HomeMy WebLinkAboutForm - Application for Game Permit (fillable)DEPARTMENT OF LIQUOR CONTROL COUNTY OF HAWAI'I
Hilo Lagoon Centre, 101 Aupuni St., Unit 230, Hilo, Hawai'i, 96720 * Phone: (808) 961-8218 * Fax: (808) 961-8684 E-Mail: cohdlc@.hawaiicounty.gov
APPLICATION FOR GAME PERMIT
Pursuant to Rule 3-2-D.3, of the Rules of the Liquor Commission of the County of Hawai‘i, application is hereby made for a game permit as required for an event at which games or game devices which simulate or resemble any game commonly associated with gambling is offered. The event shall be in compliance
with §712-1220 and §712-1231, Hawai‘i Revised Statutes, related to gambling.
LICENSEE:
NAME OF GROUP:
GROUP CONTACT: PHONE NO.:
DATE OF EVENT: TIME OF EVENT:
LOCATION OF EVENT:
DESCRIBE ACTIVITIES, GAMES, DEVICES, PRIZES BEING OFFERED (Attach as necessary)
The undersigned certifies that no fees, including donations, are being assessed in order to participate.
Licensee:
By
(Signature)
Name:
Title: Date:
Phone No.:
E-Mail:
PERMIT
The application for a game permit has been approved as requested.
Conditions: The term of the permit shall be for one day, as listed above.
The event shall not be open to the public.
No fees to participate shall be assessed to the participants.
By: Director
Date:
Ratified by the Liquor Commission on:
Hawai’i County is an Equal Opportunity Provider and Employer