It is hereby agreed, understood and acknowledged:

1. That the activities for which the license is sought will be conducted, managed and operated solely and personally by the regular members of the organization without the assistance of professionals.
2. That a commission, salary, compensation, reward, or recompense will not be paid to any person for holding, operating, or conducting, or assisting in the holding, operating, or conducting of a game of bingo.
3. The proceeds from the activities for which the license is sought shall be used solely for the legitimate charitable, benevolent, or tax-exempt purposes of the qualified organization named above.
4. That the applicant, by one of its principal officers, within 15 days after the last day named in the application for the permit to conduct activities authorized by this section, will file a report under penalties of perjury certifying the following:

• That the authorized activities were conducted at the time and place stated in the application by the regular members of the organization, without the assistance of professionals.
• The disposition of the cash proceeds of the licensed activities.
• That a fee for the rental of premises will not be paid by any licensee to itself, to its trustee, to a committee of licensee or to any organization whose members are the same, or substantially the same, as the licensee.

The undersigned hereby certifies that he\she is authorized by t he above-named eligible organization to file this application. I solemnly affirm under the penalties of perjury and upon persona l knowledge that the contents of the foregoing application are true. I hereby acknowledge receipt of the Gambling/Bingo law and understand it is my responsibility to have full knowledge of the law. Any person who shall keep any gaming table or any house, vessel or place, on land or water for the purpose of gambling; or who shall bet, wager or gamble in any manner; or who shall have any interest in any gaming table or the profit thereof; except as permitted by law, shall be guilty of a misdemeanor and may be punished by a fine not to exceed $1,000.00, or by imprisonment not to exceed one (1) year, or both fine and imprisonment.

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