Reg. Number: __________________
Date Received: _________________
Date Approved: ________________
Date Expired: __________________
To: City of Mount Carroll
Subject: Application for a Raffle License
Name of organization ___________________________________________________________
Address of organization _________________________________________________________
Telephone number of organization _________________________________________________
Name of local representative of organization _________________________________________
Address of local representative of organization _______________________________________
Phone number of local representative of local organization _____________________________
Dates of raffle _________________________________________________________________
(Ord. 2012-03-13, passed 3-13-2012)