BINGO LICENSE QUESTIONAIRE ORINGAL - REDACTED.PDF

Bingo License Questionnaire
licensee: ST. Sreveat'’s Roman Caritotice Cuuect

1. What is your Bingo License Number?

(wot_tssuep yer p)

2. Please list all the license numbers associated with your organization. (if applicable)

NONE

3. What is the email address associated with the licensee?

4. What is the address where the bingo games are being played?

24927 S. boson Roap, Sun Lanes AZ 85246

5. What is the mailing address of the licensee?

4 Do@Son Roab 62

6. What are your live bingo game hours of operation?

—Montusy , rHvespay _ 5:40 -7 Pad

7. \sa person on the premises physically drawing and calling the numbers when live bingo games are being
conducted?
Yes ONo
8. Does a secondary supervisor verify the live bingo game numbers?
x Yes ONo

9. Whois your live bingo supplier? (For all bingo supplies and equipment)

AMAZON

10. Please provide a copy of your most recent itemized bingo order. 4 axtoched)
V

11. Do you currently own or are you renting machines as “technological aids” for the live bingo games?
O Yes No

a. If yes, please provide a copy of your purchase or rental agreement.

b. If no, do you foresee purchasing/renting machines as “technological aids” for the live bingo

games? Pooslory in THE FOTURE

1600 West Monroe Street, Phoenix AZ 85007-2650 www.azdor.gov

12. If you have “technological aids,” are they being used in conjunction with numbers being called and players
physically present marking their own cards?
OYes ONo )XN/A

13. Print name of the preparer of this questionnaire.

Marre, Rinarpt- Saeeo

Medical Care

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