f. Permit for calendar raffle-Red River Valley Kart Assn

f).T 4, , , , ,A is APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT 'ic'h- -' ''., OFFICE OF ATTORNEY GENERAL y4''- ��'y4, ' SFN 9338(07-2009) Application for: p Local Permit *❑Charity Local Permit (one event per year) Name of Non-profit Organization Date(s)of Activity Red River Valley Kart Association - FON**.q./4gr ,t49 id4,12e 4 I 9014 to 9/15/2014 Person Responsible for the Gaming Operation and the Disbursement of Net Income Title Business Phone Number Deanne Schatz-eisenschenk Sec/treas. (701)261-3673 Business Address City State Zip Code 3208 1st Ave. N Fargo ND 58102-1103 Mailing Address(if different) City State Zip Code Name of Site Where Game(s)will be Conducted Site Address Red River Valley Fair Grounds Go Kart Track 1805 Main Ave. West City State Zip Code County West Fargo ND 58078-1341 Cass Check the Game(s)to be Conducted: *Poker,Twenty-one,and Paddlewheels may be Conducted only by a Charity Local Permit. ❑Bingo IN Raffle Calendar Raffle ❑Sports Pool ❑Poker* ❑Twenty-one* ❑ Paddlewheels* DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED Retail Value of Retail Value of Game Type Description of Prize Game Type Description of Prize Prize Prize 50/50 Cash $25.00 ' (Limit$12,000 per year) Total: $ 25.00 Intended uses of gaming proceeds:Put into the non-profit to pay for track improvement/Club Trophies for Kids/year end banquet Does the organization presently have a state gaming license? MI No ❑Yes - If"Yes,"the organization is not eligible for a local permit or charity local permit and should call the Office of Attorney General at 1-800-326-9240. 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," the organization does not qualify for a local permit or charity local permit. Has the organization received a local permit from this or another city or county for the fiscal year July 1 through June 30? No ❑ Yes - If"Yes," indicate the total value of all prizes previously awarded:$ . This amount is part of the total prize limit of$12,000 per year. S a e if fir a o ' o. R • '=I Da a Titl ..s P • e per ►' 1 i ► , ,l r' - "l1'./ l,.. • / i s 1 I!_ .i (1 al