Section
University of Alaska Anchorage
ADMINISTRATIVE SERVICES MANUAL
Policies and Procedures
ACT
Part
Proced
Statement
10
Effective Date
March 1, 2015
Games of Chance and Skill Permit Activities
Permit Location
The University of Alaska Anchorage permit for games of chance and skill is held in the Budget Office.
The permit is for use by qualified university community groups and is intended to serve as a fund raising
vehicle.
Applicable Regulations
All activities held will be in conformance with the following regulations:
Alaska Statute 05.15 http://www.touchngo.com/lglcntr/akstats/Statutes/Title05/Chapter15.htm
Alaska Statutes and Revenue Regulations Governing Games of Chance and Skill
Title 15, Chapter 160, Article 7
http://www.tax.alaska.gov/programs/documentviewer/viewer.aspx?210s
Use of Permit
University groups wishing to use the permit should complete the Application for Use of Games of
Chance and Skill Permit (Appendix 10) and forward it to the Budget Office. Financial record keeping
(including disposition of net proceeds from the gaming activity) and award recipients' lists required for
the Internal Revenue Service will be the responsibility of the user and must be forwarded to the
Budget Office within 10 business days after the activity.
Use Fee
To offset administrative costs, groups using the permit will be charged a $20 use fee plus 5% of the gross
proceeds of the activity.
Prior to approval for use of the permit, groups will need to submit the following information
(Application for Use of Games of Chance and Skill Permit (Appendix 10):
1. An outline of the procedures for conducting the activities including the date of prize drawing(s), and
the intended deposition of the net revenue
2. The date(s) of the activity
3. An itemized budget which includes projected gross revenue and expenses
4. A list of prizes, their cost to the organization, and their retail value
5. A draft sample of the stubbed tickets to be used. All raffle tickets and stubs must:
• Be serially numbered
• Contain UAA and your organization’s name
• List all prizes
• List the date, time, and location(s) of all prize drawings
• Whether the player must be present at the drawing to be eligible for a prize
• The price of the raffle ticket
•
List the permit number (furnished by UAA Budget Office when approval is granted)
• The ticket stub must have adequate space for the player's name, email address, and
telephone number
6. Name, address, and telephone number of the person from your organization in charge of the program
7. An account number for raffles will be assigned after the activity has been approved
8. The department account number that will cover any deficits
Reporting Requirements
Within two weeks after the activity has taken place; submit to the Budget Office a final report that is to
include:
1. The financial report for the program. The report should contain both budgeting and actual
expenses and revenue
2. Original signed UA Taxable Status Determination form that the prizes were accepted by the winners
3. Copies of deposit receipts for all revenue
4. Receipts/invoices for all expenses (the only expenses that may be incurred or paid in connection with
an activity under the permit are goods, wares, and merchandise necessary for the operation of the
activity)
5. Ticket log must contain all ticket #s, purchaser name and prize(s) awarded
6. All ticket stubs and unsold tickets
7. Vendor prize donation forms
Follow-Up Report
State law requires that the net revenue earned from the use of the permit be expended within one
year after conclusion of your activity and that the expenditures be for the purpose approved.
Submit to the Budget Office a statement explaining when and how the net revenue was spent.
Section
ACT
University of Alaska Anchorage
Part
Append
Statement
ADMINISTRATIVE SERVICES MANUAL
10
Effective Date
Policies and Procedures
March 1, 2015
Gaming Application
Application for Use
Games of Chance and Skill Permit
Organization:
Person in Charge:
Phone:
Address:
Type of Use:
Raffle
For raffle: Number of tickets to be printed:
Outline of Event (location, location of sales, date of drawings, who will sell the tickets, etc.):
Revenue will be used for (specific use):
Date (s) revenue will be used:
Account number that all funds will be deposited to and all expenses will be paid from:
- XXXX
(All revenue will be deposited into object code 9871)
Department account number to cover any deficit:
- XXXX
Tentative Budget
Expenses
Income
Advertising
Printing
Prizes
Postage
Other
Sales
Admission
Other
Total
Total
Projected net:
Prizes to be awarded (may be submitted as an attachment):
Signature of person in charge:
Date:
University of Alaska Taxable Status Determination Form
PRIZES AND AWARDS
Date:
/
MM
Section A: General Information. To be completed by all. Please print clearly.
Name:
UA ID# (if applicable):
Gender:
Male
Female
/
Birthdate:
DD
/
YYYY
U.S. SSN:
Check one
and provide
ID#:
(Last, First, MI)
/
/
U.S. ITIN:
/
Mailing Address:
Daytime Phone Number:
Evening Phone Number:
E-mail:
YOU MUST ANSWER THIS QUESTION:
Are you a U.S. Citizen or Permanent Resident?
Yes, skip to section C.
No, complete rest of form.
Section B: Tax Residency Information. Please print clearly. This information will be used to determine tax residency status.
You may be subject to tax withholding up to 30% on any payments or benefits you may receive.
Citizenship:
Citizen of
Nation of Birth:
What country did you live in prior to coming to the U.S.?
Dates of residence?
/
/
to
MM / DD / YYYY
/
Date of First Entry into the U.S. in any Visa category:
MM
Current I-94 Expiration:
D/S or
/
Date:
/
/
DD
/
/
/
MM / DD / YYYY
Current Entry I-94 Date:
/
YYYY
/
MM / DD / YYYY
/
MM / DD / YYYY
Expiration Date:
Passport #:______________ Country of Issue:
/
/
MM / DD / YYYY
U.S. Visa Type:
B-1
B-2
J-1
F-1
WB/WT
/
Expires:
/
MM / DD / YYYY
J Visa, category as specified on DS-2019:
/
Expires:
/
MM / DD / YYYY
In the table below, please list your travel to the United States and travel dates for the last seven years through the present,
including your current visit. Attach additional pages if necessary.
Check box if you have been in the U.S. as Visa category F,J, M, L, or Q prior to 7 years ago and complete travel information.
Arrival Date
(mm/dd/yy)
Departure Date
(mm/dd/yy)
Visa Type
(ex: J-1,
TN, B-1,
etc.)
UA Staff Use Only
Purpose of presence in U.S.
(ex: study, tourist, conference, etc.)
Exempt from SPT?
Yes/No
Year
SPT Calculation
By:___________
Date:________
# days in current year: ___________
# days in last year:
x 1/3
+__________
# days year before last
x 1/6
+__________
Total Days for SPT
=__________
If <= 182 is NRA
If >=182 is RA
Travel W/H% :_____ Tax Treaty W/H %:_____ Default W/H %:_____
Section C: Certification. To be completed by all. I certify that the above information is true and correct to the best of my knowledge.
Signature
Date
MM / DD / YYYY
Sponsoring Department
Contact Name
Description of prize:
Fax Number:
Phone Number:
Event name:
Cash value of prize:
Taxable Status Determination Form
Revised: 3/10/2008