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OREGON DEPARTMENT OF JUSTICE
Raffle Receipt Record
This record must be maintained with your official raffle records for a period of three (3) years.
This record must be completed in non-erasable ink.
Licensee: Eastern Oregon University
Raffle License #: R-4966
Date of Raffle Drawing:
Time:
Location of Drawing:
TICKET SALES INFORMATION
Maximum number of tickets to be sold:
Ticket price: $
Beginning ticket number: Ending ticket number:
Starting date for sales: Ending date of sales:
Total sales: $
Total Expenses (other than prizes): $
(must be itemized on back of this page)
Total Expenses (of noncash prizes): $ (must be itemized on back of this page)
Total amount of cash prizes awarded: $ (cannot exceed $1500)
Attach a complete voided sample ticket to this sheet
PRIZE INFORMATION
Attach a copy of your completed raffle notice for this raffle to this sheet. If you added any additional
prizes to the raffle since the raffle notice was filed, describe each prize and list its retail value on a
separate sheet and attach.
SPECIAL PRIZE RECEIPTS
You must obtain and attach a receipt from the seller, distributor, or contributor of each prize with retail
value of $500 or more. Attach the receipts to this sheet.
RESPONSIBLE OFFICIALS
Name: Telephone:
Address:
Name: Telephone:
Address:
Name: Telephone:
Address:
Name: Telephone:
Address:
Name: Telephone:
Address: