Laserfiche WebLink
(3:::41:;:tA APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT <br /> `�l ', t OFFICE OF ATTORNEY GENERAL <br /> \`y ` - SFN 9338(9-2009) <br /> Application for: 0 Local Permit *0 Charity Local Permit (one event per year) <br /> Name of Non-profit Organization Date(s)of Activity <br /> Cass County 4-h 3/16/2014 to 3/16/2014 <br /> Person Responsible for the Gaming Operation and the Disbursement of Net Income Title Business Phone Number <br /> Maxine Nordick 4-h Youth Agt (701) 241-5700 <br /> Business Address City State Zip Code <br /> 1010 2nd Ave S Fargo ND 58103-0000 <br /> Mailing Address(if different) City State Zip Code <br /> Po Box 2806 Fargo ND 58108-2806 <br /> Name of Site Where Game(s)will be Conducted Site Address <br /> Red River Valley Fairgrounds 1805 Main Ave <br /> City State Zip Code County <br /> West Fargo ND 58078-0797 Cass <br /> Check the Game(s)to be Conducted: *Poker,Twenty-one,and Paddlewheels may be Conducted only by a Charity Local Permit. <br /> © Bingo © Raffle EICalendar Raffle ❑Sports Pool 0 Poker* ❑Twenty-one* 0 Paddlewheels* <br /> DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> Game Type Description of Prize Retail Value of Game Type Description of Prize Retail Value of <br /> Prize Prize <br /> Please Print <br /> — $ 4-H Raffle & Carnival <br /> 6 <br /> Sunday–March 17, 2013 <br /> Name \e Carnival-3:00-5:OOpm • Raffle Drawing-5:OOpm • <br /> _� ,n/( Red River Valley Fairgrounds,West Fargo, ND <br /> Gam _ Drawing For: D <br /> — <br /> - A' f 4-H Council Sponsored Prizes:Windows 8 Tablet/$300 value 0 <br /> I" <br /> Business Donated Prizes:$100 Pampered Chef Products,$100 Hornbachers,$100 7 <br /> Address Maple River Grain,RRVF Mega Passes(2),7030 Remote Control Tractor/RDO <br /> Kindred,$50 Three Gems Tack,$50 Classic Jewelers,$50 West Acres,1 Month —I <br /> — Pass/Family Wellness Center,$30 Casselton Veterinary Clinic,$25 Cash Wise, 0 i <br /> $20 Rustad's Sand&Gravel,2 Cleaning Cloths/Norwex,Spice Grinder&Spice Z <br /> Mill/Creative Kitchens,10 Swim Passes/Day's Inn Casselton,2 Buffets/Casselton m <br /> — City State Zip Pizza Ranch <br /> Need Not Be Present To Win <br /> $1 —ADMISSION TICKET -- $1 <br /> — Phone Proceeds go to Cass County 4-H Program <br /> Permit No.474 <br /> I I I I I <br /> (Limit$12,000 per year) <br /> Total: $ 1,500.00 <br /> Intended uses of gaming proceeds: Cass County 4-H events and activities <br /> Does the organization presently have a state gaming license? © No ❑Yes - If"Yes,"the organization is not eligible for a local permit or charity local <br /> permit and should call the Office of Attorney General at 1-800-326-9240. <br /> Has the organization received a charity local permit from this or another city or county for the fiscal year July 1 through June 30? © No ❑ Yes- If"Yes," <br /> the organization does not qualify for a local permit or charity local permit. <br /> Has the organization received a local permit from this or another city or county for the fiscal year July 1 through June 30? 13 No ❑ Yes - If"Yes," <br /> indicate the total value of all prizes previously awarded:$ . This amount is part of the total prize limit of$12,000 per year. <br /> Signature of Organization' Executive Official s Date Title Business Phone Number <br /> r 12/2/2013 4-h Youth Agent g (701)241-5798 <br />