Bingo License Application Redacted
Extracted text (via tesseract_tsv)
51684 characters
Arizona Form 833 Application for Bingo License
* Type or print in black ink and complete all information requested on this form. If you do aot, your application will be returned, All
information is subject to verification, If you need more space, attach additional sheets.
* All bingo ticenses 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.
1 Applicant's Name
Falsification of information
George T. Diehl Sr. VFW Post 7968
contained in this application
2a Mailing Address
250 S. Phelps Dr. constitutes a Class 6 felony.
2b City State ZIP Code USE ONLY. DO NOT MARK IN THIS AREA.
age
Apache Junction AZ 85120 (88
Ja Administrative Office Location
George T. Diehl Sr. VEW Post 7968
ab City State ZIP Code
Apache Junction AZ 85120
4a Name of Contact Person 4b Telephone No.
Jason Walker
4c E-mail Address 4c Fax No. PM RCVD
viwpost7968@msn.com (480} 671-0894 i
5 Class B and Class C license applicants only: If applying as a qualified organization, check one box to indicate the type of
organization:
O Charitable DO Social D Religious [4 Veterans
CO Fraternal (J Volunteer Fire Department [J Homeowners Association 0 Nonprofit Ambulance Service
6 Class B and Class C license applicants only applying as a qualified organization, provide parent or auxiliary information:
6a Parent Name 6b Auxiliary Name
Department of Arizona VEW VFW Post 7968 Auxiliary
Address = Number and Street, Rural Rt., Apt. No. Address — Number and Street, Rurai Rt., Apt. No.
6423 S. Ash Ave 250 S. Phelps Dr
City State ZIP Code City State ZIP Code
Tempe AZ 85283 Apache Junction AZ 85120
7 Class B and Class C license applicants only applying as a qualified organization, fist the current officers or Board of
Directors of the organization;
Ta Name 7b Name
Jennifer J. Schroeder Mark R. Schrand
Title Title
Commander Jr. Vice Commander
Address - Number and Street, Rural Rt., Apt. No. Address — Number and Street, Rural Rt., Apt. No.
7316 E. Southern Ave Unit 7112 1069 N. Cortez RD
City State ZIP Code City State ZIP Code
Mesa AZ 85216 Apache Junction AZ 85119
7e Name 7d Name
Frank J. White Jason M. Walker
Title Title
Sr. Vice Commander {Quartermaster
Address = Number and Street, Rural Rt., Apt. No. Address — Number and Street, Rural Rt., Apt. No.
11495 E Fossil Spgs 1297 E Broadway Ave Unit 92
City State ZIP Code City State ZIP Code
Gold Canyon AZ 85118 Apache Junction AZ 85119
8 Class B and Class C ticense applicants only: Bingo checking account information:
Checking Account Number Bank Name Bank Branch
Apache Junction
Print Page
Continued on page 2>
CITY OF ARRGHESEACTION— 7
OCT 19°26 aMB:11
Name (as shawn on page 1)
nian
eorge T. Diehl Sr. VFW Post 7968 APPLICATION FOR BINGO LICENSE
9 Ciass B and Class C license applicants only: Bingo interest-bearing account information:
Account Number Bank Name 8ank 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 Name 10b Name
Jennifer J. Schroeder Jason M. Walker
Title Title
Commander Quartermaster
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.
dia Name 11b Name
Jason M. Walker Candy M. Petty
Title Title
Quartermaster Club Mgr.
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 Title
Jason M. Walker Quartermaster
43 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. éf additional names are required, please attach affidavits.
13a Name 13b Name
Jason M. Walker Candy M. Petty
Title Title
Quartermaster Club Mgr.
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
Please see attached List
14¢ Name 14d Name
15 Street address of the PHYSICAL location where live bingo will be played:
250 S. Phelps Dr. Apache Junction, AZ 85120
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
Bam. Ella.m. (a.m. a.m. Bda.m. Blam. Bam.
10-10 p.m. OFF Bom.|. 10-10 JBilp.m. |. OFF —Bip.m.|. 10-10 {Ap.m.|. 10-10 p.m}. 10-10 filp.m.
Continued on page 3 >
| Print Page
ADOR 10334 (2/20) Arizona Form 833 Page 2 of §
CITY GF APACHE JUNCTION
OCT 19°26 evG:11
Name (as shown on page 1)
en
George T. Dieh! Sr. VEW Post 7968 APPLICATION FOR BINGO LICENSE
17 Indicate the type of premises where bingo will be played. Check one box:
a (OJ Neither rent nor morigage will be paid from bingo funds.
b CJ Rented orleased. 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 Owned solely by the organization. Affach 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.
George T. Diehl Sr. VEW Post 7968 250 S. Phelps Dr
Telephone Number (with area code) City State ZIP Code
a
Apache Junction AZ 85120
d ©) 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 RL, 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 Z)P Code
3) Co-Owner Hoider: Address —- Number and Street, Rural Rt., Apt. No.
Telephone Number (with area code) City State 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
Auxiliary Post #7968
a
Address — Number and Street, Rural Rt., Apt. No. Address — Number and Street, Rural Rt., Apt. No.
250 S. Phelps Dr.
City State ZIP Code City State ZIP Code
Apache Junction AZ 85120
Cantinued on page 4 >
Print Page _|
ADOR 10334 (2/20) Arizona Form 833 Page 3 of 5
CITY OF APACHEJUNCTION
OCT 1926 av8:11
Applicant's Name (as shown on page 1)
George T. Diehl Sr. VEW Post 7968 APPLICATION FOR BINGO LICENSE
19 Expected bingo expenses:
a Mortgage: $3,975.84 per month
Address — Number and Street, Rural Rt, Apt. No.
1000 E. Florence Blvd.
Telephone number (with area code) City State ZIP Code
Casa Grande AZ 85122
b Rent: $ , perOJ month CJ hour (J occasion
Payable to Address — Number and Street, Rural RL. Apt. No.
Telephone number (with area code) City State ZIP Code
¢ Janitorial Services: $2,700.00 , perf} month Ohour £8 occasion
Payable to Address - Number and Street, Rural Rt., Apt. No.
Tresa Weinkauf 2024 S Cortez Rd #127
Telephone number (with area code) City State ZIP Code
a
Apache Junction AZ__85119
d Accounting Services: $____————,sper month CJ hour (J occasion
Payable to Address ~ Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
e Security Services; $122.14 per &@ month Clhour (J occasion
Payable to Address — Number and Street, Rural RL, Api. No.
ADT
Telephone number (with area code) City State ZIP Code
t Bingo Supplies: $218.17 , per_invocies attac
Payable to Address — Number and Street, Rural Rt., Apt. No.
Amazon
Telephone number (with area code) City State ZIP Code
20 Who is your live bingo supplier? (For all bingo supplies). Do you foresee purchasing/renting machines as “technological aids for
your live bingo games?
Bonanzo Bingo Supply, Amazon |
Continued on page 5 >
| Print Page |
ADOR 10334 (2/20) Arizona Form 833 Page 4 of 5
CITY OF APACHE JUNCTION
OCT 19°26 a8: 11
Applicant's Name (as shown on page 1}
George T. Diehl Sr. VEW Post 7968 APPLICATION FOR BINGO LICENSE
1, Jason M. Walker , under penalty of perjury and upon cath, declare that | am duly authorized to sign
and file this application. 1 hereby swear or confirm that [ 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.
[CO -le@-2e Qussryermasre tl
fore ttek
APPLICANT'S SIGNATURE DATE TITLE
Please mail to:
Arizona Department of Revenue
1600 W Monroe Street, Division Code 22
Phoenix, AZ 85007
TP (602) 716-7801
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
1 Approved (1 Disapproved f]ClassALicense [Class B License [Class C License
Reviewer's Name (please print) Date License Number Effective Date Expiration Date
Print Page |
ADOR 10334 (2/20) Arizona Form 833 Page § of 5
CITY OF APACHE JUNCTION
OCT 19°26 awB:11
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 Socia! 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
George T. Diehl Sr. Post 7968 VFW 11-043-B
Position (check the appropriate boxes):
bd Manager Supervisor Proceed Coordinator _ [XJ Assistant USE ONLY. DO NOT MARK IN THIS AREA.
a
Affiant's Name
Jason Walker
Number Date of
= — a
Address
1297 E Broadway Ave #92
City State ZIP Code
Apache Junction AZ 85119 PM go] RCVD
Phone No. area code) code)
= “t Cd
If licensee is a qualified organization, complete the following section:
Member? Date Joined Organization
GlYes OCINo P4 -1- 2057
Officers? Officer Title
[el Yes _[L.No Quartermaster
Oo you have an affidavit on file for any other licensee?
OlYes [PINo_ If Yes, list license number(s):
I, Jason Walker , the above-named affiant, under penalty of perjury, upon oath, depose
AFFIANT'S NAME
and say that J 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 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. 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.
gnature of Affiant
G-22-Ab
Date
Please mail to:
Arizona Department of Revenue
1600 W Monroe Street, Division Code 22
Phoenix, AZ 85007
2 (602) 716-7801
CITY OF APACHETONCTION
OCT 19°26 an8:12
TT =
Arizona Form aes,
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
George T. Diehl Sr. Post 7968 VFW 11-043-B
Pasition (check the appropriate boxes).
Manager kl Supervisor Proceed Coordinator Assistant REVENUE USE ONLY, DO NOT MARK IN THIS AREA.
Affiant's Name
Senniter Schivedel
73le E Sothern Ave Unk V1 2-
Ci Y State ZIP Code
Mesa AZ SOSAaTlIL fe] >M RCVD
30)
|
If licensee is a qualified organization, complete the following section:
Member? Date Joined Organization
fe] Yes OINo VA: ayvORP
Officers? Officer Title 4
Tl Yes Commatide A.
_ONo r
Do you have an affidavit on file for any other licensee?
OlYes [JNo _ If"Yes’, list license number(s):
Jens Ler Se der
l, chy ve, , the above-named affiant, under penalty of perjury, upon oath, depose
AFFIA
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. 1 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, I 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.
WIL) 2220
Date
Please mail to:
Arizona Department of Revenue
1600 W Monroe Street, Division Code 22
Phoenix, AZ 85007
Tf (602) 716-7801
ADOR 10327 (2/20)
CITY OF APACHE JUNCTION
OCT 1926 am8:12
Arizona Form
Affidavit Bingo
830
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
This affidavit All information is subject to verification. Disclosure of your Social Security Number (SSN) is voluntary. This information
affidavit will be returned to you. checks pursuant. to Anzona Revised Statutes § 5-404.
be used to establish positive identification for purposes of criminal background
may
License Number
Licensee’s Name 11-643 ay ke
Position {check boxes):
ones PT Assistant REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
Manager. Supervisor (J Proceed Coordinator
Affiant’s Name
FRaWl< 1A) H? TE
Social Security Number
OS E& FOSSI SPRIVLS
State ZIP Code
City
¥ 90 A 2 Rs HZ i[ey]™ a] RCVD
O LW
bate. Work Phone No. (with area code)
If licensee is a qualified organization, complete the following section:
Dale Joined Organization
Member?
ves [CINo pod IPF %e
Officers? Officer Title
Sr VU pnn Covezmn Le
Oyves [No
Do you have an affidavit on file for any other licensee?
/ +) [ 3 © / 2,
ves [CI No _ if *Yes", list license number(s):
d PAIK tr) / 1 i TE the above-named affiant, under penalty of perjury, upon oath, depose
1, .
AFFIANT'S NAME
conduct assist in conducting all bingo games in compliance with the terms of the license, Arizona Revised
and say that I will or
and the rules of the licensing authority. I am of good moral character and have never been convicted of
Statutes, Title 5, Chapter 4,
mora} turpitude or felony. I have not and shall not receive any reward, compensation or recompense
any misdemeanor involving
in the conduct of bingo games except as provided for by law. 1 hereby swear or confirm that J have read
for my participation
and verify that the information and statements made herein are true and correct to the best of my
and understand the foregoing
knowledge.
ZA IT
Sigrtdture of Affiant
G. 2B. 26
Date
Arizona Department of Revenue, PO Box 29019, Phoenix, AZ 85038-9019
Please mail to:
fF (602) 716-7801
CITY UNCTION
Gao
e:12
Arizona Form
Affidavit Bingo
830
wishes assist in the conduct of any game of bingo. If any information is biank or incorrect, the
This affidavit must be completed by each person who to
All information is subject to verification. Disclasure of your Social Security Number (SSN) is voluntary. This information
affidavit will be returned to you.
identification for purposes of criminal! background checks pursuant to Arizona Revised Statutes § 5-404.
may be used to establish positive
License Number
Licensee's Name . A -
4 1 24 1 3 0 183 677 2161 102 -1
5 1 24 1 3 1 183 707 45 50 60.092613 (A
5 1 24 1 3 2 233 726 129 35 73.488205 Manager
5 1 24 1 3 3 409 710 44 42 43.909359 Ef
5 1 24 1 3 4 458 711 238 41 5.552092 Supervisor]
5 1 24 1 3 5 709 717 120 27 96.299141 Proceed
5 1 24 1 3 6 839 716 168 25 93.417412 Coordinator
5 1 24 1 3 7 1050 684 44 66 20.098314 El
5 1 24 1 3 8 1105 684 129 66 20.098314 assistant
5 1 24 1 3 9 1625 677 145 102 29.587927 eae
5 1 24 1 3 10 1781 699 59 22 95.007812 USE
5 1 24 1 3 11 1846 699 81 22 87.452698 ONLY.
5 1 24 1 3 12 1937 698 41 21 87.452698 DO
5 1 24 1 3 13 1988 696 58 23 96.356377 NOT
5 1 24 1 3 14 2056 694 120 24 96.312401 MARK
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5 1 24 1 3 17 2255 693 89 23 95.108093 AREA.
4 1 24 1 4 0 183 814 209 25 -1
5 1 24 1 4 1 183 815 113 24 88.025223 Affiant’s
5 1 24 1 4 2 307 814 85 24 96.476952 Name
4 1 24 1 5 0 204 833 444 65 -1
5 1 24 1 5 1 204 846 180 52 51.462280 Landy,
5 1 24 1 5 2 433 833 215 62 72.264526 Petty
4 1 24 1 6 0 239 895 836 49 -1
5 1 24 1 6 1 239 911 4 4 69.678200 i
5 1 24 1 6 2 409 895 112 49 96.631470 Number
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5 1 24 1 6 4 1034 898 41 25 90.997963 irth
4 1 24 1 7 0 180 1000 966 41 -1
5 1 24 1 7 1 180 1000 127 41 95.840340 Address
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5 1 24 1 8 1 205 1037 172 48 52.486099 JOD
5 1 24 1 8 2 421 1037 37 42 45.940189 S
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5 1 24 1 8 4 907 1011 92 64 35.905220 hd
5 1 24 1 8 5 1071 1009 225 54 45.454029 foo
5 1 24 1 8 6 1326 1009 55 47 29.659229 Ss
5 1 24 1 8 7 1423 1067 11 7 0.000000 -
4 1 24 1 9 0 186 1080 1208 59 -1
5 1 24 1 9 1 186 1091 54 48 69.406509 City
5 1 24 1 9 2 471 1086 63 53 21.989170 _—_
5 1 24 1 9 3 902 1080 74 48 96.990898 State
5 1 24 1 9 4 1257 1086 52 25 96.300636 ZIP
5 1 24 1 9 5 1317 1085 77 26 96.109024 Code
4 1 24 1 10 0 231 1116 1963 143 -1
5 1 24 1 10 1 231 1117 185 77 52.781181 Apache
5 1 24 1 10 2 450 1129 133 44 25.916752 Oe
5 1 24 1 10 3 952 1123 123 48 82.934456 AS
5 1 24 1 10 4 1283 1128 184 41 19.153461 Ssy2C
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5 1 24 1 10 6 2037 1116 157 143 26.578117 Ee
4 1 24 1 11 0 187 1186 1160 38 -1
5 1 24 1 11 1 187 1192 93 32 22.578968 Horge.
5 1 24 1 11 2 388 1196 45 23 94.239861 No.
5 1 24 1 11 3 452 1198 49 21 94.365623 (with
5 1 24 1 11 4 511 1202 55 17 96.194191 area
5 1 24 1 11 5 575 1196 60 22 91.538116 cade’
5 1 24 1 11 6 823 1211 4 6 47.925400 ,
5 1 24 1 11 7 902 1188 75 25 96.384720 Work
5 1 24 1 11 8 988 1187 92 25 94.150307 Phone
5 1 24 1 11 9 1090 1186 45 25 90.771164 No.
5 1 24 1 11 10 1146 1187 58 28 96.561546 (with
5 1 24 1 11 11 1214 1191 55 18 96.642693 area
5 1 24 1 11 12 1279 1186 68 27 96.663452 code)
4 1 24 1 12 0 191 1240 37 29 -1
5 1 24 1 12 1 191 1240 37 29 38.263126 r=
2 1 25 0 0 0 1595 544 23 725 -1
3 1 25 1 0 0 1595 544 23 725 -1
4 1 25 1 1 0 1595 544 23 725 -1
5 1 25 1 1 1 1595 544 23 725 95.000000
2 1 26 0 0 0 888 1081 12 199 -1
3 1 26 1 0 0 888 1081 12 199 -1
4 1 26 1 1 0 888 1081 12 199 -1
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2 1 27 0 0 0 1624 1137 10 127 -1
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4 1 27 1 1 0 1624 1137 10 127 -1
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3 1 28 1 0 0 844 1243 1521 45 -1
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3 1 29 1 0 0 181 1316 1217 51 -1
4 1 29 1 1 0 181 1316 1217 51 -1
5 1 29 1 1 1 181 1334 21 30 95.875412 if
5 1 29 1 1 2 215 1332 146 31 67.206017 licensee
5 1 29 1 1 3 373 1330 29 31 95.627335 is
5 1 29 1 1 4 416 1338 20 23 95.627335 a
5 1 29 1 1 5 448 1327 146 40 95.788391 qualified
5 1 29 1 1 6 607 1325 229 40 96.464638 organization,
5 1 29 1 1 7 850 1321 163 39 87.477104 complete
5 1 29 1 1 8 1026 1320 55 30 96.319931 the
5 1 29 1 1 9 1092 1319 155 38 84.027603 following
5 1 29 1 1 10 1262 1316 136 31 96.365913 section:
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4 1 30 1 1 0 179 1346 1458 41 -1
5 1 30 1 1 1 179 1346 1458 41 95.000000
2 1 31 0 0 0 233 1444 1405 40 -1
3 1 31 1 0 0 233 1444 1405 40 -1
4 1 31 1 1 0 233 1444 1405 40 -1
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3 1 32 1 0 0 902 1367 13 195 -1
4 1 32 1 1 0 902 1367 13 195 -1
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3 1 33 1 0 0 235 1538 1403 40 -1
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3 1 34 1 0 0 162 567 34 1100 -1
4 1 34 1 1 0 162 567 34 1100 -1
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3 1 35 1 0 0 1630 1357 17 291 -1
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3 1 36 1 0 0 190 1375 1093 94 -1
4 1 36 1 1 0 190 1375 1089 41 -1
5 1 36 1 1 1 190 1391 129 25 96.414474 Member?
5 1 36 1 1 2 917 1379 67 27 96.323181 Date
5 1 36 1 1 3 993 1378 93 27 96.323181 Joined
5 1 36 1 1 4 1096 1375 183 34 95.794731 Organization
4 1 36 1 2 0 265 1402 1018 67 -1
5 1 36 1 2 1 265 1448 37 19 66.974678 es
5 1 36 1 2 2 367 1433 96 36 36.598946 [C]No
5 1 36 1 2 3 911 1417 90 46 74.975327 03)
5 1 36 1 2 4 1016 1422 76 41 33.121277 fei
5 1 36 1 2 5 1116 1402 167 59 0.000000 Zonk
3 1 36 2 0 0 188 1475 892 49 -1
4 1 36 2 1 0 188 1475 892 49 -1
5 1 36 2 1 1 188 1483 131 41 96.030861 Officers?
5 1 36 2 1 2 918 1476 95 27 93.282913 Officer
5 1 36 2 1 3 1020 1475 60 25 89.007683 Titte
3 1 36 3 0 0 194 1528 269 38 -1
4 1 36 3 1 0 194 1528 269 38 -1
5 1 36 3 1 1 194 1530 109 36 30.771074 DlYes
5 1 36 3 1 2 368 1528 95 37 23.334475 [No
3 1 36 4 0 0 194 1571 774 42 -1
4 1 36 4 1 0 194 1571 774 42 -1
5 1 36 4 1 1 194 1582 38 25 95.809891 Do
5 1 36 4 1 2 242 1588 51 25 95.809891 you
5 1 36 4 1 3 304 1582 69 23 95.719429 have
5 1 36 4 1 4 383 1584 36 20 96.717064 an
5 1 36 4 1 5 548 1583 34 18 96.765205 on
5 1 36 4 1 6 592 1575 40 26 96.809677 file
5 1 36 4 1 7 641 1575 38 25 96.896645 for
5 1 36 4 1 8 689 1582 53 23 96.690681 any
5 1 36 4 1 9 750 1573 74 27 96.917114 other
5 1 36 4 1 10 833 1571 135 25 96.782440 licensee?
3 1 36 5 0 0 195 1620 804 44 -1
4 1 36 5 1 0 195 1620 804 44 -1
5 1 36 5 1 1 195 1625 109 39 65.455765 ClYes
5 1 36 5 1 2 368 1623 96 36 0.000000 ETNo
5 1 36 5 1 3 476 1616 14 52 75.644562 _
5 1 36 5 1 4 518 1625 20 29 42.482685 If
5 1 36 5 1 5 546 1625 90 33 42.482685 “Yes”,
5 1 36 5 1 6 650 1625 43 28 95.295868 list
5 1 36 5 1 7 704 1623 113 28 63.971184 license
5 1 36 5 1 8 828 1620 171 33 81.623611 number(s):
2 1 37 0 0 0 183 1633 1457 42 -1
3 1 37 1 0 0 183 1633 1457 42 -1
4 1 37 1 1 0 183 1633 1457 42 -1
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3 1 39 1 0 0 263 1824 601 177 -1
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4 1 39 1 2 0 774 1942 90 59 -1
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2 1 40 0 0 0 1161 1878 1159 43 -1
3 1 40 1 0 0 1161 1878 1159 43 -1
4 1 40 1 1 0 1161 1878 1159 43 -1
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5 1 40 1 1 2 1184 1892 48 29 96.908554 the
5 1 40 1 1 3 1245 1888 220 31 92.438286 above-named
5 1 40 1 1 4 1477 1886 112 35 91.380890 affiant,
5 1 40 1 1 5 1600 1885 96 30 96.653320 under
5 1 40 1 1 6 1707 1883 119 38 94.945351 penalty
5 1 40 1 1 7 1840 1883 38 28 96.482025 of
5 1 40 1 1 8 1884 1882 125 37 96.423294 perjury,
5 1 40 1 1 9 2023 1889 81 27 94.743988 upon
5 1 40 1 1 10 2117 1879 77 34 96.801178 oath,
5 1 40 1 1 11 2209 1878 111 35 96.924469 depose
2 1 41 0 0 0 807 1916 363 17 -1
3 1 41 1 0 0 807 1916 363 17 -1
4 1 41 1 1 0 807 1916 363 17 -1
5 1 41 1 1 1 807 1916 363 17 95.000000
2 1 42 0 0 0 238 1947 2090 279 -1
3 1 42 1 0 0 238 1947 2090 279 -1
4 1 42 1 1 0 238 1947 2084 64 -1
5 1 42 1 1 1 238 1974 58 30 96.961670 and
5 1 42 1 1 2 308 1982 54 29 96.908295 say
5 1 42 1 1 3 375 1973 59 29 96.308731 that
5 1 42 1 1 4 446 1973 10 28 96.166008 I
5 1 42 1 1 5 468 1971 61 30 94.961121 will
5 1 42 1 1 6 544 1969 125 32 96.759071 conduct
5 1 42 1 1 7 681 1978 35 21 96.892136 or
5 1 42 1 1 8 727 1965 47 32 96.069588 ass
5 1 42 1 1 9 869 1965 178 36 96.936043 conducting
5 1 42 1 1 10 1059 1963 36 29 96.259499 all
5 1 42 1 1 11 1109 1963 91 36 96.808846 bingo
5 1 42 1 1 12 1213 1968 102 31 96.674805 games
5 1 42 1 1 13 1327 1959 30 29 96.243469 in
5 1 42 1 1 14 1369 1958 186 36 95.760735 compliance
5 1 42 1 1 15 1567 1957 71 28 96.968758 with
5 1 42 1 1 16 1650 1957 51 27 96.732513 the
5 1 42 1 1 17 1711 1959 88 25 96.697212 terms
5 1 42 1 1 18 1813 1954 36 28 96.869118 of
5 1 42 1 1 19 1856 1954 50 26 94.274506 the
5 1 42 1 1 20 1917 1953 122 31 94.274506 license,
5 1 42 1 1 21 2049 1950 131 29 96.515732 Arizona
5 1 42 1 1 22 2192 1947 130 29 96.222206 Revised
4 1 42 1 2 0 240 2017 2088 61 -1
5 1 42 1 2 1 240 2047 137 31 96.480095 Statutes,
5 1 42 1 2 2 388 2044 71 28 96.480095 Title
5 1 42 1 2 3 471 2043 25 34 96.437965 5,
5 1 42 1 2 4 507 2042 128 36 96.413902 Chapter
5 1 42 1 2 5 642 2042 29 34 96.413902 4,
5 1 42 1 2 6 681 2040 59 29 96.839409 and
5 1 42 1 2 7 748 2040 48 27 96.896454 the
5 1 42 1 2 8 806 2039 78 28 95.214996 rules
5 1 42 1 2 9 894 2036 37 30 96.794853 of
5 1 42 1 2 10 934 2038 50 27 96.794853 the
5 1 42 1 2 11 993 2034 145 37 96.370148 licensing
5 1 42 1 2 12 1146 2032 152 35 96.324135 authority.
5 1 42 1 2 13 1317 2032 12 28 83.026489 I
5 1 42 1 2 14 1339 2039 49 21 96.291992 am
5 1 42 1 2 15 1398 2030 36 29 96.747688 of
5 1 42 1 2 16 1439 2029 79 37 96.467880 good
5 1 42 1 2 17 1530 2028 90 29 96.407829 moral
5 1 42 1 2 18 1632 2028 148 27 96.968399 character
5 1 42 1 2 19 1787 2025 58 29 96.968399 and
5 1 42 1 2 20 1855 2024 76 29 96.902245 have
5 1 42 1 2 21 1939 2030 92 21 96.880257 never
5 1 42 1 2 22 2038 2022 76 28 95.971703 been
5 1 42 1 2 23 2124 2019 156 31 96.576378 convicted
5 1 42 1 2 24 2290 2017 38 32 96.917641 of
4 1 42 1 3 0 240 2092 2083 61 -1
5 1 42 1 3 1 240 2126 58 27 96.497665 any
5 1 42 1 3 2 308 2115 220 31 96.800591 misdemeanor
5 1 42 1 3 3 539 2113 150 36 0.000000 involving
5 1 42 1 3 4 700 2109 94 31 96.960411 moral
5 1 42 1 3 5 805 2108 145 38 96.704636 turpitude
5 1 42 1 3 6 962 2117 33 19 95.493721 or
5 1 42 1 3 7 1005 2107 107 35 95.493721 felony.
5 1 42 1 3 8 1135 2105 11 29 32.553856 I
5 1 42 1 3 9 1158 2105 76 29 93.771423 have
5 1 42 1 3 10 1244 2107 50 25 96.332947 not
5 1 42 1 3 11 1307 2103 58 27 96.875298 and
5 1 42 1 3 12 1375 2101 74 29 96.798279 shall
5 1 42 1 3 13 1461 2105 52 24 96.442230 not
5 1 42 1 3 14 1523 2098 115 31 96.403618 receive
5 1 42 1 3 15 1650 2107 57 28 96.471283 any
5 1 42 1 3 16 1718 2096 122 33 96.471283 reward,
5 1 42 1 3 17 1850 2092 225 40 96.849365 compensation
5 1 42 1 3 18 2087 2103 33 19 96.830002 or
5 1 42 1 3 19 2131 2098 192 30 96.465141 recompense
4 1 42 1 4 0 243 2161 2081 65 -1
5 1 42 1 4 1 243 2189 45 28 97.004097 for
5 1 42 1 4 2 302 2196 51 30 96.865753 my
5 1 42 1 4 3 367 2184 201 40 78.023285 participation
5 1 42 1 4 4 583 2184 28 29 96.121758 in
5 1 42 1 4 5 626 2183 47 28 97.007904 the
5 1 42 1 4 6 689 2182 128 29 96.691078 conduct
5 1 42 1 4 7 829 2179 38 31 96.870598 of
5 1 42 1 4 8 876 2179 91 37 96.394058 bingo
5 1 42 1 4 9 981 2186 101 30 96.609795 games
5 1 42 1 4 10 1095 2180 105 33 96.870522 except
5 1 42 1 4 11 1214 2183 32 21 96.938011 as
5 1 42 1 4 12 1261 2172 144 39 95.923759 provided
5 1 42 1 4 13 1418 2171 47 30 96.680557 for
5 1 42 1 4 14 1476 2171 41 38 96.680557 by
5 1 42 1 4 15 1532 2171 61 29 93.064583 law.
5 1 42 1 4 16 1621 2169 13 30 95.251694 I
5 1 42 1 4 17 1647 2167 110 38 95.251694 hereby
5 1 42 1 4 18 1770 2176 94 21 96.755547 swear
5 1 42 1 4 19 1878 2176 33 18 96.954636 or
5 1 42 1 4 20 1925 2163 126 31 96.948250 confirm
5 1 42 1 4 21 2063 2163 63 29 96.469162 that
5 1 42 1 4 22 2140 2163 11 27 92.365662 I
5 1 42 1 4 23 2165 2162 75 28 96.991257 have
5 1 42 1 4 24 2254 2161 70 29 96.332695 read
2 1 43 0 0 0 243 2232 2082 60 -1
3 1 43 1 0 0 243 2232 2082 60 -1
4 1 43 1 1 0 243 2232 2082 60 -1
5 1 43 1 1 1 243 2261 57 29 96.613472 and
5 1 43 1 1 2 312 2257 178 33 96.613472 understand
5 1 43 1 1 3 502 2257 48 29 96.996262 the
5 1 43 1 1 4 565 2255 154 37 96.606560 foregoing
5 1 43 1 1 5 731 2254 59 30 96.958733 and
5 1 43 1 1 6 802 2253 96 37 96.561417 verify
5 1 43 1 1 7 911 2253 60 27 96.360649 that
5 1 43 1 1 8 984 2251 48 28 96.360649 the
5 1 43 1 1 9 1046 2247 188 31 96.423264 information
5 1 43 1 1 10 1246 2246 59 30 97.011818 and
5 1 43 1 1 11 1317 2249 171 26 96.303055 statements
5 1 43 1 1 12 1501 2241 87 31 95.856216 made
5 1 43 1 1 13 1599 2240 102 30 95.967667 herein
5 1 43 1 1 14 1713 2248 48 22 96.723778 are
5 1 43 1 1 15 1775 2244 61 25 96.905991 true
5 1 43 1 1 16 1850 2237 58 31 96.905991 and
5 1 43 1 1 17 1920 2241 113 26 92.273956 correct
5 1 43 1 1 18 2045 2240 31 25 96.414352 to
5 1 43 1 1 19 2089 2236 49 28 96.695503 the
5 1 43 1 1 20 2151 2234 64 30 97.011803 best
5 1 43 1 1 21 2228 2232 36 31 96.892784 of
5 1 43 1 1 22 2273 2241 52 29 97.008308 my
2 1 44 0 0 0 1417 2475 869 27 -1
3 1 44 1 0 0 1417 2475 869 27 -1
4 1 44 1 1 0 1417 2475 869 27 -1
5 1 44 1 1 1 1417 2475 869 27 95.000000
2 1 45 0 0 0 1188 2363 688 202 -1
3 1 45 1 0 0 1188 2363 688 202 -1
4 1 45 1 1 0 1188 2363 688 202 -1
5 1 45 1 1 1 1188 2363 688 202 95.000000
2 1 46 0 0 0 1192 2655 1097 33 -1
3 1 46 1 0 0 1192 2655 1097 33 -1
4 1 46 1 1 0 1192 2655 1097 33 -1
5 1 46 1 1 1 1192 2655 1097 33 95.000000
2 1 47 0 0 0 1901 2660 388 15 -1
3 1 47 1 0 0 1901 2660 388 15 -1
4 1 47 1 1 0 1901 2660 388 15 -1
5 1 47 1 1 1 1901 2660 388 15 95.000000
2 1 48 0 0 0 179 1809 29 967 -1
3 1 48 1 0 0 179 1809 29 967 -1
4 1 48 1 1 0 179 1809 29 967 -1
5 1 48 1 1 1 179 1809 29 967 95.000000
2 1 49 0 0 0 2360 1780 31 965 -1
3 1 49 1 0 0 2360 1780 31 965 -1
4 1 49 1 1 0 2360 1780 31 965 -1
5 1 49 1 1 1 2360 1780 31 965 95.000000
2 1 50 0 0 0 198 2725 2183 61 -1
3 1 50 1 0 0 198 2725 2183 61 -1
4 1 50 1 1 0 198 2725 2183 61 -1
5 1 50 1 1 1 198 2725 2183 61 95.000000
2 1 51 0 0 0 268 2828 2059 56 -1
3 1 51 1 0 0 268 2828 2059 56 -1
4 1 51 1 1 0 268 2828 2059 56 -1
5 1 51 1 1 1 268 2828 2059 56 95.000000
2 1 52 0 0 0 201 2830 2126 55 -1
3 1 52 1 0 0 201 2830 2126 55 -1
4 1 52 1 1 0 201 2830 2126 55 -1
5 1 52 1 1 1 201 2830 2126 55 95.000000
2 1 53 0 0 0 268 2829 2059 55 -1
3 1 53 1 0 0 268 2829 2059 55 -1
4 1 53 1 1 0 268 2829 2059 55 -1
5 1 53 1 1 1 268 2829 2059 55 95.000000
2 1 54 0 0 0 200 2874 6 104 -1
3 1 54 1 0 0 200 2874 6 104 -1
4 1 54 1 1 0 200 2874 6 104 -1
5 1 54 1 1 1 200 2874 6 104 95.000000
2 1 55 0 0 0 601 2928 1746 45 -1
3 1 55 1 0 0 601 2928 1746 45 -1
4 1 55 1 1 0 601 2928 1746 45 -1
5 1 55 1 1 1 601 2928 1746 45 95.000000
2 1 56 0 0 0 1131 2930 1216 34 -1
3 1 56 1 0 0 1131 2930 1216 34 -1
4 1 56 1 1 0 1131 2930 1216 34 -1
5 1 56 1 1 1 1131 2930 1216 34 95.000000
2 1 57 0 0 0 54 2333 2329 686 -1
3 1 57 1 0 0 54 2333 2329 682 -1
4 1 57 1 1 0 243 2333 186 38 -1
5 1 57 1 1 1 243 2333 186 38 95.944305 knowledge.
4 1 57 1 2 0 1903 2468 117 62 -1
5 1 57 1 2 1 1903 2468 117 62 72.368706 J
4 1 57 1 3 0 1300 2568 625 102 -1
5 1 57 1 3 1 1300 2568 625 102 24.693117 4-(2-J902a4
4 1 57 1 4 0 1194 2686 67 25 -1
5 1 57 1 4 1 1194 2686 67 25 96.243462 Date
4 1 57 1 5 0 429 2840 1954 103 -1
5 1 57 1 5 1 429 2905 128 29 95.567154 Please
5 1 57 1 5 2 569 2902 76 30 96.507172 mail
5 1 57 1 5 3 657 2867 50 63 96.759750 to:
5 1 57 1 5 4 730 2893 150 47 96.056656 Arizona
5 1 57 1 5 5 894 2855 231 83 95.271767 Department
5 1 57 1 5 6 1130 2888 44 48 96.989853 of
5 1 57 1 5 7 1184 2851 181 92 28.538609 Revenue,
5 1 57 1 5 8 1379 2890 55 32 96.103104 PO
5 1 57 1 5 9 1448 2888 70 32 96.045532 Box
5 1 57 1 5 10 1532 2886 129 37 69.482323 29018,
5 1 57 1 5 11 1674 2885 166 35 96.437500 Phoenix,
5 1 57 1 5 12 1847 2843 75 82 89.903633 AZ
5 1 57 1 5 13 1930 2875 226 48 95.699547 85038-9019
5 1 57 1 5 14 2332 2840 51 101 38.379028 |
4 1 57 1 6 0 54 2938 2309 81 -1
5 1 57 1 6 1 54 2974 93 41 54.060760 CITY
5 1 57 1 6 2 164 2969 49 44 96.733223 OF
5 1 57 1 6 3 243 2959 158 59 0.000000 APACHE
5 1 57 1 6 4 415 2959 213 59 0.000000 JUNCTION
5 1 57 1 6 5 879 2957 39 6 40.356850 on
5 1 57 1 6 6 1056 2957 6 2 33.549805 ‘
5 1 57 1 6 7 1104 2956 67 53 7.118111 #F
5 1 57 1 6 8 1184 2966 91 53 84.544258 (602)
5 1 57 1 6 9 1289 2974 164 31 93.793602 716-7801
5 1 57 1 6 10 1759 2948 11 2 0.000000 -
5 1 57 1 6 11 1951 2943 27 5 0.000000 —
5 1 57 1 6 12 2352 2938 11 4 0.000000 :
2 1 58 0 0 0 153 3018 385 43 -1
3 1 58 1 0 0 153 3018 385 43 -1
4 1 58 1 1 0 153 3018 385 43 -1
5 1 58 1 1 1 153 3022 79 39 96.320076 OCT
5 1 58 1 1 2 249 3020 130 41 72.991486 19°26
5 1 58 1 1 3 392 3020 82 39 0.000000 aw:
5 1 58 1 1 4 485 3018 53 39 51.852306 12
2 1 59 0 0 0 204 3166 302 60 -1
3 1 59 1 0 0 204 3166 302 60 -1
4 1 59 1 1 0 204 3166 250 27 -1
5 1 59 1 1 1 204 3169 82 22 92.749840 ADOR
5 1 59 1 1 2 297 3168 76 20 96.026520 10327
5 1 59 1 1 3 383 3166 71 27 96.132652 (1/14)
4 1 59 1 2 0 205 3198 301 28 -1
5 1 59 1 2 1 205 3202 110 21 96.318985 Previous
5 1 59 1 2 2 325 3201 102 20 94.423615 71-1003
5 1 59 1 2 3 437 3198 69 28 70.132011 (4/06)
Position (check thé appropriate boxes):
_ Arizona AON eS Department eRe SS of Revenue + Bingo Section
7600 Weet Monroe, Phoenix, AZ 65007 + (602) 716-7801
AFFIDAVIT
This affidavit must be completed by each person who wishes to assist In the conduct of any game of bingo. If
any informatio# is blank or Incorrect, the affidavit will be returned to you. Ali Information is subject to verification.
Disclosure of your Social Security Number is voluntary. This Information may be used to establish positive
Kdentification for purposes of criminal background checks pursuant to Arizona Revised Statutes, §5-404.
Pease type or print in bleck ink.
(OCERSEE'S NAME LICENSE NUMBER
11-043-B
Post 7968 7 _.
Check the appropriate boxes: _([) Manager _[) Supervieor_[7] Proceed Coordinator Ch Assistant __|
ENE
hr Schnotd te
ADORESS
Ilo E Sopthern Ave. OI de
mm MCS AZ SE216-So46
te
oe
f — : DATE JOINED ORGANIZATION
OFFICERS? OFFICER TITLE d
|Z ves _ONo Hur: leary (Carat
00 YOU HAVE AN AFFIDAVIT ON FILE FOR ANY OTHER LICENSEE? 6)
Yes _(2/No_It *Yee", iist license number(s):
L Sohn Schroeder | the above named affiant, under penalty of
AFPIANT® NAME
pegury, upon oath, depose and say that I will cotaduct 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. T have not and shall not receive any reward, compensation or recompense for
my participation in the conduct of bingo games extept ae provided for by law. I hereby swear or confirm
that I have read and understand the foregoing and verify thst the information and statements made herein
are true and correct to the best of my knowledge. ?
IRE OF AFFIANT
J-4- Jodo
ADOR 74-1004 (4/08)
“ITY GF APACHE JUNCTIO
OCT 19 '26 anB:12
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 Arizona Revised Statutes § 5-404.
Weeneds Nene eh OB License Num
| FA (met 7X 7 ot = _ io
Position (check the appropriate boxes):
[1 Manager [1 Supervisor 1 Proceed Coordinator PB assistant REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
}
-— PEER Va LZ0
PM iso RCVD
Work Phone No. (wit areattde) ‘
Aisle
If licensee is a qualified organization, complete the following section:
Member? Date Joined Organization
Cl] Yes rh No 1 |
Officers? Officer Title
ro
CJ Yes
Do you have angffidavit on file for any other licensee?
Nc
Ol Yes If “Yes”, list license number(s):
I , the above-named affiant, under penalty of perjury, upon oath, depose
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. ] 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 ] 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, PO Box 29019, Phoenix, AZ 85038-9019
aN IEA alt
CITY OF APACHEJUNCTION
GCT 19°26 av@:13
ADOR 10327 (1/14)
Previous 71-1003 (4/06
Arizona Department of Revenue » Bingo Section
1600 Weet Monroe, Phoenix, AZ 65007 + (602) 716-7801
AFFIDAVIT
‘This affidavit must be completed by each person who wishes to assist In the conduct of any game af bingo. If
any informa@tio® is blank or Incorrect, the affidavit will be retumed to you. All information te subject to verification.
Disclosure of your Social Security Number is voluntary. This information may be used -to establish positive
identification for purposes of crimins! background checks pursuant to Arizona Revised Statutes, §5-404.
armed (aa wine black ink.
LICENSE NUMBER
Post 7962 7 11-043-B
|Check appropriate the boxee: [1 Ma Proceed Coordinator _[f Assistant
Datere)
3 1 13 2 0 0 393 1210 1250 341 -1
4 1 13 2 1 0 431 1210 574 88 -1
5 1 13 2 1 1 431 1210 226 88 7.299156 BLRICIA
5 1 13 2 1 2 688 1215 205 54 42.431892 SHAS
5 1 13 2 1 3 904 1225 101 42 42.431892 OW
4 1 13 2 2 0 394 1356 1118 57 -1
5 1 13 2 2 1 394 1356 67 47 19.707632 cIry
5 1 13 2 2 2 546 1407 73 6 0.000000 _
5 1 13 2 2 3 1399 1375 24 10 46.267738 DF
5 1 13 2 2 4 1443 1363 69 22 89.534698 CODE
4 1 13 2 3 0 433 1391 1210 74 -1
5 1 13 2 3 1 433 1391 205 68 13.190393 MizsK
5 1 13 2 3 2 1238 1402 74 63 38.448681 PPA
5 1 13 2 3 3 1423 1405 220 49 4.599991 L220?
4 1 13 2 4 0 393 1460 1118 91 -1
5 1 13 2 4 1 393 1463 583 88 45.505711 i
2 1 14 0 0 0 390 1589 1175 39 -1
3 1 14 1 0 0 390 1589 1175 39 -1
4 1 14 1 1 0 390 1589 1175 39 -1
5 1 14 1 1 1 386 1585 28 47 81.106171 ff
5 1 14 1 1 2 429 1585 114 47 0.000000 teense
5 1 14 1 1 3 566 1585 31 47 83.711319 is
5 1 14 1 1 4 613 1598 12 22 29.324131 e
5 1 14 1 1 5 648 1585 138 47 22.999729 qualified
5 1 14 1 1 6 795 1590 226 38 68.257797 organization,
5 1 14 1 1 7 1034 1589 531 39 79.846466 complete
5 1 14 1 1 8 1196 1585 48 47 95.729790 the
5 1 14 1 1 9 1259 1585 154 47 93.506119 following
5 1 14 1 1 10 1431 1585 138 47 96.657936 section:
2 1 15 0 0 0 394 1621 1757 309 -1
3 1 15 1 0 0 398 1621 1753 309 -1
4 1 15 1 1 0 1251 1621 900 102 -1
5 1 15 1 1 1 1251 1621 900 102 39.188736 mace
4 1 15 1 2 0 394 1717 1536 79 -1
5 1 15 1 2 1 394 1718 160 49 77.237679 OFFICERS?
5 1 15 1 2 2 1181 1757 7 4 19.368677 ;
5 1 15 1 2 3 1271 1717 208 79 46.673920 wipes
5 1 15 1 2 4 1848 1754 15 13 24.540052 .
5 1 15 1 2 5 1907 1753 23 10 82.088547 fs
4 1 15 1 3 0 447 1736 1570 85 -1
5 1 15 1 3 1 447 1775 57 30 76.608223 Yes
5 1 15 1 3 2 558 1771 103 46 1.678162 _[)
5 1 15 1 3 3 620 1767 42 71 87.466743 No
5 1 15 1 3 4 912 1803 11 5 27.035870 .
5 1 15 1 3 5 1059 1778 78 43 30.822071 ae
5 1 15 1 3 6 1272 1763 96 47 28.308220 LA
5 1 15 1 3 7 1389 1770 56 40 41.569382 ES
5 1 15 1 3 8 1455 1765 218 43 41.569382 DENT
5 1 15 1 3 9 1733 1736 120 69 61.957260 fut
5 1 15 1 3 10 1878 1740 139 64 46.455692 ia
4 1 15 1 4 0 399 1821 733 28 -1
5 1 15 1 4 1 395 1817 39 46 87.879440 00
5 1 15 1 4 2 448 1817 47 46 92.928925 YOU
5 1 15 1 4 3 513 1817 63 46 86.397369 HAVE
5 1 15 1 4 4 590 1817 35 46 93.598923 AN
5 1 15 1 4 5 640 1817 135 46 49.693420 AFFIDAVIT
5 1 15 1 4 6 789 1817 32 46 94.373383 ON
5 1 15 1 4 7 839 1817 55 46 79.557899 FILE
5 1 15 1 4 8 908 1817 51 46 96.883629 FOR
5 1 15 1 4 9 973 1817 51 46 96.343582 ANY
5 1 15 1 4 10 1039 1817 96 46 95.003471 OTHER
4 1 15 1 5 0 417 1862 777 68 -1
5 1 15 1 5 1 417 1866 87 64 0.000000 Yes
5 1 15 1 5 2 565 1862 97 50 0.000000 [No
5 1 15 1 5 3 666 1856 66 78 0.000000 _if
5 1 15 1 5 4 751 1856 75 78 80.734604 Vee",
list Boorse number(e):
LNAI A SH oh! , the above named affient, under penalty of
perjury, upon cath, depose and say that I will cotduct or asaist in conducting el! 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 misdemeenor 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 exéépt as provided for by law. I hereby swear or confirm
are true and correct to the best of my knowledge. ae
G
_
“SIGNATURE OF AFFIANT
DATE
ADOR 11-1003f (4/08)
CITY OF APACHEJUNCTION
OCT 19°26 av8:13
Arizona Form
Affidavit
830 Bingo
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 Arizona Revised Statutes § 5-404.
Position (check the appropriate boxes):
C1 Manager () Supervisor [J Proceed Coordinator nt USE ONLY. DO NOT MARK IN THIS AREA.
a
Affiant's Name
tha Miev-s
“Mew
s : —T
?
| Jed P™ AZ SSi20
PM 80] RCVD
H Work Phone No. (with area code)
if licensee is a qualified organization, complete the following section:
Mi Date Joined Organization
Yes O1No ZI/fi / TF
Officers? Officer Title
FlYes {PNo
Do you have an affidavit on file for any other licensee?
OlYes [YNo__[f “Yes” list license number(s):
i arthe ft
Vere above-named affiant, under penalty of perjury, upon oath, depose
and say that I will coriduct or assist in conducting ail 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. I hereby swear or confirm that I have revd
and understand the foregoing and verify that the information and siatements made herein are true and correct to the best of
my
knowledge.
Please mail to: Arizona Department of Revenue, PO Box 29019, Phoenix, AZ 85038-9019
CITY OF APACHE JUNCTION ‘@ (602) 716-7801
OCT 19°26 aw8:13
ADOR 10327 (1/14)
Previous 71-1003 (4/06}
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 Sectal Security Number (SSN) is voluntary. This information
may be used to establish positive identification for purposes of criminal background checks pursuant te Arizona Revised Statutes § 5-404
Licensee's Name License Number
/ 7 - ne a — 2
G e@orre TO) iech| se fost 796 Gi Yow — ~- -6¢3 =
(i
Position (cheek the appropriate boxes)”
(1 Manager (1 Supervisor {J Proceed Coordinator EKecsstant | REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
Affiant’s Name
TAM SAYDER
1853 gh (9h Ave
City, State ZIP Code
_ ;
ftpache Jur fi 2. L5/2O PM RCVD
L
Home Phone No. (with area code) Work Phone No. (with aree code}
If licensee is a qualified organization, complete the foilowing section:
Member? Dale Joined Organization
Bb Yes [No FAT COT
Officers? Officer Title
OlYes [INo
De you have an affidavit on file for any other ficensee?
OlYes [No _ if “Yes’, jist license number(s):
L DADAM SWYDER , the above-named affiant. under penalty of perjury, upon oath, depose
AFFIANT'S NAME
and say that J 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 niles of the licensing authority. I am of good moral character and have never been convicted of
any misdemeanor involving moral 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 I have read
and understand the foregoing and venfy that the information and statements made herein are true and correct to the best of my
knowledge
tan Alot ZLUwW
Signaturé of Affiant
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Date
Please mail to: Arizona Department of Revenue, PO Box 29019, Phoenix, AZ 85038-9019
APACHE JUNCTION @ (602) 716-7801
CITY OF
OCT 19°26 ax8:13
ADOR 10327 (4/14)
Previous 71-1003 (4/06
Arizona Form
Affidavit
Binge
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. Disctosure 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 Arizona Revised Statutes § 5-404.
Licensee's Name License Number
Js 1 Deh lSr hosp VILE VRS 1 -~CF35~ QO
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ae
Position appropriate boxes):
E?aracer [eySiupervsor ["] Proceed Coordinator PT Acsietant REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
Affiant's Name
Date
of Birth
(0220 E Apne he Te.| lat 4
City Stat ZIP Code
Az.
Apache Soaetion OS 120 eq] PM [eq RCVD
Work Phon ‘with
If licensee ts a qualified organization, compiete the following section:
Member? Date Joined Organization
Yes DNo 02101 L2OLS
Officers? Officer Title
|
yes OCNo Comm4gnc ef
Do you have an affidavit on file for any other licensee?
OC Yes 4] No __ If “Yes”, list license number(s):
— _
1, iw) fly Vv & { l iS the above-named affiant, under penalty of perjury, upon oath, depose
,
AFFIANT'S NAME
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. I am of good moral character and have never been convicted of
any misdemeanor involving moral 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 I have read
and understand the foregoing and venfy that the information and statements made herein are true and correct to the best of my
knowledge.
Signature of Affiant
we LO (722 2H
? ee
Please mail to: Arizona Department of Revenue, PO Box 29019, Phoenix, AZ 85038-9019
CITY OF APACHE JUNCTION @ (602) 716-7801
OCT 19°26 axB:13
ADOR 10327 {1/14}
Previous 71-1003 (4/06)
Home of the Superstition Mountains
September 28, 2026
Jason Walker
VFW Post 7968 Quartermaster
250 S. Phelps Drive
Apache Junction, AZ 85120
Dear Mr. Watker,
Please be advised that your application for a Class C Bingo License for the George T.
Diehl, VFW Post 7968, located at 250 S. Pheips Drive, Apache Junction, has been
recommended for approval to the Department of Revenue. Your application and
payment to the Arizona Department of Revenue were sent through the USPS to the
Arizona Department of Revenue on September 18, 2024.
The Apache Junction City Council held a public hearing on September 17, 2024, at 7:00
p.m. at which time the council recommended approval of your application.
Inspections of the premises for safety and code compliant matters have been received
from the Apache Junction Police Department, Building and Safety Division, Planning
and Zoning Department, and the Superstition Fire and Medical District.
Games of Bingo are for members of the VFW Post 7968 only, and no outside
advertising for non-members of the VFW Post 7968 is allowed. If you have questions
about conducting Bingo, A.R.S. Titie 5 chapter 4 will assist you, or you may contact the
Department of Revenue.
Please remember, under A.R.S. §5-405(B) each license issued for the conduct of any
game or games of bingo shall be conspicuously displayed at the place where any game
is to be conducted at all times during any game.
Sincerely,
Evie McKinney
City Clerk
S:Bingo Licenses/VFW Post 7968/Approval Letter To Applicant/2026
* Voice (480) 982-8002 * FAX (480) 982-7018 * TDD (480) 983-0095
j ionaz.qov
y
300 E. Superstition Boulevard, Apache Junction, AZ 85119
Home of the Superstition Mountains
September 28, 2026
Arizona Department of Revenue
1600 W Monroe Street,
Division Code 22
Phoenix, AZ 85007
Dear Sirs,
At the regular meeting of September 17, 2024, the Apache Junction City Council voted to
recommend approval of the application for a Class C Bingo License for the George T. Diehl,
VFW Post 7968, located at 250 S. Phelps Drive, in Apache Junction, AZ 85119.
A payment in the amount of $200.00, and the required forms for your action were mailed to the
Arizona Department of Revenue on September 18, 2024.
Should you have any questions regarding this matter, please contact me at (480) 474-5061.
Sincerely,
x
Cue M
Evie McKinney
City Clerk
* Voice (480) 982-8002 + FAX (480) 982-7018 * TDD (480) 983-0095
300 E. Superstition Boulevard, Apache Junction, AZ 85119
Arizona Form 832 Endorsement by Local Governing Body Bingo
FOR OFFICIAL USE ONLY PURSUANT TOA.R:S. § 5-404.A
e License Applicants: Compiete 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.
ARS. §§ 5-409 and 5-410
Date License Number
&J New Application (1) Change of Location
From (Name of local governing body)
USE ONLY. DO NOT MARK IN THIS AREA.
ae"
Address (number and street, PO Box)
City State ZIP Code
Phone No. (with area code)
leq] PM RCVD
1 This is to certify that on| )a hearing was conducted pursuant to Arizona Revised Statute, Title 5,
Chapter 4, in the matter of:
& Application for a bingo license by the following applicant.
Ci Application for a bingo jicense location transfer.
2 Applicant's Name
George T. Diehl Sr. VEW Post 7968
3 Location/Address where live bingo will be conducted: _|City State [ZIP Code
250 S. Phelps Dr. Apache Junction AZ 85120
4 Fill in the time on the days live bingo will be played:
SUN MON TUE WED THUR FRI SAT
a.m. Eda.m. Blam. a.m. Ela.m. a.m. Blam.
10-10 Blp.m. OFF _By.m,|_10-10 p.m. . OFF. f)p.m,|_10-10 Rlp.m. 10-10 8p.m.|_ 10-10 &4p.m.
5 Who is your live bingo supplier?
Bonanza Bingo Supply, Amazon
6 Recommendation for the application: (1 Approved ©) 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
1600 W Monroe Street, Division Code 22
Phoenix, AZ 85007
B (602) 716-7801
ADOR 10326 (2/20)
| Print Form |
CITY OF APACHE JUNCTION
OCT 19°26 av8:10