c. Permit for raffle-Chaffee Lions; Cowboy Up

=A A LOCAL PERMIT OR CHARITY LOCAL PERMIT 4 1, OFFICE OF ATTORNEY GENERAL ai y 6l�li SFN 17926 (06 -2009) a0 4,pee,� Permit Number Type: Local Permit Charity Local Permit 484 Name of Organization Date(s) Authorized (Read instruction 2) Chaffee Lions Club Contact Person Business Phone Number 12/3/2013 t 12/3/2013 Steve Poulson (701) 361 Beginning Ending Mailing Address City State Zip Code 4591 152nd Avenue S. E. Wheatland ND 58079 -9520 Site Name Site Address Embden Farmer's Union Cenex 307 Front Street City State Zip Code County Embden ND 58079 4205 Cass Check the Game(s) Authorized: Poker, Twenty -one, and Paddlewheels may be Conducted only by a Charity Local Permit. Bingo p Raffle Calendar Raffle Sports Pool Poker* Twenty -one* Paddlewheels* Restriction: Requirement: For a "Charity Local Permit," the organization must file a "Report on a Charity Local Permit" with the city or county auditor and Office of Attorney General within 30 days of the event. Date Signature of: ❑City Auditor DI County Auditor Printed Name of City or County Auditor Auditor Telephone Number 10/21/2013 Michael Montplaisir (701) 241 -5600 Please see the instructions on the backside of this form on how to complete the Permit. For a raffle or calendar raffle, read "Information Required to be Preprinted on a Standard Raffle Ticket" below. cut along this line INFORMATION REQUIRED TO BE PREPRINTED ON A STANDARD RAFFLE TICKET: 1. Name of organization; 2. Ticket number; 3. Price of the ticket, including any discounted price; 4. Prize, description of an optional prize selectable by a winning player, or option to convert a merchandise prize to a cash prize that is limited to the lesser of the value of the merchandise prize or two thousand five hundred dollars. However, if there is insufficient space on a ticket to list each minor prize that has a retail price not exceeding twenty dollars, an organization may state the total number of minor prizes and their total retail price; 5. For a licensed organization, print "office of attorney general" and license number. For an organization that has a permit, print the authorizing city or county and permit number; 6. A statement that a person is or is not required to be present at a drawing to win; 7. Date and time of the drawing or drawings and, if the winning player is to be announced later, date and time of that announcement. For a calendar raffle, if the drawings are on a same day of the week or month, print the day and time of the drawing; 8. Location and street address of the drawing; g. If a merchandise prize requires a title transfer involving the department of transportation, a statement that a winning player is or is not liable for sales or use tax; 10. If a purchase of a ticket or winning prize is restricted to a person of minimum age, a statement that a person must be at least years of age to buy a ticket, or win a prize; 11. Rifatement that a purchase of the ticket is not a charitable donation; 12. If a secondary prize is an unguaranteed cash or merchandise prize, a statement that the prize is not guaranteed to be won and odds of winning the prize based on numbers of chances; and 13. If a prize is live beef or dairy cattle, horse, bison, sheep or pig, a statement that the winning player may convert the prize to a cash prize that is limited to the lesser of the market value of the animal or two thousand five hundred dollars.