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Executive Summary
This document is an application form for organizations seeking a Bingo License. Applicants are required to submit four copies of the completed form to the Municipal Clerk's office in the relevant municipality. The application mandates detailed information including the organization's name and address, proposed dates and hours for bingo games, the address where games will be played, and whether the applicant owns or rents the premises. It also requires a schedule of anticipated expenses, the specific purposes to which net proceeds will be devoted, and a description of all prizes to be offered.
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--- Document: Bingo License Document --- Application No. BA_ ________________ Identification No._ __________________ Application for a Bingo License Submit four (4) copies of this application to the Municipal Clerk’s office in the municipality where the games will be conducted. Please print clearly. Name of municipality:_ ____________________________________________________________________________________ Part A - General 1. Name of applying organization:__________________________________________________________________________ 2a. Street address of headquarters:___________________________________________________________________________ b. Mailing address (if different):_ _ 3. List date(s) and hours for games: Date Hours Date Hours _____________________________ ___________ _____________________________ ___________ _____________________________ ___________ _____________________________ ___________ _____________________________ ___________ _____________________________ ___________ _____________________________ ___________ _____________________________ ___________ _____________________________ ___________ _____________________________ ___________ _____________________________ ___________ _____________________________ ___________ _____________________________ ___________ _____________________________ ___________ 4. Address of place where bingo will be played: _ _ a. Does the applicant own the premises or regularly occupy them for its general purposes? Yes No b. If “No,” from whom will the applicant rent the premises? Name__________________________________________Address_ ______________________________________________ c. If premises are to be rented, attach Form 10, “Statement of Landlord.” Part B - Schedule of Expenses The items of expense intended to be incurred or paid in connection with the games listed in this application, the names and addresses of the persons to whom each item is to be paid, and the purpose for which each item is to be paid, are: Item of Expense Name and address of supplier Purpose ___________________________ _________________________________________________ _________________________ ___________________________ _________________________________________________ _________________________ ___________________________ _________________________________________________ _________________________ ___________________________ _________________________________________________ _________________________ ___________________________ _________________________________________________ _________________________ ___________________________ _________________________________________________ _________________________ ___________________________ _________________________________________________ _________________________ ___________________________ _________________________________________________ _________________________ ___________________________ _________________________________________________ _________________________ ___________________________ _________________________________________________ _________________________ ___________________________ _________________________________________________ _________________________ ___________________________ _________________________________________________ _________________________ ___________________________ _________________________________________________ _________________________ ___________________________ _________________________________________________ _________________________ Part C - Schedule of Purposes 1. The specific purpose(s) to which the entire net proceeds of the games listed in this application are to be devoted, and the manner in which they are to be so devoted, are: _ _ _ _ 2. If any part of the net proceeds are to be devoted to a purpose allowed by the Bingo Licensing Law by turning the same over to another organization which is exclusively devoted to such purposes, secure the signature of its president or other executive officer to the following certificate: “It is hereby certified that_________________________________________________________________________________ Name of organization will accept from the licensee any part of the net proceeds of the games listed in this application to be turned over to it.” Date:___________________________________ Signature:____________________________________________ Part D - Schedule of Prizes A description of all prizes to be offered and given in all of the games listed in this application is as follows. (For cash prizes, state the amount; for merchandise, describe the article and state the retail value; if prizes are to be donated, indicate that fact and estimate as accurately as possible the information requested below.) Description of Prize Amount (for cash prizes) or Article Retail value (Additionally, please attach a schedule of the games to be conducted.) ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ ________________________________________________________________________ ___________________________ SIGN Part E - Officers of Applicant Office Name of officer Residence address Age ___________________________ ________________________________ _____________________________________ ______ ___________________________ ________________________________ _____________________________________ ______ ___________________________ ________________________________ _____________________________________ ______ ___________________________ ________________________________ _____________________________________ ______ ___________________________ ________________________________ _____________________________________ ______ Part F - Members of Applicant who will be in charge of the games Name of member in charge Residence address Telephone No. Age (include area code) ______________________________ __________________________________________ _________________________ ______ ______________________________ __________________________________________ _________________________ ______ ______________________________ __________________________________________ _________________________ ______ ______________________________ __________________________________________ _________________________ ______ ______________________________ __________________________________________ _________________________ ______ Part G - Members of Applicant who will assist in conducting the games Name of member Residence address Age _________________________________________ _________________________________________________________ ______ _________________________________________ _________________________________________________________ ______ _________________________________________ _________________________________________________________ ______ _________________________________________ _________________________________________________________ ______ Part H - Names of other organizations whose members will assist in conducting the games Name and address of organization How related Identification No. _______________________________________________________ ____________________________ _____________________ _______________________________________________________ ____________________________ _____________________ _______________________________________________________ ____________________________ _____________________ continue ➨ If more space is needed in any section of this application, insert extra sheets of paper. Part I - Statement of Applicant and member(s) in charge State of New Jersey County of __________________________________ We do hereby each make the following statement, under oath, with respect to the foregoing application: ____________________________________________________ Signature of Officer and Title ____________________________________________________ Member in Charge ____________________________________________________ Member in Charge ____________________________________________________ Member in Charge ____________________________________________________ Member in Charge If more space is needed in any section of this application, insert extra sheets of paper. Applicant’s registration slip from the Legalized Games of Chance Control Commission must be presented to the Municipal Clerk with this application. Sworn and subscribed to before me this ______day of_________________ , 20_ ___. ____________________________________ Notary Public (Print name) ____________________________________ Signature of Notary Public Affix seal here 1. The applicant (is) (is not) limited in its activities to the furtherance of one or more authorized purposes as defined in the Bingo Licensing Law. 2. Prior to the issuance of any license to it to conduct games of chance, the applicant was actively engaged in serving one or more “authorized purposes.” 3. The applicant has received and used, and in good faith expects to continue to receive and use, to further one or more authorized purposes, funds from sources other than games of chance. 4. The conduct of the games on the occasion or occasions for which this application is made will be to raise and devote the entire net proceeds to the authorized purpose described in the application. 5. For each occasion for which a license is sought, one or more of the members listed who are familiar with the Bingo Licensing Law and the Rules and Regulations, will be in full charge of, and primarily responsible for, the conduct of the games. 6. No commission, salary, compensation, reward or recompense will be paid to any person for holding, operating or conducting or assisting in the holding, operation or conducting, of the games, except to bookkeepers or accountants for professional services not exceeding the amounts fixed by the Schedule of Fees, as well as the compensation for the Licensed Compensated Workers pursuant to N.J.A.C. 13:47-6A. All prizes offered for games conducted on a single occasion will not exceed the limit on the sum or retail value of prizes as provided by the Bingo Licensing Law (N.J.S.A. 5:8-25 et seq.) and N.J.A.C. 13:47-6.16 and 13:47-7.2. 7. All statements in the foregoing application are true. } ss. SIGN SIGN
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Timeline
First Discovered
Apr 27, 2026
Last Info Update
May 20, 2026
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