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THE CORPORATION OF THE CLIY OF PORT COQUITLAM

APPLICATION FOR LOTTERY LICENCE

Section 6.18 of B.C, Reg. 265/78

Organization Name: Wu Wy Xp) wIOksEaTS

Total number of tickets ie be printed:
WOO Per Wenterl

Selling price of ticket: Zlbzav value of prize to be awarded tig TLL LD
(must not be greater. than $200.00)

Period during which tickets will be sold = From: WME to: ST
(Cannot exceed four months)

tt

Place and date of event or draw for winner or winnedai ¢

Place: “O50 MARY Midd DD oh Caaw tga Date: RLEPT, aoteo”
Se. .

Eatimated disposition of Proceeds: ;
1. Expenses: $
2, Donated to Charity: $ BO? 2 or

3. Retained by Licance holder: $

Prtat, Name? 2 ZA Fb ea da

R.C.M. Police,
Coquitlam Detachment.

This is to certify that the above noted organization are heraby licenced to

conduct a Lottery for the Purposes and in accordance with their application hereon,

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Date:

City Clerk,
City of Port Coquitlam

SE ERG YR A PE EP NAN NT LF ALON LP A a a

THIS LICENCE IS ONLY EFFECTIVE WITHIN THE CITY OF PORT COQUITLAM.

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