Organization NameOrganization Contact PersonProof of Non-Profit Status:IRS (Internal Revenue Service)Nevada Department of TaxationUpload Proof of Nonprofit StatusChoose FileNo file chosenDelete uploaded fileQualified Organization Activity in NevadaArtsAmateur AthleticsPeace OfficersHealthSocial ServicesEducationalFraternalPatrioticHumanitarianReligiousCivicStreet AddressPO Box / SuiteCityCountyStateZip CodePhone Number:Email AddressList person(s) responsible for the operation of the charitable lottery or gaming event and their relationship to the organization (i.e., officer, member, volunteer, employee, etc.)NameTitle:Phone Number:Email AddressNameTitle:Phone Number:Email AddressNameTitle:Phone Number:Email AddressEvent NameDraw DateDraw Time *Hours-000102030405060708091011121314151617181920212223Minutes-000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859Location NameLocation AddressDate Ticket Sales BeginDate Ticket Sales EndTicket Purchase PriceMethod of salesOnlineTicket BoothOnsite Ticket SalesPhone SalesDirect MailTotal Prize ValueDescription & Proof of Prize Value Upload (Invoice etc.)Choose FileNo file chosenDelete uploaded fileSpecify which Nevada charities will benefit from the fundraising:Charitable Gaming RulesScreenshotsChoose FileNo file chosenDelete uploaded fileVendor ContractsChoose FileNo file chosenDelete uploaded fileVendor FeesCharitable Lottery ControlsChoose FileNo file chosenDelete uploaded fileAnticipated ExpensesAdvertising FeesSuppliesPhoneDateRaffle PermitChoose FileNo file chosenDelete uploaded fileAuthorized Signature*By signing this form, the qualified organization agrees to comply with NGC Rebulation 4A and all state laws related to charitable lotter and/or games pusuant to NRS 462Your browser does not support e-Signature field.Send Message
