In order to ensure that your business runs smoothly, it is important to have the proper forms and applications in place. One of the most commonly used forms in businesses today is Form BG 5. This form can be used for a variety of purposes, such as tracking inventory or making note of damaged goods. In this blog post, we will discuss what Form BG 5 is and how it can be used by businesses. We will also provide tips on how to properly complete this form so that you can get the most out of it. Stay tuned!
| Question | Answer |
|---|---|
| Form Name | Form Bg 5 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | Bingo Games Application state of maine gaming fillable form |
STATE OF MAINE
DEPARTMENT OF PUBLIC SAFETY GAMING & WEAPONS SECTION
164 STATE HOUSE STATION, AUGUSTA, MAINE
(207)
Application for a License to Operate Beano/Bingo or a Game of Chance
**The Gaming & Weapons Unit must receive this application at least eight days before Beano or a Game of Chance may begin**
1. |
For what license are you applying (please check one): BEANO OR GAMES OF CHANCE |
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IF YOU CHECKED GAMES OF CHANCE: |
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2. |
Organization Name: _______________________ |
Name of Game: ______________________________ |
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Organization Number: _____________________ |
Number of Games: _______________________ |
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Federal Tax ID # (EIN): _________________ |
Open to Public? Yes No |
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Business Address: __________________________________________________________________________ |
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Mailing Address: ________________________________________________ Phone: ____________________ |
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3. |
Current Officers: |
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__________________________________________________________________________________________ |
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NAME & TITLE |
ADDRESS |
CITY/ZIP |
PHONE |
DATE TERM EXPIRES |
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NAME & TITLEADDRESSCITY/ZIPPHONE DATE TERM EXPIRES
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NAME & TITLEADDRESSCITY/ZIPPHONE DATE TERM EXPIRES
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NAME & TITLE |
ADDRESS |
CITY/ZIP |
PHONE |
DATE TERM EXPIRES |
4.Location where Beano/Bingo or Game of Chance is to be conducted:
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BUILDING |
ADDRESS |
CITY/ZIP |
5.Person responsible for operation of Beano or Games of Chance:
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NAME |
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DAYTIME PHONE & EVENING PHONE |
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Name & Address where Licenses will be sent: ____________________________________________________ |
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6. |
Circle the days of the week you expect to operate: Mon |
Tue |
Wed |
Thu |
Fri Sat Sun |
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What are the hours of operation? ___________________________________________________________ |
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7. |
For Tournaments and Beano Only: |
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What time do the doors open? _________________ What time does the game start? __________________ |
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8. Dates to be licensed – Please specify weeks (Monday through Sunday) or full months. You may apply in advance for up to 6 months of licenses for Beano and 12 months for Games of Chance. See back of this form for rates.
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BG 5 (05/12) |
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FOR OFFICE USE ONLY
Check #_______________
Amount $ _____________
9. Does the organization own all the equipment used in operating this amusement? Yes No If “NO”, please explain the circumstances under which the equipment was acquired:
________________________________________________________________________________________________________________________
10.Has any current officer of this organization or association ever been convicted of or have any charges currently
pending for violating the gambling or lottery laws of the United States or the State of Maine? Yes No
If “YES” give the person’s name, address, and date and place of conviction or date and location of pending charge:
________________________________________________________________________________________
11.If the Applicant is a Fair Association, attach a list of the names and home addresses of the persons operating or
assisting in the licensed activity. Please write your organization name and number on the list.
12.The applicant agrees to obey the laws of the State of Maine and the United States and the rules and regulations governing Beano or Game of Chance promulgated by the Chief of the State Police. The applicant warrants the truth of the foregoing statements on penalty of perjury.
Signed: _____________________________________________________ Age 18 or older: Yes No
Name: ______________________________________Title:________________________ Date: ___________
(Please print – must be duly authorized officer of this organization – title is required)
13.The following consent must be completed by the municipal officers of the city or town where the Beano/Bingo or Game of Chance will take place unless a separate “Blanket Letter of Approval” is filed with the Chief of the State Police.
Check here if you have previously filed a “Blanket Letter of Approval” with us, which is still valid
Check here if you have attached a “Blanket Letter of Approval”.
The undersigned being municipal officers of the City/Town of _________________________ hereby certify that we
consent to this application for a license to operate Beano/Bingo or a Game of Chance in accordance with the provisions of 17 M.R.S.A. Chapter
Name: __________________________________________________________ Date: ________________________
Name: __________________________________________________________ Date: ________________________
Name: __________________________________________________________ Date: ________________________
Name: __________________________________________________________ Date: ________________________
Beano:$5.00/one game; $12.00/Week; $36.00/Month; $400.00/Year |
Game of Chance: $15.00/Week; $60.00/Month; $700/Year |
Video Poker: $15.00/Week or $60.00/Month |
Card / Cribbage: $30.00 Per Calendar Year |
Tournament Game (up to 100 players):$150.00/Per Tournament or $250.00/Month (Two Tournaments)
Make check payable to Treasurer, State of Maine
Return your signed and completed application to: Department of Public Safety Gaming and Weapons Section 164 State House Station Augusta, ME