Port Hope Lottery Licence Questionnaire

Part One

Please list and describe the specific programs and services delivered by the Organization and associated cost(s): (DO NOT restate your mandate or mission statement)

Services

Cost

If yes, please indicate type of gaming event and which Municipality:

For the purpose of lottery licensing, all organizations must have a lottery trust account. Please complete the following information:

Pursuant to the Municipal Freedom of Information and Protection of Privacy Act, the personal information contained in this form will be used solely for the purposes of determining eligibility for various licensing processes in the Municipality of Port Hope.  The application forms part of the public record.  Questions regarding this collection may be directed to the Municipal Clerk at 905.885.4544 or by email.