Lottery License

Application for Licensing Eligibility

This form is to be completed by an applicant for a lottery license not previously approved in the Town of Erin.

Name of Organization *

Business Address *

Including Postal Code

Mailing Address *

If different than above

Contact Name *

Contact Address *

Contact Phone Number *

Contact Email *

Is the Applicant incorporated as a non-profit organization in the Province of Ontario? *

Yes

No

If Yes, please enter Incorporation Number *

Is the Applicant a registered charity with Revenue Canada? *

Yes

No

If Yes, please enter Registration Number *

How long has the Organization been in existence? *

How many members are in the Organization? *

What category best describes the Organization? *

Relief of Poverty

Advancement of Religion

Advancement of Education

Health and Welfare

Other Charitable Purposes Beneficial to the Community

If Other, please specify sub-category *

Culture & Arts

Health & Welfare

Amateur Sports Organizations

Enhancement of Youth

Public Safety Programs

Community Service Organizations

Describe the Organization's purpose and objectives *

Please list and describe the specific programs and services delivered by the Organization and associated costs *

Do not restate your mandate or mission stament

Indicate the specific purpose(s) for which lottery proceeds will be used *

Is the Applicant currently licensed, or even been licensed, to conduct lotteries within other Municipalities? *

No

Yes

If Yes, indicate type of lottery and where *

For the purpose of lottery licencing, all Organizations must have a lottery trust account. Please complete the following if available at this time.

Note: It will be required at the time of license approval.

Name of the Bank *

Branch Address *

Trust Account Number *

Date of fiscal year-end *

The following documents of the Organization must be submitted with this application where applicable:
1. A copy of its Letters Patent
2. A copy of its Notification of Charitable Registration letter from the Canada and Revenue Agency
3. A copy of its Constitution and By-laws.
4. A copy of its budget for the current year.
5. A copy of its financial statements for the preceding year.
6. A list of Board of Directors.
7. Any other supporting documentation that will demonstrate the charitable nature of the organization's purposes, objectives and activities.

Upload Files *

We, the undersigned, as active, bone fide members of this organization declare that all information provided in and with statement is factual and correct.

Name of Designated Member *