INSTRUCTIONS: ARIZONA APPLICATION FOR BINGO LICENSE (Form 71-1010)

To conduct a bingo game in Arizona, you must submit an application for a bingo license. This form 71-1010 can be obtained from the website of the Arizona Department of Revenue.

Arizona Application For Bingo License 71-1010 Step 1: Lines 1 through 4b in the table on the first page require you to enter your name, telephone number, administrative office location, mailing address, and the city, state and zip code for both.

Arizona Application For Bingo License 71-1010 Step 2: Lines 5 through 11 are only to be completed by those applying for Class B and C licenses. Line 5 requires you to check the box next to your type of qualified organization.

Arizona Application For Bingo License 71-1010 Step 3: Line 6 requires you to provide information about your parent or auxiliary.

Arizona Application For Bingo License 71-1010 Step 4: Line 7 requires you to give the date your organization was established in Arizona.

Arizona Application For Bingo License 71-1010 Step 5: The table on line 8 requires you to give the name, title and address of your current officers.

Arizona Application For Bingo License 71-1010 Step 6: Enter your checking account information on line 9 and and your interest-bearing account information on line 10. The chart on line 11 requires information about officers and supervisors authorized to sign checks from these accounts.

Arizona Application For Bingo License 71-1010 Step 7: Provide the name, title and address of the one or two people will be managers in the table on line 12.

Arizona Application For Bingo License 71-1010 Step 8: Give the name, title and address of the proceeds coordinator on line 13, the supervisors on line 14, and the assistants on line 15. On line 16, give the street address where the bingo games will be held.

Arizona Application For Bingo License 71-1010 Step 9: On line 17, give the hours during which games will be held for every day. Give the dates of proposed cancellations, if any, on line 18.

Arizona Application For Bingo License 71-1010 Step 10: On line 19, give information about the premises where games will be held. Line 20 is for detailing any other licensees who will be sharing the space with you. Proposed expenses are detailed in section 21, and section 22 requires an explanation of the projected use of net bingo proceeds.