Lgccc Raffle Report Form PDF Details

Welcome to the LGCCC Raffle Report Form. As a member of our LGCCC organization, you know that we’re committed to using funds in creative and innovative ways through various activities like raffles. To help make it easier for us to track these fundraising efforts, we’ve created this easy-to-use online form so that all members can have full visibility of our finances. Through this reporting system, we will be able to provide more transparency while ensuring that all donations are properly accounted for and reported accurately according to state regulations - as well as ensure maximum revenue is being generated from each activity!

QuestionAnswer
Form NameLgccc Raffle Report Form
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namesinstant raffle ticket printable, state of new jersey raffle license, nj raffle report, nj lgccc report

Form Preview Example

New Jersey Office of the Attorney General

DIVISION OF CONSUMER AFFAIRS

Ofice of Consumer Protection

Legalized Games of Chance Control Commission

P.O. Box 46000, Newark, NJ 07101

(973) 273-8000

Instructions for Filing the Instant Rafle Report of Operations

PURSUANT TO N.J.A.C. 13:47-9.1, licensees are to ile a report of operations with the Legalized Games of Chance Control Commission (“Commission”) no later than the 15th day of the calendar month immediately following the calendar month in which the licensed activity was held, operated or conducted.

You may download this report and complete ALL of the entries for each occasion(s) relating to the conduct of instant rafle games. Once completed, a member/oficer shall certify that he/she has reviewed the report and that the information provided is true, accurate and complete. This will require the person to state his/her name and title, and to sign the document before a notary public. Reports which are not properly certiied will be mailed back.

Instant Rafle Ticket Report of Operations completed on paper must be mailed to the Legalized Games of Chance Control Commission, P.O. Box 46000, Newark, New Jersey 07101.

However, for your convenience, we offer the ability to ile reports electronically via e-mail. To employ this option, you must do a “SAVE AS” of the report, and place it onto your personal computer. Complete the report by using the “TAB” key to maneuver through each ield.

Upon completion, the member/oficer shall certify by placing a check in the box provided, that he/she has reviewed the report and that the information provided is true, accurate and complete. Subsequently, the member/oficer must state his/her name and title. Reports that are not properly certiied will be sent or e-mailed back.

Instant Rafle Ticket Report of Operations completed online must be e-mailed to the Commission at PetermanA@dca.lps.state.nj.us .

It is recommended that you maintain a copy of all reports as part of the organization’s records.

Municipality:_______________________________________

New Jersey Office of the Attorney General

Identiication number:________________________________

DIVISION OF CONSUMER AFFAIRS

 

 

 

Ofice of Consumer Protection

License number: ____________________________________

 

Legalized Games of Chance Control Commission

 

 

P.O. Box 46000, Newark, NJ 07101

 

 

(973) 273-8000

 

 

INSTANT RAFFLE TICKET REPORT OF OPERATIONS

 

This report, as required by N.J.S.A. 5:8-37 and N.J.A.C. 13:47-9.1, must be iled with the Legalized Games of Chance Control Commission no later than the 15th day of the month following the conduct of the game(s) of chance.

SECTION A

Name of Licensee: _________________________________________________Address: ___________________________________________________________ Location of Games: __________________________________

 

Date

 

 

Form

Serial

 

Sales Invoice

Size of Ticket

Ideal

Ideal

Actual

Gross

Number of

Actual

Cost of

NET

 

 

Name of Game

Distributor

Net

Tickets

Tickets

Prize $

 

Start

End

Number

Number

Number

Deal

Price

 

Receipts

Deal

PROCEEDS

 

 

 

Payout Receipts

Sold

Redeemed

Paid Out

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

TOTALS

Totals = Lines 1 through 17

SECTION B

Schedule of Expenses

 

 

 

 

 

DATE

Description

Check Number

Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION C

UTILIZATION OF NET PROCEEDS

DATE

Description

Check Number

Amount

SECTION E

I certify that all of the statements on this report of operations are true, accurate and complete. I am aware that if any of the foregoing statements are willfully false, I am subject to punishment.

Member in Charge

Address

Signature

DATE

 

 

 

 

I certify that I have reviewed this report and that the information on this report of operations is true, accurate and complete. I am aware that if any of the foregoing statements are willfully false, I am subject to punishment. Facts stated on this report are regarded as if made under oath.

I certify by placing a check in this box, that I have reviewed the report and that the information provided is true, accurate and complete.

You must state your name and title below. Reports that are not properly certiied will be sent or e-mailed back.

SECTION D

 

BANK

 

 

 

 

 

Name

 

Address where Balance is Deposited

Account Number

 

 

 

 

 

Person Responsible for Use of Proceeds

 

Name

 

Address

Telephone Number

 

(include area code)

 

 

 

 

Where are the unused tickets kept? (Please provide the address.) ________________________________________

______________________________________________

Name and title of oficer (please print)

Sworn and subscribed to before me this __________________

day of ____________________________ , ______________

MonthYear

__________________________________________________

Name of Notary Public (please print)

__________________________________________________

Signature of Notary Public

_________________________________________

Signature (oficer)

Afix Seal Here

Form LGCCC 8B-A2Rev. December 2007

Municipality:_______________________________________

New Jersey Office of the Attorney General

Identiication number:________________________________

DIVISION OF CONSUMER AFFAIRS

 

 

 

Ofice of Consumer Protection

License number: ____________________________________

 

Legalized Games of Chance Control Commission

 

 

P.O. Box 46000, Newark, NJ 07101

 

 

(973) 273-8000

 

 

INSTANT RAFFLE TICKET REPORT OF OPERATIONS

 

This report, as required by N.J.S.A. 5:8-37 and N.J.A.C. 13:47-9.1, must be iled with the Legalized Games of Chance Control Commission no later than the 15th day of the month following the conduct of the game(s) of chance.

SECTION A

Name of Licensee: _________________________________________________Address: ___________________________________________________________ Location of Games: __________________________________

 

Date

 

 

Form

Serial

 

Sales Invoice

Size of Ticket

Ideal

Ideal

Actual

Gross

Number of

Actual

Cost of

NET

 

 

Name of Game

Distributor

Net

Tickets

Tickets

Prize $

 

Start

End

Number

Number

Number

Deal

Price

 

Receipts

Deal

PROCEEDS

 

 

 

Payout Receipts

Sold

Redeemed

Paid Out

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

TOTALS

Totals = Lines 1 through 17

SECTION B

Schedule of Expenses

 

 

 

 

 

DATE

Description

Check Number

AMOUNT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION C

UTILIZATION OF NET PROCEEDS

DATE

Description

Check Number

AMOUNT

SECTION E

I certify that all of the statements on this report of operations are true, accurate and complete. I am aware that if any of the foregoing statements are willfully false, I am subject to punishment.

Member in Charge

Address

Signature

DATE

 

 

 

 

I certify that I have reviewed this report and that the information on this report of operations is true, accurate and complete. I am aware that if any of the foregoing statements are willfully false, I am subject to punishment. Facts stated on this report are regarded as if made under oath.

I certify by placing a check in thisbox, that I have reviewed the report and that the information provided is true, accurate and complete.

You must state your name and title below. Reports that are not properly certiied will be sent or e-mailed back.

SECTION D

 

BANK

 

 

 

 

 

NAME

 

Address where Balance is Deposited

Account Number

 

 

 

 

 

Person Responsible for Use of Proceeds

 

NAME

 

Address

Telephone Number

 

 

(include area code)

 

 

 

 

Where are the unused tickets kept? (Please provide the address.) ________________________________________

______________________________________________

Name and title of oficer (please print)

Sworn and subscribed to before me this __________________

day of ____________________________ , ______________

MonthYear

__________________________________________________

Name of Notary Public (please print)

__________________________________________________

Signature of Notary Public

_________________________________________

Signature (oficer)

Afix Seal Here

Form LGCCC 8B-A2Rev. December 2007

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