Games Of Chance Registration
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Games Of Chance Registration Form. This is a New York form and can be use in Miscellaneous Secretary Of State.
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Tags: Games Of Chance Registration, DOS-0255-f-l-a, New York Secretary Of State, Miscellaneous
NYS Department of State
Division of Corporations, State Records
and Uniform Commercial Code
One Commerce Plaza, 99 Washington Avenue
Albany, NY 12231-0001
Games of Chance Registration
(In connection with Sale of Commodities)
Send this completed form and all necessary attachments to the above address along with a nonrefundable $100 filing fee.
Please make your check payable to NYS Department of State.
Attach: —Certificate of Deposit or prize monies in a trust account OR Surety Bond for total prize amount; and
—Rules and Regulations pertaining to the promotion, advertising scheme or plan.
1. NAME AND ADDRESS OF PERSON, FIRM OR CORPORATION PROPOSING TO ENGAGE IN THE GAME, CONTEST OR PROMOTION
2. GEOGRAPHIC AREA IN NEW YORK STATE COVERED BY PROMOTION
(List by county, if not statewide)
3. DESCRIPTION OF GAME, CONTEST OR PROMOTION (if not provided
by your rules and regulations)
4. TIME PERIOD COVERED BY CONTEST
8. PROPORTIONATE OPPORTUNITY OF WINNING PRIZES
BEGINNING:
ENDING:
Level of Prize
Proportionate Opportunity
5. NUMBER OF ENTRY BLANKS
TO BE MADE AVAILABLE
IN NEW YORK STATE
6. NUMBER OF PRIZE WINNING
CHANCES INCLUDED IN PLAN
IN NEW YORK STATE
7. RETAIL VALUE OF PRIZES
TO BE MADE AVAILABLE
IN NEW YORK STATE
9. NAME OF PERSON SUBMITTING FORM
RELATIONSHIP TO FIRM
ADDRESS
Signature
X
Date
REMINDER: Filing fee and specified documentation must accompany this registration statement.
DOS-0255-f-l-a (Rev. 09/11)
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