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Virginia Administrative Code
Title 11. Gaming
Agency 20. Department of Agriculture and Consumer Services, Charitable Gaming
Chapter 20. Charitable Gaming Regulations
12/3/2024

FORMS (11VAC20-20).

GAME MANAGEMENT FORMS

Annual Financial Report, Form 101 (rev. 5/2024)

Quarterly Financial Report, Form 102 (rev. 5/2024)

Bingo Session Reconciliation Summary, Form 103 (rev. 8/2013)

Admission Sales Reconciliation - Paper, Form 104-A (rev. 8/2013)

Floor Sales Reconciliation - Paper, Form 104-B (rev. 12/2014)

Decision Bingo Reconciliation, Form 104-C (rev. 8/2013)

Raffle/Treasure Chest Sales Reconciliation - Bingo Session, Form 104-D (rev. 8/2013)

Paper Instant Bingo/Seal Cards/Pull-Tabs Reconciliation, Form 105 (rev. 8/2013)

Storeroom Inventory Issue - Paper, Form 106-A (rev. 8/2013)

Storeroom Inventory Issue - Instant Bingo/Seal Cards/Pull-Tabs, Form 106-B (rev. 8/2013)

List of Bingo Workers, Form 107 (rev. 8/2013)

Prize Receipt, Form 108 (rev. 8/2013)

Storeroom Inventory - Paper, Form 109-A (rev. 8/2013)

Storeroom Inventory - Instant Bingo/Seal Cards/Pull-Tabs, Form 109-B (rev. 8/2013)

Raffle Sales Reconciliation - Stand Alone Raffle, Form 110 (rev. 8/2013)

Instant Bingo/Seal Cars/Pull-tabs Reconciliation (Non-Bingo), Form 111 (rev. 8/2013)

Instant Bingo/Seal Cars/Pull-tabs Reconciliation Continuation (Non-Bingo), Form 111-A (rev. 8/2013)

Destruction of Unused Charitable Gaming Supplies, Form 112 (rev. 5/2024)

ORGANIZATION LICENSING FORMS

Charitable Gaming Permit Application - New Applicants, Form 201-N (rev. 5/2024)

Charitable Gaming Permit Application - Renewal Applicants, Form 201-R (rev. 5/2024)

Permit Amendment, Form 202 (rev. 5/2024)

Gaming Personnel Information Update (rev. 7/2013)

Report of Game Termination, Form 0 (rev. 5/2024)

MANUFACTURER OF ELECTRONIC GAMING DEVICES, SUPPLIER, AND NETWORK BINGO PROVIDER LICENSING FORMS

Charitable Gaming Supplier Permit Application, Form 301 (rev. 2/2018)

Annual Supplier/Manufacturer Sales and Transaction Report, Form 302 (rev. 8/2013)

Certification of Non-Charitable Gaming/Gambling, Form 304 (rev. 7/2013)

Manufacturer of Electronic Pull-tab System Permit Application, Form 305 (rev. 10/2012)

Manufacturer of Electronic Pull-tab System Permit Application - Personal Information, Form 305A (rev. 10/2012)

Manufacturer of Electronic Pull-tab System Permit Renewal Application, Form 306 (rev. 10/2013)

Manufacturer of Electronic Pull-tab System Permit Renewal Application - Personal Information, Form 306A (rev. 10/2013)

Network Bingo Provider Permit Application, Form 307 (eff. 5/2014)

Network Bingo Provider Permit Application - Personal Information, Form 307A (eff. 5/2014)

BINGO MANAGER AND BINGO CALLER REGISTRATION FORMS

Charitable Gaming Bingo Caller Certificate of Registration Application, Form 401 (rev. 7/2018)

Charitable Gaming Bingo Manager Certificate of Registration Application, Form 402 (rev. 7/2018)

Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.

As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.