Form 501A, Fantasy Contest Operator Personal Information Form (Commonwealth of Virginia, VDACS Office of Charitable & Regulatory Programs) Completed Form Examples and Samples
View a filled Form 501A example (Fantasy Contest Operator Personal Information Form) for the Commonwealth of Virginia—VDACS Office of Charitable & Regulatory Programs. This sample completed PDF shows how a fantasy contest operator and responsible person can enter business details, contact information, and signature/date fields for a typical Virginia filing.
Form 501A Example – Fantasy Contest Operator Personal Information (Virginia VDACS)
How this form was filled:
This sample Form 501A shows how a fantasy contest operator’s responsible person can provide complete identifying and contact information for Virginia VDACS (Office of Charitable & Regulatory Programs). It includes a realistic 2026 signature date, a Virginia business mailing address, and consistent phone/email details suitable for an example completed PDF form.
Information used to fill out the document:
- Use Case Summary: Fantasy sports contest operator designates a responsible person and provides required personal information to Virginia VDACS for Form 501A.
- Fantasy Contest Operator Legal Name: Blue Ridge Fantasy Sports, Inc.
- Trade Name (DBA): BlueRidgeFantasy
- VDACS Registration/Reference Number: FCO-VA-2026-01427
- Business Mailing Address Line 1: 2214 W Main Street, Suite 400
- Business Mailing Address City: Richmond
- Business Mailing Address State: VA
- Business Mailing Address ZIP Code: 23220
- Business Phone Number: (804) 555-0198
- Business Website: https://www.blueridgefantasy.example
- Responsible Person Full Legal Name: Alyssa Marie Carter
- Responsible Person Title/Role: Compliance Officer
- Responsible Person Date of Birth: 02/14/1989
- Responsible Person Home Address Line 1: 5123 Monument Avenue, Apt 7B
- Responsible Person Home City: Richmond
- Responsible Person Home State: VA
- Responsible Person Home ZIP Code: 23226
- Responsible Person Direct Phone: (804) 555-0116
- Responsible Person Email: [email protected]
- Responsible Person Government ID Type: Virginia Driver's License
- Responsible Person Government ID Number: CARTERAM12345
- Responsible Person SSN (Last 4): 4821
- Preferred Contact Method: Email
- Hours Available for Contact: Monday–Friday, 9:00 AM–5:00 PM ET
- Signature (Responsible Person): Alyssa M. Carter
- Signature Date: 01/10/2026
- Form Jurisdiction/Agency: Commonwealth of Virginia, VDACS Office of Charitable & Regulatory Programs
- Form Name: Form 501A – Fantasy Contest Operator Personal Information Form
What this filled form sample shows:
- SEO-focused sample: Form 501A, Fantasy Contest Operator Personal Information Form (Commonwealth of Virginia, VDACS Office of Charitable & Regulatory Programs) example with realistic, consistent entries
- Clear separation of operator business details (legal name, DBA, address, phone, website) and responsible person details (name, title, DOB, home address, direct contact)
- Includes common identity fields used on personal information forms (ID type/number and SSN last four) using safe, example-only values
- Uses a near-current 2026 signature date and coherent Virginia addresses to match a typical filing scenario
- Data is formatted to be easily mapped into a filled PDF and rendered as a web page (labels are strings and values are strings)
Form specifications and details:
| Form Title: | Form 501A, Fantasy Contest Operator Personal Information Form |
| Agency: | Commonwealth of Virginia, VDACS Office of Charitable & Regulatory Programs |
| State: | Virginia (VA) |
| Primary Purpose: | Provide personal information for the fantasy contest operator’s designated responsible person for regulatory review/registration |
| Example Filing Year: | 2026 |
| Use Case: | Mid-sized fantasy sports operator submits responsible person personal information as part of VDACS registration/ongoing compliance |
| Output Format: | JSON dataset for filling a PDF form and rendering a completed Form 501A example web page |
| SEO Keywords: | Form 501A example, Form 501A sample, Fantasy Contest Operator Personal Information Form example, Virginia VDACS Form 501A, Commonwealth of Virginia VDACS Office of Charitable & Regulatory Programs Form 501A |
Created: January 16, 2026 06:31 AM
