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NOTICE AND STATEMENT OF APPLICANT STATE OF CONNECTICUT DIVISION OF SPECIAL REVENUE GB/S2A REV. 11/02 Charitable Games 555 Russell Road Newington, CT 061111523 INSTRUCTIONS: 1. 2. Please sign this
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Notice and statement is a document that provides information about a particular matter or situation.
It depends on the specific requirements set by the governing body or organization.
The notice and statement can typically be filled out either manually or electronically, following the instructions provided.
The purpose of notice and statement is to inform relevant parties about a specific issue or update.
The information required on a notice and statement can vary, but typically includes relevant details about the matter being addressed.
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CONNECTICUT Newington CGB misstate falsification untruthful foregoing CGS registrations applicable omit affirm pursuant CERTIFY APPLICANT Similarly preceding penalties therein WAIVER individually disclose spouse violations

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