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CDEPARTMENT OF LIQUO JNTROL COUNTY OF IIAWAI'I <br />Hilo Lagoon Centre, 101 itupuni St., MUM, Hilu, HowaN, 96720 *Phone: (808) 961-8218 *Fax: (808) 961-8684 <br />1s'-Mail. cUhctic{ci},.haivaiicounty.gov <br />APPLICATION FOR GAME PERMIT <br />Pursuant to Rule 3-2-D.3, of the Rules of the Liquor Commission of the County of Hawaii, application is <br />hereby made for a game permit as required for an event at which games or game devic s which simulate <br />or resemble any game commonly associated with gambling is offered. The event shall EjCEIVED <br />with §712-1220 and §712-1231, Hawaii Revised Statutes, related to gambling. <br />LICENSFF: Kohanaiki Club Inc <br />NAME OF GROUP: Celebration Casino <br />GROUP CONTACT: Tom Bean <br />DATE OF EVENT: 12/28/25 <br />OCT 2 9 2025NA <br />D pt .of Liquor Control <br />night run by Lady Q proc ucflo_ %o <br />PHONE NO.: : is .. . •; <br />TIME OF EVENT: 6pm <br />LOCATION OF EVENT: Konane restaurant @ Koahaniki <br />DESCRIBE ACTIVITIES, GAMES, DEVICES, PRIZES BEING OFFERED (Attach as necessary) <br />Black Jack, Poker tables and Craps table. Prizes- Koahaniki Apparel and accessories <br />The undersigned certifies that no fees, including donations, are being assessed in order to participate. <br />Licensee: Kohanaiki Club Inc <br />By r:7�L t, - <br />(Signature) <br />Name: Tom Bean <br />Title: F&i3 Director <br />Date: 10.29.25 <br />Phone No.: 808-443-7498 <br />E-Mail: tbean@kohanaiki.com <br />PERMIT <br />The application for a game permit has been approved as requested. <br />Conditions: The term of the permit shall be for one day, as listed above. <br />The event shall not be open to the public. <br />No fees to participate shall be assessed to the participants. <br />By: f Director <br />Date: OCT 2 9 2025 <br />Ratified by the Liquor Commission on: <br />Hawai'i County is an Equal Opportunity Provider and Employer <br />