CASINO LOTTERY

1. Dates on which the Casino event will ba heid: Ba
a TO

2. Hours of Operation: Start: Finish: ———___.

3. Name and address of Casino location: ___BOYA) plane
f Pat ta
ROYAL DIAMOND cre:

835 DAVIE STREET
\

4. Name and address of casino company: —VANCOUVER BC-Veg gan —
| .
(Enctose Copy of contract)

5. Number of games to be Operated (to a Maximum of 15):
Blackjack ~——

Roulette , a A
Wheels of Fortune fo Specify No. and types SC “Zo ee

6. Members Who will be Present to operate casino:
TELEPHONE ALTERNATE'S NAME TELEPHONE .
——Gloria Aitken 942-6926 BANKER Judy Leadbeater 42.578 _

eistie Breriape_oiacssy AN ASST, Gloria Ste henson 941-7410
lee Doren aceag CASHIER 1 “lide Kbit oyna

Janice Doran

CASHIER 2 Kelly Horvath , 464.0395
Irene Jakse 9 Py Wendy Crandell 941.4908
(The above is the MINIMUM number of volunteers who must be present)

(ensure you have alternate volunteers available),

CERTIFICATION

7. We the undersi jointly and Severally, hereby certify on behalf of this organization that:
a) é of the matters Set out herein;

———— PRINT NAME ___ Ej Bac me
ST OFFICE HELD ide | Oa R .
Peay ve. ADDRESS __ #1024 . 3655 Shay hnessy St,
a

POSTAL CODE

SIGNATURE arent —
SIGNATURES OF TWO PRINCIPAL OFFICERS REQUIRED

7

ibe accompanied by acer
rate Relations, in the amount of T ) of the gross
proceeds, must be Submitted to the British ] ‘alement within 30
days of the explration of the licence,

10, All applications Should ba Submitted to:

Ministry of Attorney General
British Columbia Gaming Commission
Parllament Buildings

Victoria 3 2
British Columbia