61 Pa. Code § 901.133 — Distributor license application form contents

The application form must include the following: (1) The name of the distributor, including a copy of the Fictitious Name Registration, Department of State Registry Statement or similar registry statement. (2) The address of the distributor, including the business, mailing and legal address. (3) The names, addresses, telephone numbers and Social Security numbers of officers, directors, owners and partners or other responsible persons. If incorporated, the application shall contain the names, addresses and telephone numbers of officers and shareholders controlling 10% or more of outstanding stock. If organized as a partnership, the application must contain the names, addresses and telephone numbers of all partners. (4) A copy of the constitution and bylaws or corporate charter only for new applications. This information must also accompany renewals if requested or if changed or amended. (5) A list of all types of games of chance to be distributed. (6) A list of manufacturers with whom distributors anticipate doing business. (7) The signature of responsible persons. (8) A complete list of distributor representatives and their addresses and telephone numbers. (9) Pennsylvania tax information, including: (i) Pennsylvania Sales Tax number. (ii) Pennsylvania Corporate box number. (iii) Pennsylvania employer identification number. (iv) Pennsylvania Unemployment Compensation account number. (v) Pennsylvania Liquor License number, if applicable. (10) A certified statement that: (i) State tax reports and returns have been filed. (ii) State taxes due and payable have been paid. (iii) State taxes owing are subject to timely administrative or judicial appeal. (iv) Delinquent State taxes are subject to an approved deferred payment plan. A copy of the approved deferred payment plan shall be attached to the certified statement. (11) A certified statement that no officer, director or other responsible person or employee eligible to make sales on behalf of the distributor has been convicted of one or more of the following: (i) A felony in a state or Federal court within the past 5 years. (ii) A violation of the Bingo Law or of the act or a gambling related offense under 18 Pa.C.S. (relating to the Crimes Code) or other comparable state or Federal law within 10 years of the date of application in a state or Federal court. (12) The logo used by the distributor. (13) Other documents as identified in the application materials. Source The provisions of this § 901.133 amended August 11, 2006, effective August 12, 2006, 36 Pa.B. 4475. Immediately preceding text appears at serial pages (265869) to (265870). Cross References This section cited in 61 Pa. Code § 901.153 (relating to raffle, daily drawing and weekly drawing ticket). No part of the information on this site may be reproduced for profit or sold for profit. This material has been drawn directly from the official Pennsylvania Code full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.