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Written application for a permit required by this chapter shall be made by affidavit under penalty of perjury and filed with the Treasurer-Tax Collector of the County of Humboldt accompanied by payment of the permit fee specified in § 911-24 of this chapter. Such application shall contain:

(a) Name of organization, names, signatures, addresses and dates of birth of all the officers of the organization.

(b) Days and hours of operation of bingo games.

(c) Attached copies of certificates or letters evidencing exempt status under §§ 23701(a), 23701(b), 23701(d), 23701(e), 23701(f), 23701(g) and 23701(z) of the Revenue and Taxation Code received from the Franchise Tax Board.

(d) Address of premises where bingo games will be conducted.

(e) Statement of ownership or lease of premises.

(f) Purpose for which such premises are used by the organization.

(g) Statement of consent for the Treasurer-Tax Collector and/or the Sheriff to inspect any bank accounts containing profits derived from bingo games.

(h) Name of each individual (including address and date of birth), corporation, partnership or other legal entity which has a financial interest in the conduct of the bingo games.

(i) Name of person (including address and date of birth) responsible for the operation of the bingo games.

(j) A statement as to whether the applicant or proposed operator of a bingo game has been convicted within the past five (5) years of crimes involving lotteries, gambling, larceny, perjury, bribery, extortion, fraud or similar crimes involving moral turpitude.

(k) A statement and agreement that the applicant or operator shall not utilize persons with conviction records referred to in subsection (j) of this § 911-32 to assist in the operation of bingo games.

(l) Such further information as may be required by the Treasurer-Tax Collector to implement the provisions of this chapter.

Said application shall be filed at least three (3) weeks before the first bingo game is to be held and shall indicate the name and address of the organization representative to be contacted and information on how such contact is to be made. (Ord. 1180, § 18, 11/8/1977; Ord. 1553, § 1, 9/21/1982)