Spring Valley, NY · Rockland County
Bingo/Raffle Game of Chance Application
This application collects applicant and contact information for people seeking a Village of Spring Valley license to conduct a bingo game or other game of chance.
What this form is
The Village Clerk accepts applications for and issues licenses for bingo games. The form asks for the applicant’s name, business name, address, telephone numbers, and date of birth, and states that the village collects a $50 fee for one game of chance in a calendar year. The application says to return it with payment.
Who needs it
Applicants seeking a Village of Spring Valley license to conduct a bingo game or other game of chance should complete this application.
How to submit it
Return the completed application with payment to the Village Clerk at 200 North Main Street, Spring Valley, New York 10977. The document states a $50 fee for one game of chance in a calendar year.
About notarization
This application is submitted without a notary; it lists no notarized attachment or sworn step, and the applicant completes the requested information fields.
How to submit this form
- 1
Download The Application
Download the Bingo/Raffle Game of Chance Application.
- 2
Complete Applicant Information
Fill in the requested applicant, business, address, telephone, and date-of-birth information.
- 3
Prepare Payment
Include payment; the document states a $50 fee for one game of chance in a calendar year.
- 4
Return To The Village Clerk
Return the application with payment to the Village Clerk at 200 North Main Street, Spring Valley, New York 10977.
Frequently asked questions
- Do I need a notary for the Bingo/Raffle Game of Chance Application?
- No. The application has no notary block and lists no notarized attachment or sworn step; it asks applicants to provide their information.
- How do I submit the Bingo/Raffle Game of Chance Application?
- Return the completed application with payment to the Village Clerk at 200 North Main Street, Spring Valley, New York 10977.
- What information does the application request?
- It requests the applicant’s name, doing-business-as name, permanent address, city, state and ZIP code, telephone numbers, and date of birth.
- What fee does the document list?
- The application states a $50 fee for one game of chance in a calendar year and asks applicants to return the application with payment.
Need something notarized?
This Bingo/Raffle Game of Chance Application doesn’t need a notary — but if you have another Spring Valley form that does, a commissioned online notary can help.