OREGON DEPARTMENT OF JUSTICE Raffle Individual Seller’s Record (Internal form) Name of Seller: R- Licensee License #: Date of Raffle Drawing: Time: Location of Drawing City: State: Zip: (street address) : Complete and sign this reconciliation report and turn in all money, stubs and unsold INSTRUCTIONS: tickets with this form to Licensee when all tickets are sold or by (date): $ 1 Price per Raffle Ticket: Number of Raffle Tickets 2 Issued to Seller: Number of Raffle Tickets 3 Returned Unsold: Number of Raffle Tickets Sold 4 (#2 less #3): Total Amount Due $ 5 (#4 times #1): Seller’s Signature: Date:
OREGON DEPARTMENT OF JUSTICE Raffle Individual Seller’s Record (Internal form) Name of Seller: Licensee License #: R- Date of Raffle Drawing: Time: Location of Drawing (street address) : City: State: Zip: INSTRUCTIONS: Complete and sign this reconciliation report and turn in all money, stubs and unsold tickets with this form to Licensee when all tickets are sold or by (date): 1 Price per Raffle Ticket: $ 2 Number of Raffle Tickets Issued to Seller: 3 Number of Raffle Tickets Returned Unsold: 4 Number of Raffle Tickets Sold (#2 less #3): 5 Total Amount Due (#4 times #1): $ Seller’s Signature: Date:
2014_raffle_form.docx