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 FeesPlatform Licensing, Serving, Hosting & Online Transaction 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