STATE OF CALIFORNIA BGC 203

(Rev. 10/2018)

DEPARTMENT OF JUSTICE

PAGE 1 of4 MAJOR LEAGUE SPORTS RAFFLE ELIGIBLE ORGANIZATION RAFFLE REPORT

PLEASE SEND COMPLETED REPORT TO: Bureau of Gambling Control P. 0. Box 168024 Sacramento, CA 95816-8024

Phone: 916-830-1700

RaffleReportPeriod: ~Seasonor 0CalendarYear Dates: (?0\-o\,err 5)'d0)~ - fe cX:>\Cf f'Jr6<'1\ 1

Eligible Organization's Name: Lo0 'roLA,y'\6~'/}y,.ct,ks CA\~~ uY\ Eligible Organization's Registration Number:

Pursuant to Penal Code section 320.6, subdivision (o)(13)(A), once registered, an eligible organization shall file with the Department of Justice, each season or year thereafter, a report that includes all of the following information. Pursuant to Penal Code section 320.6, subdivision (o)(13)(B), failure to submit the seasonal or annual report shall be grounds for denial of an annual registration and for the imposition of penalties under Government Code section 12591.1.

SECTION 1: SEASON OR ANNUAL RAFFLE TOTALS

Total number of raffles conducted for the season or calendar year. 46 The gross receipts generated from the sale of

raffle tickets for the season or calendar year. ? J..17, -;;J.. 9 D

The average per raffle gross receipts generated from the sale of raffle tickets for the season or calendar year.

# ~.0~'3 The prize total for the season or calendar year, including any prize that was not claimed. ti 1 :;15) {;6 0

The average per-raffle prize total for the season or calendar year, including any prize that was not claimed.

.# 3 1

oJL-( The prize total that was not claimed, if any, during the season or calendar year. .ti !5) d, 3;t._

For each raffle in which the raffle prize was not claimed, list the name of the eligible recipient organization that received the prize (attach additional sheets, if needed).

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STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC203 PAGE2 of4

(Rev. 10/2018) MAJOR LEAGUE SPORTS RAFFLE ELIGIBLE ORGANIZATION RAFFLE REPORT

neTION ~ COST IELATED INFORMA110N -Provide a total of the direct costs of conducting the raffles for:

Labor Consulting Software Marketing Raffle Equipment

1' 0 #Q ~ J:t) 931, 'iS- ~ l-/57. b;J... 1) d--'-1, D 9·q, d--S-

Provide a schedule of vendors used to operate the raffles and total payments made to each vendor . Attach additional sheets if needed.) Amount Paid

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A-s(Q,,y\ A ~ (Ve.A~e_~r Wo-<" \6 {) ti<M.-

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if L/57, bd--. ~;J..d-, loL(. 115 ~;tilYo,3l

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Fiduciary's Printed Name A Fiduciary's Signature: -- .... ~-----~-.,.._-..._ _ __ _ ____ _ Date: ~-e2~

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC203 PAGE 3 of4 MAJOR LEAGUE SPORTS RAFFLE (Rev. 10/2018)

ELIGIBLE ORGANIZATION RAFFLE REPORT

SECTION 3: FOR EACH RAFFLE EVENT PLEASE PROVIDE THE FOLLOWING INFORMATION (attach additional sheets, if needed) - -

Registered Event ID#

Event Date Benefitting Organization (Eligible Organization

Recipient Organization) or Eligible

Gross Receipts Generated by

the Sale of Raffle Tickets

Amount Each Organization

Received

Winning Ticket Number

Prize Status (Claimed/

Unclaimed)

Se.Q.... ~C(~i\

CERTIFICATION

I declare under penalty of perjury under the laws of the State of California that the foregoing information is true, correct, and complete. First Name Last Name Middle Initial

Registered Event ID# Event Date Benefitting Organization

Gross Receipts

Generated by the

Sale of Raffle Tickets

Amount Each Organization Received

Winning Ticket Number Prize Status

18-00026-02 10/3/2018 Los Angeles Clippers Foundation $ 1,765.00 s 883.00 A-468722 Claimed

18-0002 7-02 10/ 9/2018 Los Angeles Clippers Foundation $ 2,410.00 $ 1,205.00 B-451350 Claimed

18-00028-02 10/11/2018 Los Angeles Clippers Foundation s 2,050.00 $ 1,025.00 C-474448 Claimed

18-00029-02 10/17/2018 Los Angeles Clippers Foundation $ 5,080.00 $ 2,540.00 D-396816 Claimed

18-00030-02 10/19/2018 Los Angeles Clippers Foundation s 2,725.00 s 1,363.00 E-477195 Claimed

18-00031-02 10/21/2018 Los Angeles Clippers Foundation $ 3,330.00 $ 1,665.00 F-561585 Claimed

18-00032-02 10/28/2018 Los Angeles Clippers Foundation $ 3,030.00 $ 1,515.00 G-313751 Claimed

18-00033-02 11/5/2018 Los Angeles Clippers Foundation $ 4,945.00 $ 2,473.00 H-489353 Claimed

18-00034-02 11/10/2018 Los Angeles Clippers Foundation $ 4,880.00 $ 2,440.00 1-381209 Claimed

18-00035-02 11/12/2018 Los Angeles Clippers Foundation $ 10,065.00 $ 5,033.00 J-537110 Claimed

18-00036-02 11/15/2018 Los Angeles Clippers Foundation $ 4,470.00 $ 2,235.00 K-198784 Unclaimed

18-00037-02 11/23/2018 Los Angeles Clippers Foundation s 4,415.00 $ 2,208.00 L-186892 Claimed

18-00038-02 11/28/2018 Los Angeles Clippers Foundation $ 3,455.00 $ 1,728.00 M-531843 Claimed

18-00039-02 12/8/2018 l as Angeles Clippers Foundation $ 2,895.00 s 1,448.00 N-304642 Unclaimed

18-00040-02 12/11/2018 Los Angeles Clippers Foundation $ 4,845.00 $ 2,423.00 0-324448 Claimed

18-00041-02 12/17/2018 Los Angeles Clippers Foundation $ 5,205.00 $ 2,603.00 P-460310 Claimed

18-00042-02 12/20/2018 Los Angeles Clippers Foundation $ 3,945.00 s 1,973.00 Q-220735 Claimed

18-00043-02 12/22/2018 Los Angeles Clippers Foundation s 2,565.00 $ 1,283.00 R-443293 Unclaimed

18-00044-02 12/26/2018 Los Angeles Clippers Foundation $ 4,375.00 $ 2,188.00 S-119720 Claimed

18-00045-02 12/29/2018 Los Angeles Clippers Foundation s 4,395.00 $ 2,198.00 T-505137 Unclaimed

19-01-001 1/6/2019 Los Angeles Clippers Foundation s 3,205.00 $ 1,603.00 U-247606 Claimed

19-01-002 1/8/2019 Los Angeles Clippers Foundation $ 4,355.00 s 2,178.00 V-516785 Claimed

19-01-003 1/12/2019 Los Angeles Clippers Foundation $ 3,010.00 $ 1,505.00 W-545872 Claimed

19-01-004 1/14/2019 Los Angeles Clippers Foundation $ 5,230.00 $ 2,615.00 X-348292 Claimed

19-01-005 1/16/2019 Los Angeles Clippers Foundation $ 2,830.00 $ 1,415.00 Y-533015 Claimed

19-01-006 1/18/2019 Los Angeles Clippers Foundation s 9,675.00 s 4,838.00 Z-178897 Claimed

19-01-007 1/27/2019 Los Angeles Clippers Foundation $ 6,255.00 $ 3,128.00 A-567122 Claimed

19-01-008 1/28/2019 Los Angeles Clippers Foundation $ 6,725.00 $ 3,363.00 B-104989 Claimed

19-01-009 1/31/2019 Los Angeles Clippers Foundation $ 15,230.00 $ 7,615.00 C-253219 Claimed

19-01-010 2/13/2019 Los Angeles Clippers Foundation s 6,925.00 s 3,463.00 D-549463 Unclaimed

19-01-011 2/25/2019 Los Angeles Clippers Foundation $ 5,435.00 $ 2,718.00 E-355016 Claimed

19-01-012 3/3/2019 Los Angeles Clippers Foundation $ 7,985.00 $ 3,993.00 F-203805 Claimed

19-01-013 3/8/2019 Los Angeles Clippers Foundation s 7,825.00 s 3,913.00 G-493022 Claimed

19-01-014 3/11/2019 Los Angeles Clippers Foundation $ 10,645.00 $ 5,323.00 H-309601 Claimed

19-01-015 3/12/2019 Los Angeles Clippers Foundation $ 8,255.00 s 4,128.00 1-202245 Claimed

19-01-016 3/15/2019 Los Angeles Clippers Foundation $ 7,095.00 $ 3,548.00 J-573402 Claimed

19-01-017 3/17/2019 Los Angeles Clippers Foundation $ 5,005.00 $ 2,503.00 K-153338 Claimed

19-01-018 3/19/2019 Los Angeles Clippers Foundation s 5,650.00 s 2,825.00 L-144065 Claimed

19-01-019 3/30/W19 Los Angeles Clippers Foundation $ 5,385.00 $ 2,693.00 M-438110 Claimed

19-01-020 3/31 / 2019 Los Angeles Clippers Foundation s 9,020.00 $ 4,510.00 N-301123 Claimed

19-01-021 4/3/2019 Los Angeles Clippers Foundation s 8,045.00 s 4,023.00 0-281271 Claimed

19-01-022 4/5/2019 Los Angeles Clippers Foundation $ 9,210.00 $ 4,605.00 P-564989 Unclaimed

19-01-023 4/10/2019 Los Angeles Clippers Foundation $ 6,660.00 $ 3,330.00 Q-546682 Claimed

19-01-024 4/18/2019 Los Angeles Clippers Foundation $ 14,110.00 $ 7,055.00 R-262286 Claimed

19-01-025 4/21/2019 Los Angeles Clippers Foundation s 11,385.00 s 5,693.00 5-533102 Claimed

19-01-026 4/26/2019 Los Angeles Clippers Foundation $ 11,295.00 $ 5,648.00 T-399149 Claimed

$ 277,290.00 $ 138,660.00

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC203

(Rev. 10/2018) MAJOR LEAGUE SPORTS RAFFLE PAGE 4 cf 4

ELIGIBLE ORGANIZATION RAFFLE REPORT

Privacy Not ice on Data Collection Forms As Required by Civil Code § 1798.17

Collection and Use of Personal Information The Division of Law Enforcement, Bureau of Gambling Control in the Department of Justice collects the information requested on this form as authorized by California Penal Code section 320.6. The Bureau uses this information to establish grounds for the license, permit or other approval indicated on this application form. In addition, any personal information collected by state agencies is subject to the limitations in the Information Practices Act and state policy. The Department of Justice's general privacy policy is available at http://oag. ca.gov/privacy-policy .

Providing Personal Information All the personal information requested in this form must be provided .

Access to Your Information You may review the records maintained by the Division of Law Enforcement, Bureau of Gambling Control in the Department of Justice that contain your personal information as permitted by the Information Practices Act. (See below for contact information.)

Possible Disclosure of Personal Information In order to process your application, we may need to share the information you give us with law enforcement or regulatory agencies.

The information you provide may also be disclosed in the following circumstances :

• With other persons or agencies where necessary to perform their legal duties, and their use of your information is compatible and complies with state law, such has for investigations or for licensing, certification, or regulatory purposes;

To another government agency as required by state or federal law.

Contact Information For questions about this notice or access to your records, you may contact the Special Agent Supervisor of Special Programs at the Department of Justice, Bureau of Gambling Control, at P. 0. Box 168024, Sacramento, CA 95816-8024, (916) 830-1700 or e-mail at GamblingControl@doj.ca.gov