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(7.0.:** ) GAMING SITE AUTHORIZATION G <br /> OFFICE OF ATTORNEY GENERAL Sne License Number <br /> SFN 17996(02-2011) (Attorney General Use Only) <br /> Red River Human Services Foundation 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: Wild Rice Bar and Grill the address of which is: <br /> 205 Main St. Wild rice 58047 Cass <br /> (Street) (City) (Zip Code) (County) <br /> Date(s)Authorized: Beginning 7/1/14 Ending 6/30/15 <br /> Specific location where games of chance will be conducted and played at the site (required): South <br /> Gamina area is the entire bar(except restrooms/office/storaae areas) <br /> Number of twenty-one tables (required) (if zero, enter "0") : 1 <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 /> rYll�had antiet c) , C.0 hAll l <br /> PRINT Name fficial Position of person 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 />