Application for License to Sell Lottery Tickets - Maine State Lottery

Application for License to Sell Lottery Tickets - Maine State Lottery

6 Pages · 2011 · 319 KB · English

For office use only. Retail Agent License #: Date Activated: Application for License to Sell Lottery Tickets . Please complete this entire application.

Application for License to Sell Lottery Tickets - Maine State Lottery free download


For office use only. Retail Agent License #: Date Activated: Application for License to Sell Lottery Tickets Please com plete this entire application. An incomplete or illegible appli cation will be returned without being reviewed. For questions relating to th is application, please call (207) 287-3721. Section 1: Type of Application New Change of ownership of an existing licensed location Section 2: Type of Ownership: (select only one) A. Individual B. Sole proprietorship C. Partnership D. Corporation E. Limited Liability Company F. Limited Partnership G. Limited Liability Partnership Federal Tax Identification Number: (if B, D, E, F or G is checked) _________________________________ Section 3: Name of Business: ________________________________________________________________________\ _________________ Section 4: Location of Business: (town/city and county) ___________________________________________ Section 5: Address and Telephone Number of Business: Physical Address: _________________ ________________________________________________________ _________________________________________________________________________ Mailing Address: (if different) ____________________ _________________________________________ _____________________________________________________________ Maine State Lottery Application to Sell Lottery Tickets, Page 2 of 6 Business Telephone Number: ________________________________________ Alternate Telephone Number: ________________________________________ Section 6: Type and Classification of Business; Hours of operation; Other Licenses. A. Classification: (select only one) 5000 Miscellaneous 5400 Grocery Store/Market 5415 Convenience Store 5416 Convenience Store/Gas 5540 Service Station 5600 Hardware Store 5615 Video Store 5700 Department/Box Store 5715 Bowling Alley 5800 Tavern/Lounge 5810 Restaurant 5910 Drug Store 5990 Newsstand/Card Shop 8640

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