	33	1	1	0	185	967	1415	8	-1	
5	1	33	1	1	1	185	967	1415	8	95.000000	 
2	1	34	0	0	0	196	969	698	160	-1	
3	1	34	1	0	0	196	969	700	160	-1	
4	1	34	1	1	0	196	969	698	160	-1	
5	1	34	1	1	1	196	977	35	23	96.969612	4a
5	1	34	1	1	2	241	971	79	158	31.898846	ke
5	1	34	1	1	3	317	969	99	99	48.884842	oth
5	1	34	1	1	4	440	978	14	24	90.369545	|
5	1	34	1	1	5	456	978	152	86	17.226181	wie
5	1	34	1	1	6	662	989	102	70	0.000000	—
5	1	34	1	1	7	771	971	123	95	52.135994	nk.
2	1	35	0	0	0	1105	980	478	85	-1	
3	1	35	1	0	0	1105	980	478	85	-1	
4	1	35	1	1	0	1105	980	478	85	-1	
5	1	35	1	1	1	1105	980	478	85	0.000000	_——
2	1	36	0	0	0	185	1063	2165	9	-1	
3	1	36	1	0	0	185	1063	2165	9	-1	
4	1	36	1	1	0	185	1063	2165	9	-1	
5	1	36	1	1	1	185	1063	2165	9	95.000000	 
2	1	37	0	0	0	448	983	4	116	-1	
3	1	37	1	0	0	448	983	4	116	-1	
4	1	37	1	1	0	448	983	4	116	-1	
5	1	37	1	1	1	448	983	4	116	95.000000	 
2	1	38	0	0	0	185	485	12	680	-1	
3	1	38	1	0	0	185	485	12	680	-1	
4	1	38	1	1	0	185	485	12	680	-1	
5	1	38	1	1	1	185	485	12	680	95.000000	 
2	1	39	0	0	0	1095	971	6	196	-1	
3	1	39	1	0	0	1095	971	6	196	-1	
4	1	39	1	1	0	1095	971	6	196	-1	
5	1	39	1	1	1	1095	971	6	196	95.000000	 
2	1	40	0	0	0	196	1069	280	94	-1	
3	1	40	1	0	0	196	1069	280	94	-1	
4	1	40	1	1	0	196	1069	280	94	-1	
5	1	40	1	1	1	196	1073	35	25	93.869492	4c
5	1	40	1	1	2	241	1074	88	24	95.751915	E-mail
5	1	40	1	1	3	227	1069	165	94	47.842922	mana
5	1	40	1	1	4	430	1074	46	85	87.317581	K
2	1	41	0	0	0	469	1076	614	124	-1	
3	1	41	1	0	0	469	1076	614	124	-1	
4	1	41	1	1	0	469	1076	614	124	-1	
5	1	41	1	1	1	469	1084	121	75	92.894592	ate
5	1	41	1	1	2	607	1096	141	64	45.915508	E5@
5	1	41	1	1	3	732	1076	21	124	31.506262	2
5	1	41	1	1	4	773	1076	166	124	7.607412	amaul:
5	1	41	1	1	5	960	1101	123	61	71.160767	Com
2	1	42	0	0	0	1105	1077	145	25	-1	
3	1	42	1	0	0	1105	1077	145	25	-1	
4	1	42	1	1	0	1105	1077	145	25	-1	
5	1	42	1	1	1	1105	1079	35	23	94.441795	4c
5	1	42	1	1	2	1150	1077	50	25	94.441795	Fax
5	1	42	1	1	3	1212	1079	38	23	96.965240	No
2	1	43	0	0	0	2034	1076	149	50	-1	
3	1	43	1	0	0	2034	1076	149	50	-1	
4	1	43	1	1	0	2034	1076	149	50	-1	
5	1	43	1	1	1	2034	1076	46	50	43.723904	80}
5	1	43	1	1	2	2092	1080	91	24	90.031395	RCVD
2	1	44	0	0	0	1629	1077	105	48	-1	
3	1	44	1	0	0	1629	1077	105	48	-1	
4	1	44	1	1	0	1629	1077	105	48	-1	
5	1	44	1	1	1	1629	1077	105	48	37.589737	[a7]
5	1	44	1	1	2	1702	1063	33	66	69.891914	PM
2	1	45	0	0	0	1217	1122	241	16	-1	
3	1	45	1	0	0	1217	1122	241	16	-1	
4	1	45	1	1	0	1217	1122	241	16	-1	
5	1	45	1	1	1	1217	1122	241	16	95.000000	 
2	1	46	0	0	0	1594	490	10	680	-1	
3	1	46	1	0	0	1594	490	10	680	-1	
4	1	46	1	1	0	1594	490	10	680	-1	
5	1	46	1	1	1	1594	490	10	680	95.000000	 
2	1	47	0	0	0	184	1158	1415	11	-1	
3	1	47	1	0	0	184	1158	1415	11	-1	
4	1	47	1	1	0	184	1158	1415	11	-1	
5	1	47	1	1	1	184	1158	1415	11	95.000000	 
2	1	48	0	0	0	128	1123	940	191	-1	
3	1	48	1	0	0	128	1123	940	191	-1	
4	1	48	1	1	0	128	1123	940	191	-1	
5	1	48	1	1	1	128	1123	235	191	48.586807	ihe
5	1	48	1	1	2	387	1230	23	28	91.987938	B
5	1	48	1	1	3	426	1230	62	28	95.928322	and
5	1	48	1	1	4	504	1230	94	28	93.154160	Class
5	1	48	1	1	5	607	1216	19	55	92.709969	C
5	1	48	1	1	6	656	1230	121	29	96.551704	license
5	1	48	1	1	7	792	1231	176	34	96.669891	applicants
5	1	48	1	1	8	985	1231	83	36	96.658432	only:
4	1	48	1	2	0	276	1277	201	34	-1	
5	1	48	1	2	1	276	1277	201	34	96.629707	organization:
2	1	49	0	0	0	285	1333	591	90	-1	
3	1	49	1	0	0	285	1333	591	90	-1	
4	1	49	1	1	0	285	1333	591	38	-1	
5	1	49	1	1	1	285	1333	36	36	26.758827	OO
5	1	49	1	1	2	335	1337	163	28	95.261383	Charitable
5	1	49	1	1	3	730	1335	35	36	35.625996	OO
5	1	49	1	1	4	781	1339	95	28	95.808540	Social
4	1	49	1	2	0	285	1385	192	38	-1	
5	1	49	1	2	1	285	1385	36	38	66.925797	D
5	1	49	1	2	2	337	1390	140	29	96.421722	Fraternal
2	1	50	0	0	0	730	1387	472	41	-1	
3	1	50	1	0	0	730	1387	472	41	-1	
4	1	50	1	1	0	730	1387	472	41	-1	
5	1	50	1	1	1	730	1387	35	36	46.449642	C
5	1	50	1	1	2	781	1394	150	27	96.824219	Volunteer
5	1	50	1	1	3	944	1394	58	27	96.414177	Fire
5	1	50	1	1	4	1015	1394	187	34	96.414177	Department
2	1	51	0	0	0	1620	490	9	727	-1	
3	1	51	1	0	0	1620	490	9	727	-1	
4	1	51	1	1	0	1620	490	9	727	-1	
5	1	51	1	1	1	1620	490	9	727	95.000000	 
2	1	52	0	0	0	1620	1211	730	6	-1	
3	1	52	1	0	0	1620	1211	730	6	-1	
4	1	52	1	1	0	1620	1211	730	6	-1	
5	1	52	1	1	1	1620	1211	730	6	95.000000	 
2	1	53	0	0	0	1101	1231	1258	39	-1	
3	1	53	1	0	0	1101	1231	1258	39	-1	
4	1	53	1	1	0	1101	1231	1258	39	-1	
5	1	53	1	1	1	1101	1231	19	28	83.792450	If
5	1	53	1	1	2	1133	1234	132	34	96.800163	applying
5	1	53	1	1	3	1282	1239	35	22	96.211517	as
5	1	53	1	1	4	1335	1240	17	21	96.088928	a
5	1	53	1	1	5	1367	1233	133	34	96.841339	qualified
5	1	53	1	1	6	1517	1233	204	35	94.897804	organization,
5	1	53	1	1	7	1739	1234	94	28	96.403641	check
5	1	53	1	1	8	1848	1240	59	22	96.621246	one
5	1	53	1	1	9	1923	1234	57	28	96.856400	box
5	1	53	1	1	10	1995	1235	28	27	96.994591	to
5	1	53	1	1	11	2039	1234	123	29	96.727989	indicate
5	1	53	1	1	12	2179	1235	48	28	96.727989	the
5	1	53	1	1	13	2244	1238	68	32	96.707413	type
5	1	53	1	1	14	2328	1234	31	29	96.726784	of
2	1	54	0	0	0	1810	1337	519	92	-1	
3	1	54	1	0	0	1810	1337	519	92	-1	
4	1	54	1	1	0	1810	1337	192	36	-1	
5	1	54	1	1	1	1810	1337	36	36	44.359051	0
5	1	54	1	1	2	1861	1342	141	28	94.946991	Veterans
4	1	54	1	2	0	1810	1390	519	39	-1	
5	1	54	1	2	1	1810	1390	36	37	36.862930	CJ
5	1	54	1	2	2	1862	1394	144	35	96.165550	Nonprofit
5	1	54	1	2	3	2015	1396	181	27	96.587822	Ambulance
5	1	54	1	2	4	2208	1396	121	27	96.587822	Service
2	1	55	0	0	0	1269	1336	453	89	-1	
3	1	55	1	0	0	1269	1336	453	89	-1	
4	1	55	1	1	0	1269	1336	198	39	-1	
5	1	55	1	1	1	1269	1336	37	37	0.000000	C
5	1	55	1	1	2	1321	1342	146	33	95.994522	Religious
4	1	55	1	2	0	1269	1390	453	35	-1	
5	1	55	1	2	1	1269	1390	37	35	42.183777	(1
5	1	55	1	2	2	1321	1395	210	27	90.962265	Homeowners
5	1	55	1	2	3	1541	1395	181	28	95.854691	Association
2	1	56	0	0	0	275	1469	2080	40	-1	
3	1	56	1	0	0	275	1469	2080	40	-1	
4	1	56	1	1	0	275	1469	2080	40	-1	
5	1	56	1	1	1	275	1469	93	28	96.496178	Class
5	1	56	1	1	2	383	1469	26	27	95.231285	8
5	1	56	1	1	3	423	1469	62	28	96.752937	and
5	1	56	1	1	4	501	1469	93	28	93.012817	Class
5	1	56	1	1	5	603	1465	20	48	91.727982	C
5	1	56	1	1	6	652	1469	119	29	83.398758	ticense
5	1	56	1	1	7	785	1471	177	33	96.668640	applicants
5	1	56	1	1	8	978	1471	70	36	96.054596	only
5	1	56	1	1	9	1066	1472	130	35	96.054596	applying
5	1	56	1	1	10	1213	1479	35	21	96.808121	as
5	1	56	1	1	11	1264	1479	18	21	96.808121	a
5	1	56	1	1	12	1296	1471	134	35	96.193672	qualified
5	1	56	1	1	13	1446	1475	204	33	96.871750	organization,
5	1	56	1	1	14	1664	1473	133	35	96.577522	provide
5	1	56	1	1	15	1808	1476	114	32	95.904808	parent
5	1	56	1	1	16	1935	1481	38	21	96.530762	or
5	1	56	1	1	17	1983	1475	148	34	96.891808	auxiliary
5	1	56	1	1	18	2144	1475	211	27	96.311844	information:
2	1	57	0	0	0	273	1508	2081	13	-1	
3	1	57	1	0	0	273	1508	2081	13	-1	
4	1	57	1	1	0	273	1508	2081	13	-1	
5	1	57	1	1	1	273	1508	2081	13	95.000000	 
2	1	58	0	0	0	283	1523	230	25	-1	
3	1	58	1	0	0	283	1523	230	25	-1	
4	1	58	1	1	0	283	1523	230	25	-1	
5	1	58	1	1	1	283	1523	34	25	96.039894	6a
5	1	58	1	1	2	329	1523	91	25	95.645226	Parent
5	1	58	1	1	3	430	1524	83	24	95.645226	Name
2	1	59	0	0	0	1319	1527	259	32	-1	
3	1	59	1	0	0	1319	1527	259	32	-1	
4	1	59	1	1	0	1319	1527	259	32	-1	
5	1	59	1	1	1	1319	1527	37	25	95.194931	6b
5	1	59	1	1	2	1362	1527	120	32	31.128616	Auxiliary
5	1	59	1	1	3	1494	1527	84	25	96.208229	Name
2	1	60	0	0	0	271	1605	2081	12	-1	
3	1	60	1	0	0	271	1605	2081	12	-1	
4	1	60	1	1	0	271	1605	2081	12	-1	
5	1	60	1	1	1	271	1605	2081	12	95.000000	 
2	1	61	0	0	0	281	1617	692	33	-1	
3	1	61	1	0	0	281	1617	692	33	-1	
4	1	61	1	1	0	281	1617	692	33	-1	
5	1	61	1	1	1	281	1617	118	26	93.070091	Address
5	1	61	1	1	2	408	1631	19	5	81.612770	—
5	1	61	1	1	3	436	1618	114	25	94.861908	Number
5	1	61	1	1	4	559	1619	52	24	96.784927	and
5	1	61	1	1	5	623	1619	83	25	91.479126	Street.
5	1	61	1	1	6	727	1619	73	25	93.274544	Rural
5	1	61	1	1	7	812	1619	30	25	92.327065	Rt.,
5	1	61	1	1	8	854	1620	60	30	90.924995	Apt.
5	1	61	1	1	9	934	1619	39	25	96.944153	No
2	1	62	0	0	0	1319	1621	699	32	-1	
3	1	62	1	0	0	1319	1621	699	32	-1	
4	1	62	1	1	0	1319	1621	699	32	-1	
5	1	62	1	1	1	1319	1621	117	25	93.088127	Address
5	1	62	1	1	2	1446	1635	18	3	92.184975	—
5	1	62	1	1	3	1475	1621	113	25	95.099678	Number
5	1	62	1	1	4	1596	1621	51	25	95.099678	and
5	1	62	1	1	5	1658	1621	92	27	94.851158	Street.
5	1	62	1	1	6	1764	1621	72	25	93.284821	Rural
5	1	62	1	1	7	1850	1621	46	27	49.495766	Rt..
5	1	62	1	1	8	1905	1621	53	32	96.558052	Apt.
5	1	62	1	1	9	1973	1623	45	24	95.424461	No,
2	1	63	0	0	0	271	1703	2081	10	-1	
3	1	63	1	0	0	271	1703	2081	10	-1	
4	1	63	1	1	0	271	1703	2081	10	-1	
5	1	63	1	1	1	271	1703	2081	10	95.000000	 
2	1	64	0	0	0	860	1715	278	25	-1	
3	1	64	1	0	0	860	1715	278	25	-1	
4	1	64	1	1	0	860	1715	278	25	-1	
5	1	64	1	1	1	860	1715	74	25	96.132904	State
5	1	64	1	1	2	1005	1717	48	23	75.228287	ZIP
5	1	64	1	1	3	1063	1717	75	23	94.951904	Code
2	1	65	0	0	0	281	1712	55	33	-1	
3	1	65	1	0	0	281	1712	55	33	-1	
4	1	65	1	1	0	281	1712	55	33	-1	
5	1	65	1	1	1	281	1712	55	33	79.499382	City
2	1	66	0	0	0	271	1510	6	294	-1	
3	1	66	1	0	0	271	1510	6	294	-1	
4	1	66	1	1	0	271	1510	6	294	-1	
5	1	66	1	1	1	271	1510	6	294	95.000000	 
2	1	67	0	0	0	335	1792	11	8	-1	
3	1	67	1	0	0	335	1792	11	8	-1	
4	1	67	1	1	0	335	1792	11	8	-1	
5	1	67	1	1	1	335	1792	11	8	0.000000	a
2	1	68	0	0	0	1315	1713	860	44	-1	
3	1	68	1	0	0	1315	1713	860	44	-1	
4	1	68	1	1	0	1315	1713	860	44	-1	
5	1	68	1	1	1	1315	1713	58	42	96.890251	City
5	1	68	1	1	2	1898	1713	73	44	96.148857	State
5	1	68	1	1	3	2040	1719	50	25	95.447960	ZIP
5	1	68	1	1	4	2100	1717	75	27	95.447960	Code
2	1	69	0	0	0	1308	1513	3	295	-1	
3	1	69	1	0	0	1308	1513	3	295	-1	
4	1	69	1	1	0	1308	1513	3	295	-1	
5	1	69	1	1	1	1308	1513	3	295	95.000000	 
2	1	70	0	0	0	2348	1517	5	292	-1	
3	1	70	1	0	0	2348	1517	5	292	-1	
4	1	70	1	1	0	2348	1517	5	292	-1	
5	1	70	1	1	1	2348	1517	5	292	95.000000	 
2	1	71	0	0	0	271	1799	2081	10	-1	
3	1	71	1	0	0	271	1799	2081	10	-1	
4	1	71	1	1	0	271	1799	2081	10	-1	
5	1	71	1	1	1	271	1799	2081	10	95.000000	 
2	1	72	0	0	0	157	1800	2197	113	-1	
3	1	72	1	0	0	157	1800	2197	113	-1	
4	1	72	1	1	0	157	1800	2197	113	-1	
5	1	72	1	1	1	157	1800	76	113	0.000000	7
5	1	72	1	1	2	251	1800	114	113	0.000000	oass
5	1	72	1	1	3	387	1854	23	28	93.273849	B
5	1	72	1	1	4	427	1854	63	28	95.805092	and
5	1	72	1	1	5	508	1854	95	29	92.638496	Class
5	1	72	1	1	6	623	1854	23	29	92.638496	C
5	1	72	1	1	7	667	1856	119	27	96.509026	license
5	1	72	1	1	8	804	1856	175	34	96.421799	applicants
5	1	72	1	1	9	1000	1857	71	33	95.771194	only
5	1	72	1	1	10	1090	1857	131	35	96.302979	applying
5	1	72	1	1	11	1241	1864	36	20	96.110672	as
5	1	72	1	1	12	1296	1864	17	20	95.782867	a
5	1	72	1	1	13	1331	1857	135	33	95.782867	qualified
5	1	72	1	1	14	1485	1858	203	34	93.292648	organization,
5	1	72	1	1	15	1705	1850	62	46	81.271706	Jist
5	1	72	1	1	16	1782	1850	54	46	96.185577	the
5	1	72	1	1	17	1855	1850	119	46	96.179573	current
5	1	72	1	1	18	1989	1850	135	46	96.504578	officers
5	1	72	1	1	19	2142	1850	39	46	95.647522	or
5	1	72	1	1	20	2200	1850	92	46	95.996925	Board
5	1	72	1	1	21	2311	1850	47	46	96.202553	of
2	1	73	0	0	0	271	1943	2079	10	-1	
3	1	73	1	0	0	271	1943	2079	10	-1	
4	1	73	1	1	0	271	1943	2079	10	-1	
5	1	73	1	1	1	271	1943	2079	10	95.000000	 
2	1	74	0	0	0	271	1902	1175	182	-1	
3	1	74	1	0	0	271	1902	1175	175	-1	
4	1	74	1	1	0	271	1902	506	35	-1	
5	1	74	1	1	1	271	1902	506	35	95.671547	Directors
5	1	74	1	1	2	442	1898	30	50	96.844589	of
5	1	74	1	1	3	487	1898	51	50	96.976990	the
5	1	74	1	1	4	554	1902	223	35	63.950756	organization:
4	1	74	1	2	0	281	1954	1165	28	-1	
5	1	74	1	2	1	281	1954	34	25	65.509331	7a
5	1	74	1	2	2	325	1954	84	25	65.509331	Name
5	1	74	1	2	3	1319	1957	35	25	88.652557	7b
5	1	74	1	2	4	1362	1957	84	25	96.596222	Name
4	1	74	1	3	0	276	2045	1099	39	-1	
5	1	74	1	3	1	276	2045	64	39	96.226494	Title
5	1	74	1	3	2	1317	2054	58	23	96.498810	Title
2	1	75	0	0	0	269	2040	2081	9	-1	
3	1	75	1	0	0	269	2040	2081	9	-1	
4	1	75	1	1	0	269	2040	2081	9	-1	
5	1	75	1	1	1	269	2040	2081	9	95.000000	 
2	1	76	0	0	0	269	2136	2081	8	-1	
3	1	76	1	0	0	269	2136	2081	8	-1	
4	1	76	1	1	0	269	2136	2081	8	-1	
5	1	76	1	1	1	269	2136	2081	8	95.000000	 
2	1	77	0	0	0	280	2145	698	32	-1	
3	1	77	1	0	0	280	2145	698	32	-1	
4	1	77	1	1	0	280	2145	698	32	-1	
5	1	77	1	1	1	280	2145	116	24	93.284523	Address
5	1	77	1	1	2	406	2158	19	4	90.865700	—
5	1	77	1	1	3	435	2145	113	26	94.475990	Number
5	1	77	1	1	4	558	2146	51	25	94.475990	and
5	1	77	1	1	5	621	2145	90	28	96.183640	Street,
5	1	77	1	1	6	725	2146	73	25	92.749115	Rural
5	1	77	1	1	7	810	2146	46	27	78.885269	Rt..
5	1	77	1	1	8	865	2147	54	30	96.462090	Apt.
5	1	77	1	1	9	933	2147	45	24	96.883446	No.
2	1	78	0	0	0	1316	2148	700	31	-1	
3	1	78	1	0	0	1316	2148	700	31	-1	
4	1	78	1	1	0	1316	2148	700	31	-1	
5	1	78	1	1	1	1316	2148	117	25	93.249619	Address
5	1	78	1	1	2	1451	2144	14	39	40.676460	~
5	1	78	1	1	3	1471	2148	114	25	96.883049	Number
5	1	78	1	1	4	1594	2149	52	23	96.651611	and
5	1	78	1	1	5	1657	2148	91	27	96.651611	Street,
5	1	78	1	1	6	1760	2148	75	25	96.071503	Rural
5	1	78	1	1	7	1846	2150	47	27	49.003101	Rt,
5	1	78	1	1	8	1902	2150	55	29	96.644691	Apt.
5	1	78	1	1	9	1969	2150	47	23	94.700699	No.
2	1	79	0	0	0	269	2230	2081	9	-1	
3	1	79	1	0	0	269	2230	2081	9	-1	
4	1	79	1	1	0	269	2230	2081	9	-1	
5	1	79	1	1	1	269	2230	2081	9	95.000000	 
2	1	80	0	0	0	269	2326	2080	11	-1	
3	1	80	1	0	0	269	2326	2080	11	-1	
4	1	80	1	1	0	269	2326	2080	11	-1	
5	1	80	1	1	1	269	2326	2080	11	95.000000	 
2	1	81	0	0	0	268	2424	2081	8	-1	
3	1	81	1	0	0	268	2424	2081	8	-1	
4	1	81	1	1	0	268	2424	2081	8	-1	
5	1	81	1	1	1	268	2424	2081	8	95.000000	 
2	1	82	0	0	0	269	2520	2080	8	-1	
3	1	82	1	0	0	269	2520	2080	8	-1	
4	1	82	1	1	0	269	2520	2080	8	-1	
5	1	82	1	1	1	269	2520	2080	8	95.000000	 
2	1	83	0	0	0	269	2616	2080	8	-1	
3	1	83	1	0	0	269	2616	2080	8	-1	
4	1	83	1	1	0	269	2616	2080	8	-1	
5	1	83	1	1	1	269	2616	2080	8	95.000000	 
2	1	84	0	0	0	371	2696	25	17	-1	
3	1	84	1	0	0	371	2696	25	17	-1	
4	1	84	1	1	0	371	2696	25	17	-1	
5	1	84	1	1	1	371	2696	25	17	42.414364	Pa
2	1	85	0	0	0	276	2234	1897	431	-1	
3	1	85	1	0	0	276	2234	1897	132	-1	
4	1	85	1	1	0	276	2234	1897	47	-1	
5	1	85	1	1	1	276	2234	58	43	96.998909	City
5	1	85	1	1	2	858	2238	73	43	96.281334	State
5	1	85	1	1	3	1002	2243	48	26	95.703926	ZIP
5	1	85	1	1	4	1060	2243	76	26	96.589211	Code
5	1	85	1	1	5	1313	2238	57	43	96.777031	City
5	1	85	1	1	6	1896	2244	72	26	96.348808	State
5	1	85	1	1	7	2038	2246	50	24	95.662376	ZIP
5	1	85	1	1	8	2098	2246	75	25	96.573738	Code
4	1	85	1	2	0	280	2337	1164	29	-1	
5	1	85	1	2	1	280	2337	34	24	34.372288	7c
5	1	85	1	2	2	323	2337	84	26	95.127869	Name
5	1	85	1	2	3	1317	2340	35	25	18.128071	7d
5	1	85	1	2	4	1360	2340	84	26	18.128071	Name
3	1	85	2	0	0	276	2430	1098	41	-1	
4	1	85	2	1	0	276	2430	1098	41	-1	
5	1	85	2	1	1	276	2430	62	41	95.887039	Title
5	1	85	2	1	2	1316	2437	58	25	94.187843	Title
3	1	85	3	0	0	279	2531	1736	33	-1	
4	1	85	3	1	0	279	2531	1736	33	-1	
5	1	85	3	1	1	279	2531	115	25	93.290810	Address
5	1	85	3	1	2	406	2544	17	4	81.807587	—
5	1	85	3	1	3	433	2531	115	26	96.381195	Number
5	1	85	3	1	4	556	2533	52	24	95.942589	and
5	1	85	3	1	5	619	2531	92	28	94.551758	Street.
5	1	85	3	1	6	723	2532	73	25	87.257851	Rural
5	1	85	3	1	7	808	2532	46	27	85.951477	Rt..
5	1	85	3	1	8	864	2533	54	31	95.590370	Apt.
5	1	85	3	1	9	931	2533	46	25	95.590370	No.
5	1	85	3	1	10	1315	2533	118	25	50.583363	Address
5	1	85	3	1	11	1444	2547	16	3	91.995117	—
5	1	85	3	1	12	1471	2533	113	25	95.867279	Number
5	1	85	3	1	13	1593	2533	51	25	96.439735	and
5	1	85	3	1	14	1656	2533	90	28	96.465454	Street,
5	1	85	3	1	15	1760	2533	74	26	93.263084	Rural
5	1	85	3	1	16	1845	2533	47	28	91.657799	Rt.,
5	1	85	3	1	17	1900	2533	57	31	95.680901	Apt.
5	1	85	3	1	18	1969	2534	46	25	95.239418	No.
3	1	85	4	0	0	279	2622	1893	43	-1	
4	1	85	4	1	0	279	2622	1893	43	-1	
5	1	85	4	1	1	279	2622	58	41	95.599724	City
5	1	85	4	1	2	856	2628	75	27	96.977798	State
5	1	85	4	1	3	1000	2629	50	26	95.971161	ZIP
5	1	85	4	1	4	1060	2628	74	27	96.021851	Code
5	1	85	4	1	5	1315	2624	54	41	83.523453	Cily
5	1	85	4	1	6	1895	2629	72	27	96.443291	State
5	1	85	4	1	7	2037	2631	50	25	94.830612	ZIP
5	1	85	4	1	8	2097	2630	75	26	95.992317	Code
2	1	86	0	0	0	1304	1513	10	1207	-1	
3	1	86	1	0	0	1304	1513	10	1207	-1	
4	1	86	1	1	0	1304	1513	10	1207	-1	
5	1	86	1	1	1	1304	1513	10	1207	95.000000	 
2	1	87	0	0	0	2343	1517	11	1204	-1	
3	1	87	1	0	0	2343	1517	11	1204	-1	
4	1	87	1	1	0	2343	1517	11	1204	-1	
5	1	87	1	1	1	2343	1517	11	1204	95.000000	 
2	1	88	0	0	0	268	2714	2080	7	-1	
3	1	88	1	0	0	268	2714	2080	7	-1	
4	1	88	1	1	0	268	2714	2080	7	-1	
5	1	88	1	1	1	268	2714	2080	7	95.000000	 
2	1	89	0	0	0	267	2801	841	6	-1	
3	1	89	1	0	0	267	2801	841	6	-1	
4	1	89	1	1	0	267	2801	841	6	-1	
5	1	89	1	1	1	267	2801	841	6	95.000000	 
2	1	90	0	0	0	277	2810	744	33	-1	
3	1	90	1	0	0	277	2810	744	33	-1	
4	1	90	1	1	0	277	2810	744	33	-1	
5	1	90	1	1	1	277	2810	133	33	96.188690	Checking
5	1	90	1	1	2	419	2810	114	27	96.305313	Account
5	1	90	1	1	3	546	2812	110	25	96.701904	Number
5	1	90	1	1	4	856	2812	71	25	96.852638	Bank
5	1	90	1	1	5	939	2813	82	24	95.938637	Name
2	1	91	0	0	0	269	1510	7	1390	-1	
3	1	91	1	0	0	269	1510	7	1390	-1	
4	1	91	1	1	0	269	1510	7	1390	-1	
5	1	91	1	1	1	269	1510	7	1390	95.000000	 
2	1	92	0	0	0	843	2802	7	100	-1	
3	1	92	1	0	0	843	2802	7	100	-1	
4	1	92	1	1	0	843	2802	7	100	-1	
5	1	92	1	1	1	843	2802	7	100	95.000000	 
2	1	93	0	0	0	174	2715	1457	116	-1	
3	1	93	1	0	0	174	2715	1457	116	-1	
4	1	93	1	1	0	174	2715	1457	116	-1	
5	1	93	1	1	1	174	2715	199	116	0.000000	Slee
5	1	93	1	1	2	377	2767	22	28	93.254158	B
5	1	93	1	1	3	412	2768	61	28	96.365219	and
5	1	93	1	1	4	485	2768	96	28	91.362053	Class
5	1	93	1	1	5	589	2763	16	48	91.362053	C
5	1	93	1	1	6	630	2769	118	27	95.964874	license
5	1	93	1	1	7	760	2769	176	33	96.136223	applicants
5	1	93	1	1	8	950	2770	82	34	96.203033	only:
5	1	93	1	1	9	1057	2769	89	38	96.342636	Bingo
5	1	93	1	1	10	1157	2771	142	33	96.479424	checking
5	1	93	1	1	11	1309	2772	127	26	96.690186	account
5	1	93	1	1	12	1447	2769	184	29	96.805008	information:
2	1	94	0	0	0	1265	2802	1089	7	-1	
3	1	94	1	0	0	1265	2802	1089	7	-1	
4	1	94	1	1	0	1265	2802	1089	7	-1	
5	1	94	1	1	1	1265	2802	1089	7	95.000000	 
2	1	95	0	0	0	1608	2814	182	24	-1	
3	1	95	1	0	0	1608	2814	182	24	-1	
4	1	95	1	1	0	1608	2814	182	24	-1	
5	1	95	1	1	1	1608	2814	71	24	96.745369	Bank
5	1	95	1	1	2	1690	2814	100	24	96.481743	Branch
2	1	96	0	0	0	1595	2804	6	98	-1	
3	1	96	1	0	0	1595	2804	6	98	-1	
4	1	96	1	1	0	1595	2804	6	98	-1	
5	1	96	1	1	1	1595	2804	6	98	95.000000	 
2	1	97	0	0	0	2348	2805	7	99	-1	
3	1	97	1	0	0	2348	2805	7	99	-1	
4	1	97	1	1	0	2348	2805	7	99	-1	
5	1	97	1	1	1	2348	2805	7	99	95.000000	 
2	1	98	0	0	0	267	2896	2087	7	-1	
3	1	98	1	0	0	267	2896	2087	7	-1	
4	1	98	1	1	0	267	2896	2087	7	-1	
5	1	98	1	1	1	267	2896	2087	7	95.000000	 
2	1	99	0	0	0	1967	3008	379	36	-1	
3	1	99	1	0	0	1967	3008	379	36	-1	
4	1	99	1	1	0	1967	3008	379	36	-1	
5	1	99	1	1	1	1967	3008	164	30	96.496422	Continued
5	1	99	1	1	2	2139	3017	40	21	96.137711	on
5	1	99	1	1	3	2188	3017	81	27	96.723511	page
5	1	99	1	1	4	2283	3008	19	28	49.090885	2
5	1	99	1	1	5	2315	3008	31	28	49.090885	>
2	1	100	0	0	0	179	3079	2167	7	-1	
3	1	100	1	0	0	179	3079	2167	7	-1	
4	1	100	1	1	0	179	3079	2167	7	-1	
5	1	100	1	1	1	179	3079	2167	7	95.000000	 
2	1	101	0	0	0	34	3088	563	108	-1	
3	1	101	1	0	0	34	3088	563	108	-1	
4	1	101	1	1	0	34	3088	563	60	-1	
5	1	101	1	1	1	34	3108	93	40	90.981979	CITY
5	1	101	1	1	2	145	3088	50	59	91.567657	OF
5	1	101	1	1	3	218	3083	165	73	0.000000	APREAE
5	1	101	1	1	4	395	3083	207	73	0.000000	FUNCTION
4	1	101	1	2	0	118	3154	411	42	-1	
5	1	101	1	2	1	118	3156	80	40	96.082031	OCT
5	1	101	1	2	2	216	3155	128	41	93.021698	12°26
5	1	101	1	2	3	356	3154	173	41	0.000000	au10:30
2	1	102	0	0	0	1110	3095	293	79	-1	
3	1	102	1	0	0	1110	3095	293	79	-1	
4	1	102	1	1	0	1110	3095	293	79	-1	
5	1	102	1	1	1	1110	3095	293	79	95.000000

Applicant's Name (as shown on page 1)
Kothee r~ A Fink Fie
APPLICATION FOR BINGO LICENSE
9 Class B and Class C license applicants only: Bingo interest-bearing account information:
Account Number Bank Name Bank Branch
10 Class B and Class C license applicants only: List all officers and/or supervisors authorized to sign checks from the accounts
listed above. If applying as a qualified organization, all supervisors must be members of the applicant:
10a ae / \ 10b Name
C1
Title Title
11 List the name(s) of the one or two persons who will serve as managers. If applying as a qualified organization, these persons
must be members of the applicant. Each person must submit an affidavit.
Ma Name 11b Name
Kirthleen Funk
Title Title
Moanager
a
12 List the name of the one person designated as proceeds coordinator If applying as a qualified organization, this person must be
an officer or director and a member of the applicant. Each person must submit an affidavit.
Name < Titie
P
vw Sms 4 Pre gemeel x Cc ee ae ne Your
13 List the name(s) of the person(s) who will serve as supervisor. If applying as a qualified organization, each person must be a
member of the applicant. Each person must submit an affidavit. If additional names are required, please attach affidavits.
Chandler
ice (fe)
SuPeCW SOR,
14 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.
14a Name 14b Name
14¢ Name 14d Name
1 ee ee
et Aaa Te Apache Tancton AZ 8420
16 Games of Bingo must not exceed 5 days a week. Indicate the time on each respective day that live bingo will be played:
SUN MON TUE WED THUR FRI SAT
Olam. m Oa.m Olam a.m. Ca.m. Olam.
Bia
Cp.m. 600 g h _Op.m |. Op.m.|. Cp.m. Op.m. (p.m.
Continued on page 3 >
ADOR 10334 (2/20) Arizona Form 833 Page 2 of 5
Print. ea
CITY OF APACHE JUNCTION _Print P
OCT 12°26 av10:30

Applicant's Name (as on page 1)
Ko) ae Funke
Koaaal APPLICATION FOR BINGO LICENSE
17 Indicate the type of premises where bingo will be played Check one box:
a Sy Neither rent nor mortgage will be patd from bingo funds
b (1 Rented or leased. Attach rental affidavit and copy of rental agreement
Landlord’s Name Address — Number and Street, Rural Rt., Apt. No.
Tetephone Number (with area code) City State ZIP Code
¢ (©) 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 (© Owned jointly with other organization Attach copy of mortgage, deed of trust, purchase agreement, escrow agreement, or
other reiated document.
1) Holder of Mortgage Address — Number and Street, Rural Rt., Apt. No.
Telephone Number (with area code) City State ZIP Cade
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.
Telephone Number (with area code) City Stale ZIP Code
18 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:
18a Name 18b Name
None
Address - Number and Street, Rural Rt, Apt. No. Address — Number and Street, Rural Rt., Apt. No.
City State ZIP Code City State ZIP Code
Continued on page 4 >
ADOR 10334 (2/20) Arizona Form 833 Page 3 of 5
CITY OF APACHE JUNCTION
OCT 12’26 av10:30

Applicant's Name (as shown on pa
oH Funk
Hhleen APPLICATION FOR BINGO LICENSE
19 Expected bingo expenses:
-NA
Mortgage: per month
Payable to Address — Number and Street, Rural Ri., Apt. No.
Telephone number (with area code) City State ZIP Code
~ NA.
Rent: perl) month CJ) hour (© occasion
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
s NA.
Janitorial Services: per month Th our {J occasion
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number {with area code) City State ZIP Code
Nf
Accounting Services: per month (h our (J occasion
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number {with area code) City State ZIP Code
N -
Security Services: §, per month Oh our (J occasion
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
A, 00 O Y Cac
Bingo Supplies $, , per
Payable to Address — Number and Street, Rural Rt, Apt. No.
; —
Bin 3210 E RoeseR te
pacts agosupplit
number (with gred gode) City »- ZIP Code
pO) 544-o9B4 Phoenit - >
5040
20 Who is your live bingo suppler? (For all bingo supplies). Do you foresee purchasing/renting machines as “technological aids for
your live
yeasied PR INGD No
purclrade
U
Continued on page 5 >
ADOR 10334 (2/20) Arizona Form 833 Page 4 of 5
CITY OF APACHE JUNCTION
OCT 12°26 an10:30

“Rotinieen A Funk
APPLICATION FOR BINGO LICENSE
i Koh) Lem A Sunk , under penalty of perjury and upon oath, declare that | am duly authorized to sign
and file this application. | 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.
/ fs [2
Wome gar
APPLICANT'S SIGNATURE DATE TITLE
Please mail to:
Arizona Department of Revenue
1600 W Monroe Street, Division Code 22
Phoenix, AZ 85007
@ (602) 716-7801
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
C Approved [J Disapproved (]ClassALicense f{JClass B License [Class C License
Reviewer's Name (please print) Date License Number Effective Date Expiration Date
:
ADOR 10334 (2/20) Arizona Form 833 vint'Pade. Page 5 of 5
CITY OF APACHEJUNCTION :
OCT 12°26 ani0:30

Arizona Form
Affidavit Bingo
830
This affidavit must be completed by each person who wishes to assist in the conduct of any game of bingo. If any information is blank or incorrect, the
affidavit will be returned to you. All information is subject to verification. Disclosure of your Social Security Number (SSN) is voluntary, This information
may be used to establish positive identification for purposes of criminal background checks pursuant to A.R.S. § 5-404.
Licensee’s Name License Number
Kithheen hk Funk
Position (check the appropriate boxes):
{Manager [2 Supervisor__(] Proceed Coordinator__[] Assistant REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
|
Affiant’s Name
roathleen A
Funk
Social Number
— _—
Add
141 Sehuce st
2
thomse OB 5
mm PM RCVD
Work Phone (with area code)
A
If licensee is a qualified organization, complete the following section:
Member? Date Joined Organization
Clyes (IJNo
Officers? Officer Title
ClYes [INo
Do you have an affidavit on file for any other licensee?
ClYes [No _If"Yes’, list license number(s):
Xorthtern A Sok
I, . the above-named affiant, under penalty of perjury, upon oath, depose
and say that | will conduct or assist in conducting all bingo games in compliance with the terms of the license, Arizona Revised
Statutes, Title 5, Chapter 4, and the rules of the licensing authority. ] am of good moral character and have never been convicted of
any misdemeanor involving mora} turpitude or felony, | have not and shal! not receive any reward, compensation or recompense
for my participation in the conduct of bingo games except as provided for by law. I hereby swear or confirm that | have read
and understand the foregoing and verify that the information and statements made herein are true and correct to the best of my
knowledge.
koathleon A Funk
Signature of Affiant
10-5 -Alw
Date
Please mail to:
Arizona Department of Revenue
1600 W Monroe Street, Division Code 22
Phoenix, AZ 85007
@ (602) 716-7801
Print SUT ENTe
ADOR 10327 (2/20) rint Form
CITY OF APACHE JUNCTION
OCT 12°26 4H10°30

Arizona Form
Affidavit Bingo
830
This affidavit must be completed by each person who wishes to assist in the conduct of any game of bingo. If any information is blank or incorrect, the
affidavit will be returned to you. Ail information is subject to verification. Disclosure of your Social Security Number (SSN) is voluntary. This information
may be used to establish positive identification for purposes of criminal background checks pursuant to A.R.S. § 5-404.
Licensee's Name License Number
Kathleey A. Funk
Position (check the appropriate boxes):
J Manager (1 Supervisor _[C] Proceed Coordinator 1 Assistant REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
Affiant’s Name
U, Ky Chaidlew
Address
Ys W Broadway Aue “372
City State ZIP Code
5. ;
Apache 4" I9C Tig = SIRO [ei] PM [eo] RVD
H i Work Phone No. (with area code}
If licensee is a qualified organization, complete the following section
Member? Date Joined Organization
Cl Yes [INo
Officers? Officer Title
OYes CINo
Do you have an affidavit on file for any other licensee?
OlYes [INo _If“Yes’, list license number(s):
V, cky Cha adler
I, . the above-nained affiant, under penalty of perjury, upon oath, depose
7 AFFIANT'S NAME
and say that I will conduct or assist in conducting all bingo games in compliance with the terms of the license, Arizona Revised
Statutes, Title 5, Chapter 4, and the rules of the licensing authority. | am of good moral character and have never been convicted of
any misdemeanor involving morat turpitude or felony. | have not and shall not receive any reward, compensation or recompense
for my participation in the conduct of bingo games except as provided for by law. | hereby swear or confirm that | have read
and understand the foregoing and verify that the information and statements made herein are true and correct to the best of my
knowledge.
Lise :
LYWF/ 2026
Date a
Please mail to:
Arizona Department of Revenue
1600 W Monroe Street, Division Code 22
Phoenix, AZ 85007
@ (602) 716-7801
ADOR 10327 (2/20) Print Form
CITY OF APACHEJUNCTION
APT 1959C .u1A on

Arizona Form
Affidavit Bingo
830
This affidavit must be completed by each person who wishes to assist in the conduct of any game of bingo. If any information is blank or incorrect, the
affidavit will be returned to you. All information is subject to verification, Disclosure of your Social Security Number (SSN) is voluntary. This information
may be used to establish positive identification for purposes of criminal background checks pursuant to A.R.S. § 5-404,
Licensee’s Name License Number
Ka thlees A. Fay kK
Position (check the appropriate boxes):
Zi Manager O Supervisor (1 Proceed Coordinator Oo Assistant REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
FS
Affiant's Name
| ALA. SMT
i i Bate of Birth
Address
lifoa ic boa? wey Ak #178
City : State ZIP Code
a Jieuetio 0 GK 85 2.6 ‘ola go] RCVD
H e) Work Phone No. (with area code)
If licensee is a qualified organization, complete the following section:
Member? Date Joined Organization
OlYes [No
Officers? Officer Title
Clyes No
Do you have an affidavit on file for any other licensee?
Yes O01 No If “Yes”, list license number(s}:
1: Lin 4a BS th, the above-named affiant, under penalty of perjury, upon oath, depose
za ,
and say that I will conduct or assist in conducting all bingo games in compliance with the terms of the license, Arizona Revised
Statutes, Title 5, Chapter 4, and the rules of the licensing authority. I am of good moral character and have never been convicted of
any misdemeanor involving moral turpitude or felony. I have not and shall not receive any reward, compensation or recompense
for my participation in the conduct of bingo games except as provided for by law. 1 hereby swear or confirm that I have read
and understand the foregoing and verify that the information and statements made herein are true and correct to the best of my
knowledge.
Please mail to:
Arizona Department of Revenue
1600 W Monroe Street, Division Code 22
Phoenix, AZ 85007
@ (602) 716-7801
ADOR 10327 (2/20)
CITY OF APACHE JUNCTION
OCT 12°26 an10:31

Arizona Form 832 Endorsement by Local Governing Body Bingo
FOR OFFICIAL USE ONLY PURSUANT TO A.R.S. § 5-404.4
e License Applicants: Complete lines 2, 3, and 4. Submit with entire license package to local governing body.
e¢ Local Governing Body: Complete and return with license package to the Department of Revenue Bingo Section.
Date License Number
WW New Application OJ Change of Location
From (Name of local governing body)
USE ONLY. DO NOT MARK IN THIS AREA.
aes
Address (number and street, PO Box)
City State ZIP Code
Phone No. (with area code)
[ga] PM RCVD
.
1 This is to certify that on I ! ) a hearing was conducted pursuant to Arizona Revised Statute, Title 5,
Chapter 4, in the matter of:
C0 Application for a bingo license by the following applicant.
C Application for a bingo license location transfer.
2 Applicant's Name
Ki wh\e ay aq KL
<n
3 US. here games will be conducted: City Cog ty $ ZIP Code
WO oe US. fire A PacheU , m 95128
Broadway Ad
ps
4 Fill in the time on the days games will be played:
SUN MON TUE WED THUR FRI SAT
Da.m Olam. Olam Olam. Oa.m. Olam. Olam.
Avo ;
Op.m :Bip.m. -Opm | p.m. |. Op.m}. /Cp.m.} :Cp.m.
5 Background investigations:
0 have C) have not been conducted on all individuals listed in the Bingo License Application.
6 Recommendation for the application: [] Approved 1 Disapproved
7 Specific reasons for disapproval are hereby listed pursuant to A.R.S. § 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) ® (602) 716-7801
Previous 71-1002 (4/06)
“Print Form
6 ITY OF APACHEJUNCTION
OCT 12°26 an10:31

October 14, 2026
To whom it may concern. | Kathleen A Funk am applying for a class A Bingo license in the
state of Arizona. | am a part-time resident of Sunrise RV Resort. A Class A license was
previously issued to the Resort however since the Resort is a for- profit company, it cannot
hold a Bingo license. A Bingo licensee must be a nonprofit or a person. Class A licensees
obtain a license for recreational and social purposes, returning all gross receipts to the
players in prizes along with paying for equipment maintenance and Bingo supplies.
The intent is to continue conducting Bingo games at Sunrise Resort, as done in the past.
Games will be played on Monday evenings at 6:00pm.
Under AZ TITLE 5 Amusement and Sports Section, Chapter 4, Section 5-401 - 5-415,
defines the rules and regulations of Games of Bingo.
5-401. Definitions
In this chapter, unless the context otherwise requires:
1. Adjusted
5	1	6	1	1	3	539	1421	99	33	96.060020	gross
5	1	6	1	1	4	652	1412	166	42	91.225281	receipts means the receipts remaining after deducting the monies paid for prizes
from gross receipts.
2. “Applicant” means a person, a group of persons or an organization that submits an application to
the licensing authority for a license required under this chapter.
5-413. License classification; requirements
A. A class A license may be issued to a person for the conduct of bingo games for which the gross
receipts do not exceed $75,000 per year. A class A license shall not be issued to a person who holds a
license issued pursuant to title 4 except a club license issued pursuant to section 4-205. For a class A
license:
1. Any person may apply as prescribed in this article.
| hope this answers your questions about the request for my Class A Bingo license.
Thank you for reviewing the application,
Kathleen Funk
815-541-8636
Nanakate55@gmail.com