Appendix 9998. FORMS (11VAC15-40)

GAME MANAGEMENT FORMS

Bingo Session Reconciliation Summary, Form 103 (rev. 1/2011)

Admission Sales Reconciliation - Paper, Form 104-A (rev. 1/2011)

Floor Sales Reconciliation - Paper, Form 104-B (rev. 1/2011)

Decision Bingo Reconciliation, Form 104-C (rev. 1/2011)

Raffle/Treasure Chest Sales Reconciliation - Bingo Session, Form 104-D (rev. 1/2011)

Instant Bingo/Seal Cards/Pull-Tabs Reconciliation, Form 105 (rev. 1/2011)

Storeroom Inventory Issue - Paper, Form 106-A (rev. 7/2008)

Storeroom Inventory Issue - Instant Bingo/Seal Cards/Pull-Tabs, Form 106-B (rev. 7/2008)

List of Volunteer Workers, Form 107 (rev. 7/2008)

Prize Receipt, Form 108 (rev. 7/2008)

Storeroom Inventory - Paper, Form 109-A (rev. 1/2011)

Storeroom Inventory - Instant Bingo/Seal Cards/Pull-Tabs, Form 109-B (rev. 1/2011)

ORGANIZATION LICENSING FORMS

Charitable Gaming Permit Application - New Applicants Only, Form 201 - N (rev. 1/2011)

Charitable Gaming Permit Application - Renewal Applicants Only, Form 201 - R (rev. 1/2011)

Permit Amendment (rev. 1/2011)

Gaming Personnel Information Update (rev. 7/2008)

Report of Game Termination (rev. 7/2008)

MANUFACTURER OF ELECTRONIC GAMES OF CHANCE SYSTEMS, SUPPLIER, AND NETWORK BINGO PROVIDER LICENSING FORMS

Charitable Gaming Supplier Permit Application, Form 301 (rev. 7/2013)

Annual Supplier/Manufacturer Sales and Transaction Report, Form 302 (rev. 8/2013)

Certification of Non-Permit Holder, Form 303 (rev. 7/2013)

Certification of Non-Charitable Gaming/Gambling, Form 304 (rev. 7/2013)

Manufacturer of Electronic Pull-tab System Permit Application, Form 305 (rev. 10/2012)

Manufacturer of Electronic Pull-tab System Permit Application - Personal Information, Form 305A (rev. 10/2012)

Manufacturer of Electronic Pull-tab System Permit Renewal Application, Form 306 (rev. 10/2013)

Manufacturer of Electronic Pull-tab System Permit Renewal Application - Personal Information, Form 306A (rev. 10/2013)

Network Bingo Provider Permit Application, Form 307 (eff. 5/2014)

Network Bingo Provider Permit Application - Personal Information, Form 307A (eff. 5/2014)

BINGO MANAGER AND BINGO CALLER REGISTRATION FORMS

Charitable Gaming Bingo Caller Certificate of Registration Application, Form 401 (rev. 1/2011)

Charitable Gaming Bingo Manager Certificate of Registration Application, Form 402 (rev. 1/2011)

Amendment to Certificate of Registration – Registered Bingo Callers and Bingo Managers (rev. 1/2011)

Personal Information Update – Registered Bingo Callers and Registered Bingo Managers, Form 404 (rev. 7/2007)

Bona Fide Member Verification, Form 405 (rev. 5/2011)