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J Town Bingo

Santa’s Toy Chest Application:

From its picturesque canals and bridges to its historic homes, Amsterdam is a full-blown fairytale. The brightly-colored bicycles and tulip stands around town don’t hurt either. Must-see sights include the. J Town Bingo information including address, telephone number, as well as links to maps, gaming options, amenities, entertainment, and restaurants. J Town Bingo (this information is available on a more. Download Bingo Town now, the newest Bingo Game, live worldwide, free to play and multiplayer with real opponents. Start your journey from town to town, playing Bingo in different Bingo Rooms for.

Please complete ALL information and return in person by *Nov. 20, 2020.

No late applications accepted!

J town bingo hall

Please bring in the following when turning in application:

1. Valid Florida state issued ID or Driver’s License

2. Valid Proof of Residence – Tax Bill, Lease, Voter’s Registration card are acceptable

3. Valid current utility bill

4. Proof of Income

5. Birth Certificates for any child ages 1 thru 12 in home.

*Turn in times are Monday, Tuesday, Thursday & Friday from 2pm – 6pm

Parent/Guardian Name: _____________________________________________________________

Parent/Guardian Address: ___________________________________________________________

____________________________________________________________

Parent/Guardian Phone: Home __________________ Cell__________________________________

(We must be able to contact you if application is accepted.)

Total # in Household_________

Names of those aged 1 – 12 in Home:

NameAgeM/FBirth Certificate

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________



Employment and Income

Employer: ______________________________

Phone #: _______________________________

Net pay total for last month: ________________

*(must provide at least 2 pay stubs within 30 days prior)

Employer: ______________________________

Phone #: _______________________________

Net pay total for last month: _______________

*(must provide at least 2 pay stubs within 30 days prior)

Anyone in home active_________ or retired military___________?

Do you or anyone in the home receive any other assistance? ________

*(please provide statement/form from any agency with amount that you or anyone in home receive)

If yes, please list below:

1) From: ______________________

Amount: ____________________

2) From: ______________________

Bingo

J Town Bingo Sessions

Amount: ____________________

3) From: _____________________

Amount: ____________________

If approved, preferred pick-up date and time (please check one provided)

Town

Monday 12/14 3pm - 6pm ______

Tuesday 12/15 1pm - 4pm ______

Town

*All information provided above must have documents to verify.

Signed: ___________________________ Date: ________________


Pick-up signature ____________________________________ Date _________________________________

__________________________________________________________________________________________

MCC received (date): _____________ by (name): _________________________________________

MCC copies rec’d and verified by: _____________________________________________________

Approved: _____________ Not approved (reason): ______________________________________

J Town Bingo Sessions

Applicant called by: ___________________ Pick-up day/time: _______________________________

J Town Bingo Hall

Pick-up signature ________________________________