Pennsylvania Code
Title 61 - REVENUE
Part VII - Local Option Small Games of Chance
Chapter 901 - LOCAL OPTION SMALL GAMES OF CHANCE
Subchapter B - LICENSING AND REGISTRATION
DISTRIBUTOR LICENSING
Section 901.133 - Distributor license application form contents
Current through Register Vol. 54, No. 44, November 2, 2024
The application form must include the following:
(1) The name of the distributor, including a copy of the Fictitious Name Registration, Department of State Registry Statement or similar registry statement.
(2) The address of the distributor, including the business, mailing and legal address.
(3) The names, addresses, telephone numbers and Social Security numbers of officers, directors, owners and partners or other responsible persons. If incorporated, the application shall contain the names, addresses and telephone numbers of officers and shareholders controlling 10% or more of outstanding stock. If organized as a partnership, the application must contain the names, addresses and telephone numbers of all partners.
(4) A copy of the constitution and bylaws or corporate charter only for new applications. This information must also accompany renewals if requested or if changed or amended.
(5) A list of all types of games of chance to be distributed.
(6) A list of manufacturers with whom distributors anticipate doing business.
(7) The signature of responsible persons.
(8) A complete list of distributor representatives and their addresses and telephone numbers.
(9) Pennsylvania tax information, including:
(10) A certified statement that:
(11) A certified statement that no officer, director or other responsible person or employee eligible to make sales on behalf of the distributor has been convicted of one or more of the following:
(12) The logo used by the distributor.
(13) Other documents as identified in the application materials.
This section cited in 61 Pa. Code § 901.153 (relating to raffle, daily drawing and weekly drawing ticket).