ST. STEVEN'S ROMAN CATHOLIC CHURCH REDACTED.PDF

Maricopa County — Formal (2024-06-26)

Extracted text (via ocr_local) 33064 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 not, your application will be returned. All
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.

1 Applicant’s Name

St. Steven’s Roman Catholic Church

Falsification of

2a Mailing Address
24827 South Dobson Road

contained in this application
constitutes a Class 6 felony.

information

2b City
Sun Lakes

State ZIP Code REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
AZ 85248

3a Administrative Office Location
24827 South Dobson Road

3b City
Sun Lakes

State ZIP Code
AZ 85248

4a Name of Contact Person
Marie Rinaldi-Sarro

4b Telephone No.

4c E-mail Address

RCVD

5 Class B and Class C license applicants only: If applying as a qualified organization, check one box to indicate the type of

organization:

0 Charitable 0 Social J Religious 0 Veterans
(1 Fraternal 1 Volunteer Fire Department [1] Homeowners Association 1 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
The Roman Catholic Diocese of Phoenix St. Steven’s Roman Catholic Parish Sun Lakes
Address — Number and Street, Rural Rt., Apt. No. Address — Number and Street, Rural Rt., Apt. No.
400 East Monroe Street 24827 South Dobson Road
City State ZIP Code City State ZIP Code
Phoenix AZ 85004 Sun Lakes AZ 85248
7 Class B and Class C license applicants only applying as a qualified organization, Jist the current officers or Board of
Directors of the organization:
7a Name 7b Name
Thomas J Olmsted Rev. Wilfred Yinah
Title Title
Bishop- Vicar General President
Address — Number and Street, Rural Rt., Apt. No. Address — Number and Street, Rural Rt., Apt. No.
Ld
City State ZIP Code State ZIP Code
L___
7c Name 7d Name
Veronica Beamer Keith Muirtield
Title Title
Secretary Treasurer
Address — Number and Street, Rural Rt., Apt. No. Address — Number and Street, Rural Rt., Apt. No.
Po
State ZIP Code City State ZIP Code

8 Class B and Class C license applicants only: Bingo checking account information:

Checking Account Number

Bank Name

Bank Branch

Continued on page 2 >

ADOR 10334 (2/20)

Applicant’s Name (as shown on page 1)
St. Stevens Roman Cathohe Chureh APPLICATION FOR BINGO LICENSE

Class B and Class C license applicants only: Bingo interest-bearing account information: N/A
Account Number Bank Name Bank Brancit

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
Rev. Fr. Wilfred Yinah Marie Rinaldi-Sarro
Title Title

Pastor Proceeds Coordinator

List the name(s) of the one or two persons who will serve as managers. !f applying as a qualified organization, these persons
must be members of the applicant. Each person must submit an affidavit.

dia Name 41b Name
Marie Rinaldi-Sarro Virginia Sigillo
Title Title

Manager Manager

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

Marie Rinaldi-Sarro Proceeds Coordinator

List the name(s) of the person(s) who will serve as supervisor. If applying as a qualified organization, each person must bea
member of the applicant. Each person must submit an affidavit. If additional names are required, please attach affidavits.

13a Name 13b Name

John Caravella Daniel Halloran
Title Title ;
Supervisor Supervisor

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.
NEXT CAGE iwmeludes names ot factatitionad ASsiSTAAL

14a Name 14b Name
Lawrence Birlin Jonella Birlin
14c¢ Name 14d Name
Marlene Bryant Neil Donohoe

Street address of the PHYSICAL location where live bingo will be played:
24827 Soutn Dobson Road, Sun Lakes, Arizona, 85248 |

Games of Bingo must not exceed 5 days a week. Indicate the time on each respective day that live bingo will be played:

Continued on page 3 >

ADOR 10334 (2/20) Arizona Form 833 Page 2 of 5

Print Page

..Page 2 continued

Names of ADDITIONAL ASSISTANTS

Ann Invandino Hill
Dennis Kissman
Bryant Sayers
Suzanne Stills
Jason Walton
Judy Thompson
Daniel Halloran *

Virginia Sigillo *

*Holds additional positions as Back-Ups

Applicant's Name (as shown on page 1)

| St. Steven's Koman Catholic. Cho cel

APPLICATION FOR BINGO LICENSE

17 Indicate the type of premises where bingo will be played. Check one box:

a (J Neither rent nor mortgage will be paid from bingo funds.

b (J 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 [8% Owned solely by the organization. Attach copy of mortgage, deed of trust, purchase agreement, escrow agreement, or

other related document:
Copy of beeb (next page)
Holder of Mortgage UJ Address — Number and Street, Rural Rt., Apt. No.
NONE

Telephone Number (with area code)

City State ZIP Code

d (J Owned jointly with other organization. Attach copy of mortgage, deed of trust, purchase agreement, escrow agreement, or

other related document:

1) Holder of Mortgage Address — Number and Street, Rural Rt., Apt. No.
Telephone Number (with area code) City State ZIP Code
2) Co-Owner Holder: Address ~ Number and Street, Rural Rt., Apt. No.
Telephone Number (with area code) City State ZIP Code
3) Go-Owner Holder: 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: AVDALE”

18a Name 18b Name
w/a w/h
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

Print Page

OFFICIAL RECORDS OF

COMMERCIAL MARICOPA COUNTY RECORDER
HELEN PURCELL

20090456359 05/20/2009 04:20

Recorded at the request of: ELECTRONIC RECORDING
Chicago Title

When recorded, mail to: 806323-3-1-1--

Roman Catholic Church of Phoenix Palumboa

400 East Monroe
Phoenix, AZ 85004

Escrow No.: CT0806323-CT2942 Space above this line for Recorder's Use

Y
/ SPECIAL WARRANTY DEED

For the consideration of Ten Dollars, and other valuable considerations,

Thomas James Olmsted, Bishop of the Roman Catholic Church of the Diocese of Phoenix, a corporation sole

does hereby convey to

St. Steven Roman Catholic Parish Sun Lakes, an Arizona corporation
the following real property situated in Maricopa County; Arizona:
Parcel No. 1:

A portion of the, Southwest quarter of the Southwest quarter of Section 29, Township
2 South, Range 5 East of the Gila and Salt River Base ‘and Meridian, Maricopa County,
Arizona, described as follows:

COMMENCING at the Southwest corner of said Section 29; thence North 00 degrees 22

minutes 54 seconds West along the West line of said Southwest quarter of the Southwest quarter

of Section 29, a distance of 720.04 feet; thence North 89:degrees 00 minutes 24 seconds East, a
distance of 55.00 feet to a point on the North line of that certain parcel as described as Recorder's No.
85-1 13968, records of Maricopa County, Arizona, and the POINT OF BEGINNING; thence

North 00 degrees 22 minutes 54 seconds West along the East line of Dobson Road, a distance of
294.37 feet; thence Southeasterly along the arc of a 15.00 foot radius curve, being concave to the
Northeast, through a central angle of 90 degrees 00 minutes 00 seconds, a distance of 23.56 feet to

a point of tangency; thence North 89 degrees 37 minutes 06 seconds East along the South line

of that certain parcel as described in Docket 10587, Page 370; records of Maricopa County, Arizona,
and a prolongation thereof, a distance of 776.40 feet; thence South 00 degrees 22 minutes 54 seconds
East, a distance of 270.92 feet; thence South 89 degrees 00 minutes 24 seconds West, a distance of
791.44 feet to the POINT OF BEGINNING.

Parcel No. 2:

Lot 78 Sun Lakes Unit Thirty-Two Phase |, according to Book 371 of Maps, page 32, and Affidavit of Correction
recorded at Recorders No. 1994-302687, records of Maricopa County, Arizona;

EXCEPT all water, oil, gas, minerals and rights thereto.

SUBJECT TO: Current taxes and other assessments, reservations in patents and all easements, rights of way,
covenants, conditions and restrictions as may appear of record.

And the Grantor hereby binds itself and its successors to warrant and defend the title, against all acts of the
Grantor herein, and no other, subject to the matters set forth.

Dated: July 29, 2008

pixdse Leofjuenyeyepoopoes/nob edoouew Jepsooeu//:-dny

sebed v [6se9sr0600z] ezrz0¢

Se = _____——_—E 20090456359

Thomas James Olmsted, Bishop of the Roman
Catholic Church of the Diocese of Phoenix,
a corporation sole

Viet James p fe Bishop

Exempt (A.R.S. 11-1134, B7)

pigxdse LsoKjuenyeyepo0poes/Ao6 edoouew Jepsooed//:diu,

sebed ¢ [ese9gr0600z] EzrZ0¢

20090456359

NOTARY ACKNOWLEDGMENT(S) TO SPECIAL WARRANTY DEED

State of Arizona

County of Maricopa

The foregoing document was acknowledged before me this Lh cay tllag. 2008" qY

by Thomas James Olmsted ,the Bishop

The Roman Catholic Church Of The Diocese OF Phoenix

a_Coxrporation Sole , on behalf of the - Corporation Sole

pigxdse yeojuenjeyepoopoe./A0B edoouew Jepsooes//:dyy

seabed v [6se9sv0600c] ezrZ0¢

RECORDER

20090456359
OFFICIAL RECORDS OF
MARICOPA COUNTY RECORDER
STEPHEN RICHER

The foregoing instrument is an
electronically prepared

full, true and correct copy

of the original record in this
office.

Attest: 04/25/2024 08:50:36 AM

By te tc “Recorder

To Verify this purchase visit

http://recorder.maricopa.gov/recdocdata/verifycert.aspx?id=307423

MCR 4 of 4

pigxdse Yaofjuanyeyepoopoes/Aob edoouew sJepsooei//:dyy

sabed » [6ge9gr06002] ezrz0e

Applicant's Name (as shown on page 1)

St. Steven's Roman CatHolie Church

APPLICATION FOR BINGO LICENSE

19 Expected bingo expenses:

Mortgage: $O(zero) —,:~per month
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
Rent: $,0 (zero) per J month (J hour © occasion
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
Janitorial Services: $0 (zero) per month (J hour © occasion
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
Accounting Services: $_0 (Zero) per J month (J hour [J occasion
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
Security Services: — $,0 (zero) per) month (J hour (J occasion
Payable to Address — Number and Street, Rural Rt., Apt. No.
Telephone number (with area code) City State ZIP Code
Bingo Supplies: $,600-800 , per_month
Payable to Address — Number and Street, Rural Rt., Apt. No.
Amazon FIO E TERRY AVE N.
Telephone number (with area code) City 7 7 State —- ZIP Code
206* 2g = 1000 Stare, LWA: 98109
7

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?

AMAZON.

“technological aids” not at this time

Continued on page 5 >

ADOR 10334 (2/20)

Arizona Form

833

Page 4 of 5

| | a* en Amazon

All Same-Day Delivery

Pay $67.24/month for 12 months, 0% interest (plus S&H and tax) when you choose equal monthly

Medical Care

‘on Basics Buy

Payments at checkout.

Shopping Cart

Deselect all items

2e0CCee coeceeo:

Price

Yuanhe Bingo Paper Game $12.99

Cards - 3 Cards - 100 Sheets
In Stock
One-Day
FREE delivery Tomorrow, May 25
FREE Returns
> This is a gift Learn more

Delete Save for later

Qty: 5
Compare with similar items

Yuanhe Bingo Daubers Dot $28.99

Markers - Mixed Colors Set of
In Stock

Overnight
FREE delivery Overnight 7 AM - 11AM

FREE Returns
> This isa gift Learn more

Qty: 4 Delete Save for later
Compare with similar items Share

INNOVATRONIX Bingo $560.00
Flashboard Controller - US

In Stock

Shipped from: Innovatronix inc

$35 delivery May 30 - Jun 4

Gift options not available. Learn more

Qty: 1 Delete —_ Save for later

Compare with similar items Share

MR CHIPS 11" (Inch) Tall
Professional Bingo Set with
In Stock

Two-Day

FREE delivery Sun, May 26
FREE Returns

~ This isa gift Learn more
Color: 3 Pc Mysterious Black

$65.99

Qty: 7 Save for later

Delete

Subtotal (11 items): $806.90

Hello, }
EN~ Account & Lists &

Memorial

Learn how it works

aE OL
You are getting FREE Overnight delivery
on eligible items!

Subtotal (11 items): $806.90
~ This order contains a gift

{ Proceed to checkout

Pair with your cart

few toe a! te! Bigger Replacement for

Neel Nal Neel Ged Ep
(oo) boo) bos) Geel ERC- ans SE Te.
esas $22.99
Koel ed Cd Gad?
See! Go! Lee! (ol
Add to Cart

Regal Bingo - Deluxe

Bingo Set - Includes 6...
17,534

$20.99
Add to Cart _
y

Rarlan Washable
Markers Bulk, Markers...
624

$42.99

|Add to cart»

Dab-O-Ink 30z Bingo

Daubers ~ Mixed Colo...
7,188

$17.95

| Add to Cart

Applicant's Name (as shown on page 1)

St: Steven's Kemax Cathohe Church

APPLICATION FOR BINGO LICENSE

» 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.

df 29) Aaa bee cth wt AMET RAT DR

APPLICANT'S SIGNATURE VU
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.
(Approved (J Disapproved fIClassA License [JClassBLicense (JClass C License
Reviewer's Name (please print) Date License Number Effective Date Expiration Date

ADOR 10334 (2/20)

Arizona Form 833

Page 5 of 5

Arizona Form
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

St. Steven's Roman Catholres Chucch

Position (check the appropriate boxes):

fi Manager [1 Supervisor val Proceed Coordinator _[-] Assistant el USE ONLY. DO NOT MARK IN THIS AREA.
88}

Affidavit Bingo

Affiant’s Name 5
INakie Kink bi- SARLO

Date

City ZIP Code
| bt) ‘Work Phone No. (with area code)

If licensee is a qualified organization, complete the following section:

Sog

Member? Date Joined Organization
Yes [INo 0426/2002.
Officers? Officer Title
OO Yes wd No
Do you have an, affidavit on file for any other licensee?
1 Yes No _ If "Yes", list license number(s):
L / If ALIE Linn AD1- prere , the above-named affiant, under penalty of perjury, upon oath, depose

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. 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 read
and understand the foregoing and verify that the information and statements made herein are true and correct to the best of my

knowledge.

Senge of Annan /

y/y Jzoz4

Date

Please mail to:
Arizona Department of Revenue
1600 W Monroe Street, Division Code 22
Phoenix, AZ 85007

® (602) 716-7801

ADOR 10327 (2/20)

Arizona Form

330 Affidavit

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 A.R.S. § 5-404.

Licensee’s Name

St. Steven's Roman Catholiea Chuoreh

License Number

Position (check the appropriate boxes):
| Manager Cl superisor__[] Proceed Coordinator fl Assistant

Affiant's Name

ViRraswit Cc. S14)

Social Security Number

LLe
——_

ZIP Code

‘Work Phone No. (with area code)

ee Phone - area -

REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

[eo RCVD

If licensee is a qualified organization, complete the following section:

Member? Date Joined Organization

Yes [J No oifit Zcoo7
Officers? Officer fitle 7 ,
1 Yes rif No

Do you have an affidavit on file for any other licensee?

Gl Yes No __ [If “Yes”, list license number(s):

knowledge.

ale ee C 5

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

and understand the foregoing and verify that the information and statements made herein are true and correct to the best of my

Q. Ea th a

Signaturd of Affiant

“ VE, CA

Date

Please mail to:
Arizona Department of Revenue
41600 W Monroe Street, Division Code 22
Phoenix, AZ 85007

@ (602) 716-7801

ADOR 10327 (2/20) ‘Print Form

Arizona Form

330 Affidavit

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 retuned to you. All information Is subject to verification. Disclosure of your Social Security Number (SSN) Is voluntary. This information
may be used to establlsh positive identification for purposes of criminal background checks pursuant to A.R.S. § 5-404.

Licansee’s Name
St. Steven's Remon Catholic Church

License Number

Position (check the appropriate boxes):
|] Manager 1H supervisor (1 Proceed Coordinator__[] Assistant

Affiants Name
Sok

CoV EN

Social Security Number

Work Phone No. (with area code)

iR E USE ONLY. DO NOT MARK IN THIS AREA.

RCVD

eye

If licensee is a qualified organization, complete the following section:

Member? Date Joined Organization
Eyes CINo 12 Jos /201F
Officers? Officer Title /
[1 Yes Ei No

Do you have an affidavit on file for any other licensee?
Yes a No _ If “Yes”, list license number(s):

knowledge.

— ss
| eetole’ CARAY 2HlA , 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. Iam 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

— Crate Me

Signature of Affiant

4/ jo LZo24

Date” / /

Please mail to:
Arizona Department of Revenue

Phoenix, AZ 85007

4600 W Monroe Street, Division Code 22

@ (602) 716-7801

ADOR 10327 (2/20)

ona Form : .
330 Affidavit 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 A.R.S. § 5-404.

Licensee's Name License Number

St. 's

Position (check the appropriate boxes):
[J Manager [Supervisor (1 Proceed Coordinator ud Assistant a USE ONLY. DO NOT MARK IN THIS AREA.

Affiant’s Name
DamieL Eveyryn tyctordn/

Sociat Security Number is " ° "
State IP Code
PM e RCVD

one No. (with area code) ith area code)

If licensee is a qualified organization, complete the following section:

Member? Date Joined Organization
Elves CINo 04/07/2024
Officers? Officer Title

[I Yes TI No

Do you have an affidavit on file for any other licensee?
Clyes [No _if"Yes’, list license number(s):

1, Vani ed Ep: ge nm) ere corer) , 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. 1 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.

Signature of Affiant
, A, OW)<
Boel) CL? DRS
Date” 7
Please mail to:

Arizona Department of Revenue
4600 W Monroe Street, Division Code 22
Phoenix, AZ 85007

@ (602) 716-7801

ADOR 10327 (2/20) Print Fo

Arizona Form

3830 Affidavit

Bingo

This affidavit must be completed by each person who wishes
affidavit will be returned to you. All information Is subject to

to assist in the conduct of any game of bingo. If any information is blank or incorrect, the
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

St. Steven's Roman Catholic Chucch
Position (check the appropriate boxes):

|] Manager [J Supervisor__[7] Proceed Coordinator Uf Assistant
Affiant's Name
L MOSK CE (24 Le aL

Saul

Date of Bi
Address

Ho Work Phone No. (with area code)

License Number

a USE ONLY. DO NOT MARK IN THIS AREA.

i Phone No. - area -

If licensee is a qualified organization, complete the following section:

Member? Date Joined Organization
WiyYes [CINo 23/1/2004
Officers? Officer/fitle / ,
Dyes MNo

Do you have an affidavit on file for any other licensee?

Yes No If “Yes”, list license number(s):

knowledge.

Z y
I, Liuabente. Jue feal , the above-named affiant, under penalty of perjury, upon oath, depose

and understand the foregoing and verify that the information and statements made herein are true and correct to the best of my

4 f/f O AR

Date

Please mail to:
Arizona Department of Revenue

Phoenix, AZ 85007

4600 W Monroe Street, Division Code 22

3 (602) 716-7801

ADOR 10327 (2/20)

Arizona Form
830

Licensee's Name License Number
St. Steven's Roman Cathe tie Church

Position (check the appropriate boxes):

Ci Manager [1] Supervisor__[7] Proceed Coordinator Assistant REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

Affidavit Bingo

Affiant’s Name
Jene \ lew B eli w

: a Date of Birth

FS} ZIP Code
PM RCVD
" “ = i area - Work Phone No. (with area code)
If licensee is a qualified organization, complete the following section:
Member? Date Joined Organization
Mies [CINo 03 fy J2ocr)
Officers? Officer Title T ,
DlyYes [No
Do you have an affidavit on file for any other licensee?
[1] Yes No _ If “Yes”, list license number(s):
L C ) onthe buliw _, the above-named affiant, under penalty of perjury, upon oath, depose

AFFIANTS NAME
and saythat 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. Iam 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.

Co oytlle’ Yalow
Signature of Affiant
y

Y - 1/6 > 2033

Date

Please mail to:
Arizona Department of Revenue
4600 W Monroe Street, Division Code 22
Phoenix, AZ 85007

@ (602) 716-7801

ADOR 10327 (2/20) Print Form |

Arizona Form

830 Affidavit

Bingo

This affidavit must be completed by each person who wishes to assist in the conduct of any game
affidavit will be returned to you. All information is subject to verification. Disclosure of your Social

of bingo. If any information is blank or incorrect, the
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

St. Steven's Roman Cathelie Church

License Number

Position (check the appropriate boxes):

aes USE ONLY. DO NOT MARK IN THIS AREA.
| 8

[Manager [C] Supervisor__[] Proceed Coordinator BH Assistant
Affiants Name __ ‘ ‘

Roan Trvandino Hill
Spe Date of Birth

‘Work Phone No. (with area code)

RCVD

If licensee is a qualified organization, complete the following section:

Member? Date Joined Organization
li Yes [JNo (2/9 Of(Z2020
Officers? Officer Title /

Dyes [No

Do you have an affidavit on file for any other licensee?
1 Yes No ___ If “Yes”, list license number(s):

for my participation in the conduct of bingo games except as provided for by law.

knowledge.

I, iN ono nV aN 4 NO i 1 | \ , the above-named affiant, under penalty of perjury, upon oath, depose

any misdemeanor involving moral turpitude or felony. I have not and shall not receive any reward, compensation or recompense

and understand the foregoing and verify that the information and statements made herein are true and correct to the best of my

I hereby swear or confirm that I have read

Signature of

Alto Java

Drones)

Date

Please mail to:
Arizona Department of Revenue

Phoenix, AZ 85007

4600 W Monroe Street, Division Code 22

(602) 716-7801

ADOR 10327 (2/20) Print Form

Arizona Form

330 Affidavit

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 A.R.S. § 5-404.

Licensee's Name

SE. Steven's Rowan Catholic Church

License Number

Position (check the appropriate boxes):
[Manager [] Supervisor _[-] Proceed Coordinator assistant

Jerome Donohoe.

Affiant’s Name .
Ne: |
j lumber

Date of Birth

fork Phone No. (with area code)

REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

If licensee is a qualified organization, complete the following section:

Member? Date Joined Organization
Biyes [INo Mf or [201s
Officers? Officef Tittle 7

[1 Yes wf No

Do you have an affidavit on file for any other licensee?
[1 Yes wi No __ If “Yes”, list license number(s):

knowledge.

I (le. { le yom ¢@ De No bp ‘e , 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. 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

410 -ath

Date

Please mail to:
Arizona Department of Revenue

Phoenix, AZ 85007

4600 W Monroe Street, Division Code 22

@ (602) 716-7801

ADOR 10327 (2/20)

Arizona Form
830

Affidavit Bingo

This affidavit must be completed by each person
affidavit will be returned to you. All informatio

n is subject to verification. Di

who wishes to assist in the conduct of any game of bingo. If any information is blank or incorrect, the
isclosure 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

Position (check the appropriate boxes):

St. Steven's Roman Cotholie Church

awe USE ONLY. DO NOT MARK IN THIS AREA.

Social Security Number

ZIP Code

ei] Pi

: i. ~ area -

‘Work Phone No. (with area code)
WTA

RCVD

If licensee is a qualified organization, complete the following section:

Member? Date Joined Organization

Yes _[1No 63 fib [2004
Officers? Officer tive = / 7
[1 Yes Dx No
Do you have an affidavit on file for any other licensee?
(1 Yes No __{f “Yes”, list license number(s):

I, Woe lene C

“Be wont

_, the above-named affiant, under penalty of perjury, upon oath, depose

AEFTANTS NAMES

Statutes, Title 5, Chapter 4, and the rules

knowledge.

and say that I will conduct or assist in conducting all bingo games in comp!

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

liance with the terms of the license, Arizona Revised

of the licensing authority. I am of good moral character and have never been convicted of

Signature of Affiant

Rue —
NI

o| t2| 2024

v T
\

Date

Please mail to:
Arizona Department of Revenue
4600 W Monroe Street, Division Code 22
Phoenix, AZ 85007

ADOR 10327 (2/20)

rey (602) 716-7801
Print Form.