INSTRUCTIONS FOR COMPLETING A CHARITABLE BINGO LICENSE
                                   APPLICATION

No one may legally conduct a bingo game in West Virginia without first obtaining a charitable
bingo license from the West Virginia Tax Division. If the application is for a new license, there
is a mandatory 60-day filing period that must be observed before any bingo activities may be
conducted. Charitable bingo licenses can be obtained by filing an application for a bingo license
(form WV/BGO-1).

HEADING
The heading of the application form must include the name and address of the organization that is
applying for the license, and the federal identification number or account number issued to the
organization by letter from the West Virginia Tax Division.

IS THIS A RENEWAL APPLICATION?
If the application is for a license renewal, the mandatory 60-day filing period may be waived. Licensees
are urged to file their renewal applications prior to the expiration of their current license, to avoid
interruption in their bingo activities. You may not conduct any bingo activities if you do not have a current
valid bingo license.

PHONE NUMBER
If the organization has a telephone number, it must be provided. If the organization
has no telephone, then the address and telephone number of the person applying for the license must
be provided.

NAME AND ADDRESS OF STATE OR NATIONAL ORGANIZATION
If the applicant is a local branch or lodge of a state or national organization, it must provide the name
and headquarters address of the state or national organization with which it is affiliated.

SECTION 1 - TAX-EXEMPT STATUS:
A copy of the organization's IRS determination letter must accompany the application. Exempt
organizations that do not have an IRS determination letter must attach a letter explaining the nature of
their exempt status.

For example: volunteer fire departments, rescue units, other similar volunteer community service
organizations or associations, churches, or government subdivisions are eligible to apply for a
charitable bingo license, even though they may not be required to have an IRS exemption letter.

The West VirginiaTax Division does not issue tax exemptions, but it recognizes exemptions issued by
the Internal Revenue Service. You should consult the IRS if you have questions about the tax
exempt status of your organization.

SECTION 2 - TYPE OF LICENSE:
Select the type of license that best suits your organization's needs (See page 9 for
further information on license types):

● ANNUAL LICENSE - $500.00: An annual license entitles an organization to conduct up to
  two bingo occasions per week for the calendar year.
● ANNUAL SENIOR LICENSE - $50.00: Bona fide senior citizen organizations pay a reduced
  rate for the annual bingo license. See the description of an annual license for limitations on
  the number of bingo occasions.
● ANNUAL LICENSE - $200.00: Volunteer or nonprofit groups with gross revenues of less than
  $20,000 per year pay a reduced rate for the annual bingo license. See the description of an
  annual license for limitations on the number of bingo occasions.
● LIMITED LICENSE - $100.00: A limited occasion license is issued for a specified period of
  time, and entitles the organization to conduct one bingo occasion every 24 hours for up to two
  weeks. If two or more organizations wish to conduct a joint bingo occasion, each participating
  organization must obtain a limited occasion license. An organization that does not hold an
  annual license may obtain up to three limited occasion licenses per year. An organization that
  holds an annual license may obtain one limited occasion license per year.
● STATE FAIR LICENSE - $500.00: This license type is issued only to the West Virginia State Fair
  Board.
● SUPER LICENSE - $5,000.00: A super bingo license entitles an organization to conduct one
  super bingo occasion each month for a calendar year. An organization may award prizes up
  to fifty thousand dollars at a super bingo occasion. Any organization that holds an annual or
  limited occasion bingo license may obtain a super bingo license.

SECTION 3 – LOCATION OF BINGO OCCASIONS
List the address or location of the premises where bingo games will be held. Bingo occasions must be
conducted in the county where the organization is principally located, unless otherwise approved in
writing by the West Virginia Tax Division.

Indicate whether you own the premises, or are renting or leasing the premises.

List the name of the owner of the premises.

If you are renting or leasing the premises, copies of all rental or lease
agreements must be attached. Rental agreements that are not reflective of the fair market value may
be disapproved by the Tax Commissioner.

SECTION 4 - DATES AND TIMES OF ANNUAL AND SENIOR BINGO
Indicate the date of the first bingo occasion to be held under the license. Circle the days of the week
when bingo occasions will be held, and indicate the playing times of regularly scheduled bingo
games. If you wish to conduct games on days or at times other than those indicated on the
application, you must obtain written permission from the West Virginia Tax Division.

SECTION 5 - DATES AND TIMES OF LIMITED BINGO OCCASIONS
Specify the dates and times that you intend to conduct limited bingo occasions. The limited occasion
license is good only for the specified dates. If you wish to conduct games at dates or times other than
those specified, you must obtain written permission from the State Tax Division.

SECTION 6 - DATES AND TIMES OF STATE FAIR BINGO OCCASIONS
Attach a copy of any lease agreement between the State Fair Board and the persons who will be
conducting the State Fair Bingo occasions. Indicate whether the persons who will be conducting the
State Fair Bingo occasions have conducted Bingo at the State Fair for at least 2 years prior to the
current license application. Indicate the date of the first bingo occasion to be held under the license,
and the hours that bingo occasions will be conducted.

SECTION 7 - DATES AND TIMES OF SUPER BINGO OCCASIONS
Indicate the date and time of each scheduled super bingo occasion.

SECTION 8 - PROOF OF EXISTENCE
In order to qualify for a bingo license, your organization must provide proof that it has been in
existence in West Virginia for two years prior to the date of filing the application. Documentary proof
may include a copy of your organization's Certificate of Registration issued by the Secretary of State
and a copy of a business registration certificate issued by the West Virginia Tax Division. These
documents are not required from organizations that are applying to renew their license, and have
previously provided them.

SECTION 9 – CONCESSIONS
If a concession is to be operated by someone other than the licensee, a copy of any written
agreement, or an explanation of any oral agreement, between the licensee and the concession
operator must be attached to the application.

SECTION 10 NAMES OF OFFICERS OF ORGANIZATION

List the names, home addresses and home telephone numbers of all of the officers, members of the
board of directors, governors, or trustees of the organization. If necessary, attach a separate sheet.

SECTION 11 – PERSONS IN CHARGE OF BINGO
List the names, titles, home addresses and home telephone numbers of persons in charge of bingo
occasions. These persons must be bona fide active members of the organization and residents of the
State of West Virginia. Annual licenses require 3 names. Limited licenses require at least two names.
One of these persons must be present at all times bingo is conducted. All persons in charge of bingo
must be over 18.

SECTION 12 – NAME OF HIGHEST ELECTED OFFICER AND DESIGNEE
List the names, titles, home addresses and home telephone numbers of the highest elected officer of
the licensee and his or her officially appointed designee. One of these persons must be present at all
times bingo is conducted.

SECTION 13
Indicate by circling the appropriate answer whether the organization has ever been denied a bingo
license, or whether any previous license issued to the organization has been revoked or suspended. If
the answer is "yes," attach an explanation on a separate sheet.

Indicate whether any member of the organization who will participate in any way in the conduct of
bingo has been convicted of a felony, or a misdemeanor for a gambling offense within the previous
ten years. If the answer is "yes,” attach an explanation on a separate sheet.

SECTION 14 – DISPOSITION OF PROCEEDS
List the organization(s)/recipient(s) to which proceeds will be donated, using a separate sheet if
necessary.

Indicate whether the recipient has a tax exempt status letter from the IRS.

Indicate the intended organization(s)/recipient(s) intended use of the proceeds. .

SECTION 15 – AGREEMENT
By signing the application form, the authorized representative of the organization is affirming that the
persons in charge of the organization's bingo operations and the officers of the applicant organization
understand:

(1) That it is a violation of the law to allow any unauthorized persons to conduct any part of the
bingo games or concessions;

(2) That the organization is required to file the reports and keep the records as provided by the
law; and

(3) That it is a crime to violate the provisions of the charitable bingo laws, and, in addition, that a
violation may result in suspension or revocation of the organization's license and denial of future
licenses.

By signing the application, the authorized presentative of the organization is certifying that the
information in the application is true to the best of his or her knowledge.

Tip: To avoid delays, make sure your application is complete, your check for the appropriate fee, your
IRS exemption letter (not required for renewals) and all other supporting documents, copies of all
leases or rental agreements, and the signature of the person submitting the application. If the
application form is not complete, your license will be denied.

The completed application form, along with a check for the applicable license fee, and supporting
documentation should be mailed to the West Virginia Tax Division, P.O. Box 2666, Charleston, West
Virginia 25330-2666.