Lottery Licensing Eligibility Application

In order to obtain any type of Lottery Licence as issued by the Town of Kingsville, organizations must maintain an "eligible status". Once an Organization is granted eligible status, an update is required periodically to ensure that the criteria for that eligiblity has been maintained.

Please note that the Town of Kingsville follows Lottery Licensing Policies as developed by the Alcohol and Gaming Commission of Ontario (AGCO), the Criminal Code of Canada, the Order-in-Council 2688/03 (as amended), and the Gaming Control Act, 1992 and its Regulations.

Name of Organization

Street Address

Town/City

Province

Postal Code

Is the mailing address for the organization different from the address noted above?

Yes

No

Is the Organization registered as a non-profit Organization in the Province of Ontario?

Yes

No

Is the Organization registered with the Canada Revenue Agency as a charitable organization?

Yes

No

What year was the Organization established?

How many members comprise your bona fide membership?

How many times per year does your group meet?

Please list the Board of Directors and Executive (members with signing authority).

Describe the requirements that a person must meet in order to become a bona fide member of the Organization.

Describe the Organization's aims, objectives and services provided.

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

What is the Organization's financial year-end date?

Please provide a copy of the Organization's complete budget, covering the current twelve month fiscal or calendar year, detailing how resources will be acquired and dispersed during this period.

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Please provide a copy of the Organization's previous year's financial statement.

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Is the Organization currently licensed, or has it ever been licensed, in any other municipality to conduct lottery events?

Yes

No

Has the Organization ever had a licence refused or revoked?

Yes

No

Trust Account Information

Please note that a licensed organization must open and maintain a separate lottery trust account, designated as a trust account by the branch of a recognized financial institution, in the Province of Ontario. The designated lottery trust account must be in Canadian funds.

Name of Financial Institution

Lottery Trust Account Number

Street Address of Financial Institution

Town/City of Financial Institution

Postal Code of Financial Institution

Phone Number of Financial Institution

Designated Member of Lotteries and Treasurer Information

A "Designated Member of Lotteries" is the member of the organization that will be responsible for keeping and maintaining records of all financial transactions pertaining to the licensed lottery activities. If the designated member changes, the Town of Kingsville must be notified immediately.

Designated Member of Lotteries

First Name

Last Name

Phone Number

Email Address

Street Address

Town/City

Province

Postal Code

Treasurer

First Name

Last Name

Phone Number

Email Address

Street Address

Town/City

Province

Postal Code

Acknowledgement

I declare that all of the information provided in and with this statement is factual and correct. I understand that the Town Clerk makes a decision as to the eligibility of an organization in consultation with all policies as developed by the Alcohol and Gaming Commission of Ontario (AGCO). I understand that without eligible status, the Organization I am applying for will not be able to obtain any type of lottery licence as issued by the Town Clerk on behalf of the AGCO.

Privacy Statement: Personal information in this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, as amended, and will be used to administer the Lottery Licensing program for the Town of Kingsville. Questions about the collection of this information can be directed to the Town Clerk, 2021 Division Road North, Kingsville, ON, N9Y 2Y9. Telephone: 519-733-2305.

Lottery Licensing Eligibility Application

Trust Account Information

Designated Member of Lotteries and Treasurer Information

Designated Member of Lotteries

Treasurer

Acknowledgement

Subscribe to Town News!