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Form 71-1002 Endorsement by Local Governing Body

71-1002_fillable.pdf

Form Instructions

INSTRUCTIONS: ARIZONA ENDORSEMENT BY LOCAL GOVERNING BODY (Form 71-1002) One of the forms to be completed by anyone wishing to conduct a bingo game in Arizona is an endorsement from the appropriate local governing body. This form 71-1002 is to be found on the website of the Arizona Department of Revenue. Arizona Endorsement By Local Governing Body 71-1002 Step 1: Indicate with a check mark whether this is a new application or one for a change of location. Arizona Endorsement By Local Governing Body 71-1002 Step 2: In the first box of the table, enter the license number. Arizona Endorsement By Local Governing Body 71-1002 Step 3: In the second box, enter the date. Arizona Endorsement By Local Governing Body 71-1002 Step 4: In the third box, enter the name of the local governing body. Arizona Endorsement By Local Governing Body 71-1002 Step 5: In the fourth box, enter the local governing body's street address or PO box number. Arizona Endorsement By Local Governing Body 71-1002 Step 6: In the fifth box, enter the local governing body's telephone number. Arizona Endorsement By Local Governing Body 71-1002 Step 7: In the sixth box, enter the local governing body's city, state and zip code. Arizona Endorsement By Local Governing Body 71-1002 Step 8: In response to question 1, enter the date on which the hearing concerning the application was held. Indicate with a check mark whether the application is for a new license or for a license transfer. Arizona Endorsement By Local Governing Body 71-1002 Step 9: In response to question 2, write the name of the applicant. Arizona Endorsement By Local Governing Body 71-1002 Step 10: In response to question 3, give the location and address where the games will be held. Arizona Endorsement By Local Governing Body 71-1002 Step 11: In response to question 4, give the hours during which games will be held every day. Arizona Endorsement By Local Governing Body 71-1002 Step 12: In response to question 5, indicate with a check mark whether background investigations have or have not been conducted.Indicate whether the application is recommended or not with a check mark in response to question 6. If not approved, give a written explanation in response to question 7. A delegated authority of the governing body should print and sign their name, and give their date and the title.

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