d. Permit for raffle-Sanford Health Foundation

LOCAL PERMIT OR CHARITY LOCAL PERMIT 'iv!! ;15'' OFFICE OF ATTORNEY GENERAL fps+ SFN 17926(06-2009) AV Permit Number Type: © ,Local Permit ❑Charity Local Permit 502 Name of Organization Date(s)Authorized(Read instruction 2) Sanford Health Foundation Contact Person Business Phone Number 8/22/2014 to 8/22/2014 Amy Hinkemeyer (701)234-6067 Beginning Ending Mailing Address City State Zip Code P. O. Box 2010 Fargo ND 58122-2399 Site Name Site Address Wild Rice Bar&Grill 205 Main Street City State Zip Code County Horace ND 58047-0000 Cass Check the Game(s)Authorized: *Poker,Twenty-one,and Paddlewheels may be Conducted only by a Charity Local Permit. ❑Bingo © Raffle ❑Calendar Raffle ❑ Sports Pool ❑ Poker* ❑Twenty-one* ❑ Paddlewheels* Restriction: Requirement: For a"Charity Local Permit,"the organization must file a"Report on a Charity Local Permit"with the city or county auditor and Office of Attorney General within 30 days of the event. Date Signature of: City Auditor ©County Auditor Printed Name of City or County Auditor Auditor Telephone Number 8/18/2014 Michael Montplaisir (701)241-5600 Please see the instructions on the backside of this form on how to complete the Permit. For a raffle or calendar raffle,read"Information Required to be Preprinted on a Standard Raffle Ticket"below. cut along this line INFORMATION REQUIRED TO BE PREPRINTED ON A STANDARD RAFFLE TICKET: 1. Name of organization; 2. Ticket number; 3. Price of the ticket, including any discounted price; 4. Prize, description of an optional prize selectable by a winning player, or option to convert a merchandise prize to a cash prize that is limited to the lesser of the value of the merchandise prize or two thousand five hundred dollars. However, if there is insufficient space on a ticket to list each minor prize that has a retail price not exceeding twenty dollars, an organization may state the total number of minor prizes and their total retail price; 5. For a licensed organization, print"office of attorney general" and license number. For an organization that has a permit, print the authorizing city or county and permit number; 6. A statement that a person is or is not required to be present at a drawing to win; 7. Date and time of the drawing or drawings and, if the winning player is to be announced later, date and time of that announcement. For a calendar raffle, if the drawings are on a same day of the week or month, print the day and time of the drawing; 8. Location and street address of the drawing; 9. If a merchandise prize requires a title transfer involving the department of transportation, a statement that a winning player is or is not liable for sales or use tax; 10. If a purchase of a ticket or winning prize is restricted to a person of minimum age, a statement that a person must be at least " "years of age to buy a ticket, or win a prize; 11. A-Vatement that a purchase of the ticket is not a charitable donation; 12. If a secondary prize is an unguaranteed cash or merchandise prize, a statement that the prize is not guaranteed to be won and odds of winning the prize based on numbers of chances; and 13. If a prize is live beef or dairy cattle, horse, bison, sheep or pig, a statement that the winning player may convert the prize to a cash prize that is limited to the lesser of the market value of the animal or two thousand five hundred dollars.