Licensing and Regulation PO Box 43085 Olympia, WA 98504-3085 Phone: 360-664-1600 Fax: 360-753-2710 www.lcb.wa.gov For Office Use Only Date: Check #: Amount rec'd: Rec'd by: APPLICATION FOR PERMIT TO RAFFLE LIQUOR This permit allows a bona fide charitable or nonprofit organization to raffle bottles of liquor or baskets that include liquor. The liquor must be purchased at retail or donated by a private citizen. It may not be donated by a liquor licensee. Only organization members may purchase tickets or be awarded prizes. The organization will not sell raffle tickets to anyone less than 21 years of age when alcohol is awarded as a prize. The organization will not sell more than $5,000 dollars' worth of raffle tickets in a calendar year. (WAC 314-38-040) Permit Processing and Posting Information 1. Select from the following options. Make your check payable to WSLCB. $11 fee for single event. $27 fee for annual permit. New application. Renewal: Raffle Permit No. Liquor License No. 2. Mail your completed and signed application and check to the above address 30 days before your ticket sales start. 3. Allow 7-14 business days for permit processing. Your permit will be mailed to you. 4. The permit must be posted at the location of the drawing- prior to and during the drawing. 5. If you have questions, please call Customer Service at 360-664-1600. Applicant Information Full name of your organization: Organization's address (Street or Route, City, State, Zip Code): Organization's mailing address (if different from above) Name of your organization officer in charge of raffle: Officer's address (Street or Route, City, State, Zip Code) Officer's e-mail address: Officer's phone: ( )- American LegalNet, Inc. www.FormsWorkFlow.com This form is continued on the back page. LIQ 084 9/15 Page 1 of 2 Application for Permit to Raffle Liquor continued Raffle Information ­ only required for an individual event The date the raffle ticket sales will start The date, time and exact location of the drawing: Date: Time: Exact Location: (WAC 314-38-040) A description of the alcohol being raffled including its estimated value: The source of the alcohol to be raffled: I declare under the penalties of perjury that the answers contain in this application are true, correct, and complete. The undersigned certifies it is understood that a misrepresentation of fact is cause for rejection of this application or revocation of any permit issued. Print Name Signature: Title: Date: American LegalNet, Inc. www.FormsWorkFlow.com LIQ 084 1/15 Page 2 of 2