THE CORPORATION OF THE a _ CITY OF PORT COQUITLAM

APPLICATION FOR LOEEERY I Wynge LICENCE C 0 U N C

Section 6.18 of B.C. Reg. 265/78
ocT 17 1983

Organization Name: +2 ox L Ce Qt Lass Fic ure S Ka ting a lof F2 CECI AA
12 Curr a ] ‘
Total number of tickets to be printed:

cards y ——Z
Selling price of tieker: “/ 1% <aylvalue of prize to be awarded” G00. 06
. (must not be greater than $200.00)

Period during which tickets will be sold ~- From: @ To:
(Cannot exceed four months)

Place and date of event or draw for winner or winners:
@! Geo. Peam@yes SO). Carereaa Fo.co Date: Nov, Da 4 Nov 29THAS2

Estimated disposition of proceeds;
1. Expenses: $ 620,00 Peer. WiCanT

2. Donated to Charity: $

3. Retained by Licence holder: $

«

QiuAC Ott — (Wong 2).

Date: 1.-TH omvosnes 1943,
(Signing Officer)

Address: \t}is? SeaTeent De. Foro print Name: AVIS BALOW ind

Telephone: OUD—GRSBS . Position: Manecsme,

RECOMMENDED:
Date: F3. - /o- OL

eM. Police,
oquitlam Detachment.

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 Coquitlan .

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

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