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EAT S" <br /> �:' °w~7"" GAMING SITE AUTHORIZATION <br /> � ^ :�' Site License Number <br /> f' OFFICE OF ATTORNEY GENERAL <br /> (Attorney General Use Only) <br /> ' :'� y� SFN 17996(02-2011) <br /> ��Nom <br /> U-eTe c S t 1■►C0p.,pUdL,I1- I'e c4 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: (11...ovn.cc 13 0-J--- the address of which is: <br /> 1,0 q m A tir-) S 1 C kA.-F F 6) 5o'79 CAL s <br /> (Street) (City) (Zip Code) (County) <br /> Date(s)Authorized: Beginning -7—I- / H Ending (0--5° /S <br /> Specific location where games of chance will be conducted and played at the site (required): <br /> Li ' FRWY\ (3 \ ( k i i t-ck.P <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 City/County Auditor Date <br /> fl hael rY p r ( A t Wit <br /> PRINT Name/Official Position of perso 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 />