A qualified organization that intends to conduct bingo shall submit a bingo license application on a form that the county provides. A qualified organization shall disclose the following information on the license application: the name of the qualified organization, and the names and addresses of its officers and directors; a complete statement of the purposes and objectives of the qualified organization and the purposes for which the qualified organization will use the proceeds from the bingo; a statement under oath by the president and treasurer, or the chief executive and fiscal officer, of the qualified organization that: an agreement does not exist to divert any of the proceeds of the bingo to another person; and another person will not receive any of the proceeds of the bingo except to further the purpose of the qualified organization; and any additional information that the county requires.