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Where Game(s) will be Conducted Site Address City State Zip Code County Check the Game(s) to be Conducted: * Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Local Permit. Bingo Raffle Calendar Raffle Sports Pool Poker * Twenty-one * Paddlewheels * DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED Game Type Description of Prize Retail Value of Prize Game Type Retail Value of Prize Description of Prize (Limit $12,000 per year) Total: $ Intended uses.

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