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+ ' dd Sa eee Aa fee Bele : ‘ vd Bniiggy't ids
arnt Wy eT bade a Lanta a Vi mye 4 ie Le PR ANA R ie Kis aT ied ea ltstacntlenty ecae He .
Ade sf inne Ros Pig oie IASON aaa tig Heieart BE UA RRHO tS PRR TEPER AE an ira Heys sailed ilies
Wiis Phi

“, THE CORPORATION OF THE CITY oF PORT COQUITLAM -

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

APPLICATION FOR LOTTERY LICENCE 4 f" | : a ee
0

a | ! ;
Organization Name; Ne ide ff 9 td Sh “1 Coo : _ a
, po ae
Total number of tickets to be printed: wry), poh ek
Selling price of ticker:“00 on. value of prize to be awarded Brow oc : —_ “ my
(must not be greater than $200.00) rc
Perdod during which tickets wll be sold ~ From: Ay ULE Tos Dey p/or” 7 | ne
(Commo exceed four months) res
Place and date of event or draw for winner ov winners: , ae A
oy —— . poe oo
Place: ee? We D Pau hp ao Date: p/oy 2e/ps7- Pe, a
Estimated disposition of proceeds: | acer i |
1. Expenses: $ Asc). ow | : ks 4%
2. Donated to Charity: $ | po 8
i ee WA
| ; i
*» Retained by Licence holder: $ at. de: ,
| _ f-
* od a r
pater (C28 as “es”. Te, 2, hnte
(Signing Officer) :
Address: Reo ce LETS hhh PSD Print Name: Az vg i, Vt re AK a.
7 Cf . . i
Telephone: Caf 1 ~ TF) £ ° Position: red. Coe FR LY A? ae a
wonoeseeansneanneceaoeanreanentaaneretasnenenneneteeceneee :
RECOMMENDED: THE RCMP NO LONGER HAVE ANY R.C,M, POLICE a
INPUT INTO LOTTERY LICENCES COQUITLAM DETACHMENT | 7
. Date: UNLESS VICTORIA HAS QUESTIONS. A OTA AB A Lo NL rector ho
INDIVIDUALS AND GROUPS NO LONGER NEED Khe C. Me POL ine) ~ ° )

COME TO US. Coquit lag cIaLyehmaee, on

Sanne Sas HHRGH REA ERR AMR NS RRR

ay This is: to certify that the above. noted organization are hereby licenced to Jt
of conduct a Lottery for the purpose 2S and in accordance with their application hereon.
4 | I
am Date: a
| Se : — City Clerk, i

Clty of Port Coquitlam

SR UE OT SR BA SE Sead So SO SY Ss ee SER SSS SOs SN SHR UN RIE SS Ch a Me SER NS 0 SM a OB a ka NA Fv a Sa ey Soa en

THIS LICENCE IS ONLY EFFECTIVE WITHIN THE CITY oF PORT COQUITLAM. i

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