Lottery Licence Application - Eligibility Questionnaire

If you are a charitable or religious organization or a non-profit group you may qualify to hold a fundraising lottery in the Township of South Stormont.

Name of Organization (as shown on governing documents)

Operating name, if different

Address

Postal Code

Phone Number

Email Address

Website

Is the organization incorporated as a non-profit organization with the Ministry of Government and Consumer Services (Ontario)?

Yes

No

Is the organization registered with Canada Revenue Agency as a charity?

Yes

No

How long has the organization been providing services?

Please provide details of specific programs and services and associated costs (do not restate your mandate or mission statement)

Approximate number of members

Date of fiscal year-end

Date of last filing

Does the organization currently manage and conduct any gaming events (lotteries) within the Township of South Stormont?

Yes

No

For the purpose of lottery licencing, all organizations must have a lottery trust account.

Name of Bank

Address of Bank

Postal Code

Trust Account Number

Date Opened

Personal information contained on this form is collected under the Municipal Freedom of Information and Protection of Privacy Act and will be used to respond to your request. Questions about this collection should be directed to the Director of Corporate Services at 613-534-8889 ext.201.

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Lottery Licence Application - Eligibility Questionnaire

Personal information contained on this form is collected under the Municipal Freedom of Information and Protection of Privacy Act and will be used to respond to your request. Questions about this collection should be directed to the Director of Corporate Services at 613-534-8889 ext.201.

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