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: GAMING SITE AUTHORIZATION <br /> G- <br /> Site License Number <br /> ‘;':k OFFICE OF ATTORNEY GENERAL <br /> SFN 17996(10-2009) (Attorney General Use Only) <br /> IA is hereby authorized to conduct games of <br /> (Full, Legal Name of aming Organization) <br /> chance under the license gp#nyed bop, Attorney General of the State of North Dakota <br /> at the f in tion: ( -/Gl- `'� the address f which is: <br /> sus Q� � z <br /> (Street) (C'y) (Zip Cope) ___(County) <br /> Date(s)Authorized: Beginning '7/1/ /9 Ending Lo/Jo �/b <br /> Specific location where aarp1s-of wil be con ucted and ()laved at the site(required): <br /> Number of twenty-one tables(required)(if zero, enter"0"): _ 9- <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 /> Maw! CAurdrCM( <br /> PRINT Name/Officia Position of pe n 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 />