Permit for Gaming Application

Permit for Gaming Application
GAMING EVENT APPLICATION NO.
FOR PERMIT in accordance with Maryland Annotated Code, Criminal Law § 13-906.1
Application of*
Name of Organization
To the County Commissioners of Carroll County: Application is hereby made on behalf of*
Name of Organization
For a permit under the provisions of Maryland Annotated Code, Criminal Law § 13-906.1 as follows:
The Applicant is a Qualified (Non-Profit) Organization pursuant to Maryland Annotated Code, Criminal Law § 13-906.1(c) located at
Address of Organization
The Permit desired is for conducting a
(*Examples: Card Game, Card Tournament, Casino Event)
at
(Name and address where event is being held)
on the following dates:*

MonthDayYear
Date
Approximate Value of Prizes
The Applicant obligates itself to see that the limitations as to a number of raffles, number and value of prizes contained in the referenced statutes shall be observed, and that no individual or individuals shall benefit financially from the operation of the games for which permit is hereby applied. The Applicant obligates itself to see that participants in events involving alcoholic products must be 21 years old to participate in the event and no alcohol products shall be opened at the event. Application may be faxed to 410-386-2770 or emailed to cctaxoffice@carrollcountymd.gov
Signature of Applicant

Clear
Name of Applicant*
Print
Mailing Address
Telephone
E-Mail
example@example.com
Should be Empty: