To be issued only for Category 1 Raffles with net profits less than $30,000 during a license period 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Name of Organization' in the designated field. Ensure that the name matches your official registration.
3. Next, input your 'Games of Chance Identification Number.' This number is crucial for identification purposes.
4. Fill in the 'Street Address,' followed by the 'City, Town or Village.' Circle the appropriate option to indicate your location.
5. Enter your 'Zip Code' accurately to avoid any processing delays.
6. Specify the 'Effective date of raffle license (Calendar Year).' This should reflect when you plan to start your raffle operations.
7. List the 'Location(s) of raffle drawing(s)' and corresponding 'Date(s) of raffle drawing(s)' clearly to ensure compliance with regulations.
8. Finally, certify the information by printing your name, title, and signing where indicated. Don’t forget to have it notarized as required.

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