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17zT'R+e G----- L --)— <br /> : .. GAMING SITE AUTHORIZATION <br /> ' a Site License Number <br /> � � OFFICE OF ATTORNEY GENERAL (Attorney General Use Only) <br /> \\ � SFN 17996(02-2011) <br /> Cass County Wildlife Club is hereby authorized to conduct games of <br /> (Full,Legal Name of Gaming Organization) <br /> chance under the license granted by the Attorney General of the State of North Dakota at the following <br /> location: Red River Valley Fairgrounds the address of which is: <br /> 1805 West Main Ave West Fargo 58078 Lass <br /> (Street) (City) (Zip Code) (County) <br /> Date(s)Authorized: Beginning 1/16/15 Ending 1/24/15 <br /> Specific location where games of chance will be conducted and played at the site(required): Hartl Aa Buildina <br /> Number of twenty-one tables (required) (if zero, enter "0") : 0 <br /> RESTRICTIONS: (to be completed ONLY if restrictions are set by the local governing body) <br /> 1. Days of week of gaming operations <br /> 2. Hours of gaming <br /> 3. List each specific game type prohibited <br /> Attorney General Date Signature of Cit oun u itor Date <br /> rhAha YY4 *" ! V i, A4 t�l 1i <br /> PRINT Names Official Position of perr signing above <br /> INSTRUCTIONS: <br /> 1. City/County Auditors- Retain a copy of the Site Authorization for your files. <br /> 2. City/County Auditors- Return the original Site Authorization form to the Organization. <br /> 3. Organizations-Send the original, signed, Site Authorization to the Office of Attorney General with any <br /> other applicable licensing forms for final approval. <br /> RETURN ALL DOCUMENTS TO: <br /> Office of Attorney General <br /> Licensing Section <br /> 600 E Boulevard Ave, Dept. 125 <br /> Bismarck, ND 58505-0040 <br /> Telephone: 701-328-2329 OR 800-326-9240 <br />