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THE CORPORATION OF THE CITY OF PORT COQUITLAM

APPLICATION FOR LOTTERY eRe LLCENES ¢ U \ C

Section 6.18 of B.C. Reg. 265/78 JUN 14
, Sion DS &

Organization Name: /fer Aypuuriam LaCkpSsE Lesocarion ALe. Apanaes

Total number of tickets to be printed: ALY
ff VA

value of prize to be awarded STE O°
(must net be greater than $200.00)

Period during which tickets will be sold — From: bane MA Lat To: _ Jy A Jeu

(Cannot exceed four months)

Selling price of ticker:

Place and date of event or draw for winner or winners:

Place: Ger Lypuitian Aeekeation Lenree Date: My Ss Lil

Estimated disposition of proceeds:

1... Expenses: $ Lob.

2. Donated to Charity: $ AL

3. Retained by Licence holder: $

Date: Wy £ V7, LIGA

Address: 17/7. Gecenmounr A VE Print Name: Lonnie _/ Lene y
Telephone: GUL2. LGB Position: 4hwrar

RECOMMENDED:

Date: SK. 0 6-0
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This is to certify that the above noted organization are hereby licenced to

conduct a Lottery for the purposes and in accordance with their application hereon.

Date:

City Clerk,
City of Port Coquitlam

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