Filing Fee: $150.00 Registration No. _______________ STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS Office of the Secretary of State 100 North Main Street Providence, Rhode Island 02903-1335 STATEMENT WITH REFERENCE TO GAMES OF CHANCE Name of Game of Chance Pursuant to the provisions of Section 11-50-1 of the General Laws, 1956, as amended, the undersigned files the follo wing statement of its proposal to engage in a game, contest, or other promotion or adverti sing scheme or plan whereby a retail establishment offers the opportunity to receive gifts, prizes, or gratuities, as determined by ch ance, in order to promote its retail business, where the total announced value of the prizes offered to the general public is in excess of five hundred dollars ($500.00). 1. Name of person, firm or corporation filing this statement: ________________________________________________________ _______________________________________________________________________________________________________ 2. Address: __________ _____________________________________________________________________________________ (street) (city or town) (state) (zip code) 3. Minimum number of participating objects to be made available: __________ _________________________________________ 4. Minimum number of prize-winning objects included in promotion or advertising scheme or plan: ___ ______________________ 5. Proportionate opportunity of winning prizes: ___________________________ ________________________________________ 6. Minimum value of prizes to be made available: ________________________________________________________________ 7. Attach a copy of the rules and regulations pertaining to the promotion o r advertising scheme or plan, including the period of time and geographic area to be covered by the contest. The undersigned certifies that the information contained in this statement is tru e and accurate. Name of person, firm or corporation filing this statement: Date: ________________________ ________________________________________________________ By: _____________________________________________________ Name of Contact Person: ______________________________ Mailing Address: _____________________________________ ___________________________________________________ ___________________________________________________ Form No. 659 Revised: 05/00 >>>> 2 State of Rhode Island and Providence Plantations Office of the Secretary of State 100 North Main Street Providence, Rhode Island 03903-1335 GAMES OF CHANCE Pursuant to Title 11, Chapter 50 of the Rhode Island General Laws, 1956, Reenactment of 1994 11-50-1 Filing requirement. - Any person, firm, or corporation proposing to engage in any game, contest, or other promotion or advertising scheme or plan whereby a retail establishment offers the opportunity to receive gifts, prizes, or gratuities, as determined by chance, in order to promote its retail business, where the total announced value of the prizes offered to the general public is in excess of five hundred dollars ($500), shall file with the secretary of state upon a form that he or she shall provide, a statement setting forth: the minimum number of participating objects to be made available; the minimum number of prize winning objects that will be included in such promotion or advertising scheme or plan; the proportionate opportunity of winning prizes; the minimum value of prizes to be made available; and the rules and regulations pertaining to the promotion or advertising scheme or plan which shall include the period of time and the geographic area to be covered by the contest. There shall be a filing fee of one hundred and fifty dollars ($150) when the statement is filed. Failure to file a statement shall be a misdemeanor. 11-50-2 Posting of available prizes Rules and winners. Every person, firm or corporation engaging in any promotion or advertising game or contest of the type set forth in 11-50-1 shall cause to be posted in a conspicuous and prominent location in every retail establishment offering the opportunity to participate in the game or contest the minimum number and value of prizes available to be won over a stated period of time and slated geographic area, and the rules and regulations pertaining to the promotion or advertising scheme or plan and the names and addresses of prize winners. Failure to cause this posting shall be a misdemeanor. 11-50-3 Records. Every person, firm, or corporation engaging in any promotion or advertising scheme or plan of the type set forth in 11-50-1 shall maintain for six (6) months following the completion of the promotion or advertising scheme or plan adequate records to enable such person, firm, or corporation to report to the secretary of state, upon his or her request, the name and address of each winner of every prize having a value of more than twenty-five dollars ($25.00), the description of the prize won by each person, and the date when the prize was delivered to each person. Failure to file such information with the secretary of state upon his or her request within six (6) months shall be a misdemeanor. 11-50-4 Manipulation of games. Every person, firm, or corporation who manipulates or rigs any promotion or advertising scheme or plan of the type set forth in 11-50-1 so that gifts, prizes, or gratuities are dispersed to predetermined individuals or retail establishments shall be guilty of a misdemeanor, provided, that this section shall not prevent distribution of gifts, prizes, or gratuities of equal value to retail establishments. 11-50-5 Failure to distribute prizes. - Every person, firm, or corporation who engages in any promotion or advertising scheme or plan of the type set forth in 11-50-1 and who fails to distribute the offered gifts, prizes, or gratuities to designated winners shall be guilty of a misdemeanor. 11-50-6 Deceptive advertising practices. Every person, firm, or corporation who prints, publishes, or circulates literature or advertising material, used in connection with any promotion or advertising scheme or plan of the type set forth in 11-50-1, which is false, deceptive, or misleading, shall be guilty of a misdemeanor. 11-50-7 Dealer Coercion. Every person, firm, or corporation who coerces a retail dealer to participate in any promotion or advertising scheme or plan of the type set forth in 11-50-1 shall be guilty of a misdemeanor. Such coercion includes, but is not limited to, circumstances in which a course