/ Licensing and Regulation / For Office Use Only
PO Box 43085 / Date:
Olympia, WA 98504-3085 / Check #:
Phone: 360-664-1600 / Amount rec’d:
Fax: 360-753-2710 / Rec’d by:

APPLICATION FOR PERMIT TO RAFFLE LIQUOR(sample)

This permit allows a bona fide charitable or nonprofit organization to raffle bottles of liquor or baskets that include liquor.

  • The liquor must be purchased at retail or donated by a private citizen. It may not be donated by a liquor licensee.
  • Only organization members may purchase tickets or be awarded prizes.
  • The organization will not sell raffle tickets to anyone less than 21 years of age when alcohol is awarded as a prize.
  • The organization will not sell more than $5,000 dollars’ worth of raffle tickets in a

calendar year.

(WAC 314-38-040)

Permit Processing and Posting Information
Select from the following options. Make your check payable to WSLCB.
$10 fee for single event.
$25 fee for annual permit.
New application.
Renewal: / Raffle Permit No.
Liquor License No.
Mail your completed and signed application and check to the above address 30 days before your ticket sales start.
Allow 7-14 business days for permit processing. Your permit will be mailed to you.
The permit must be posted at the location of the drawing- prior to and during the drawing.
If you have questions, please call Customer Service at 360-664-1600.
Applicant Information
Full name of your organization:
West Olympia Golf Club
Organization’s address (Street or Route, City, State, Zip Code):
12345 Doe Lane SE, Olympia, WA 98512
Organization’s mailing address(if different from above)
PO BOX 1234, Olympia, WA 98512
Name of your organization officer in charge of raffle:
John Doe / Officer’s e-mail address:

Officer’s address (Street or Route, City, State, Zip Code)
1111 Sunny Lane NE, Olympia, WA 98512 / Officer’s phone:
(555) 555 - 5555

This form is continued on the back page.

LIQ084 5/18Page 1 of 2

/ Licensing and Regulation / For Office Use Only
PO Box 43085 / Date:
Olympia, WA 98504-3085 / Check #:
Phone: 360-664-1600 / Amount rec’d:
Fax: 360-753-2710 / Rec’d by:

Raffle Information –only required for an individual event (WAC 314-38-040)
The date the raffle ticket sales will start
6/1/2018
The date, time and exact location of the drawing:
Date: / 6/8/2018
Time: / 6:00pm
Exact Location: / Conference Room - 1234 Golf View Road, Olympia, WA 98512
A description of the alcohol being raffled including its estimated value:
Bottles of wine ranging in price from $5 - $25
The source of the alcohol to be raffled:
Private donations from members of the West Olympia Golf Club

I declare under the penalties of perjury that the answers contain in this application are true, correct, and complete. The undersigned certifies it is understood that a misrepresentation of fact is cause for rejection of this application or revocation of any permit issued.

Print Name / John Doe / Title: / Owner
Signature: / John Doe / Date: / 5/1/2018

LIQ084 5/18Page 1 of 2