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<br /> <br />APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT <br />OFFICE OF ATTORNEY GENERAL <br />SFN 9338(07-2003) <br /> <br />Application for: <br /> <br />Gi Local Permit <br /> <br />* 0 Charity Local Permit (one event per year) <br /> <br />Name of Non-profit Organization Date(s) ~~vit~ a,a,!> <br />FF(\ ,A I 4, .¡st, to m C\.,v C h .~ I ~t- Ö5 <br /> 1"\..iV 'JU Vi <br />Person Responsible for the Gaming Ope.ration, Including Disbursement of Net Income Title Business Phone Number <br />eLl-V1-- US\\-e" Advisor 428-3177 <br />Business Address City State ZiS ~oð51 <br />55 1st AVe S Kindred ND <br />Mailing Address (if different) City State Zip Code <br /> ~'\n ~v'e it ND 5Ðo5 I <br />Name of Site Where Game(s) will be Conducted Site Address <br />Kindred School 55 1st Avp. ~" <br />City State IZiP Code County <br />Kindred ND 58051 Cass <br />Check the Game(s) to be Conducted: . Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Local Permit. <br />ŒBingo L.; Raffle DCalendar Raffle 0 Sports Pool 0 Poker' 0 Twenty-one' 0 Paddlewheels' <br /> <br />DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> <br />! Game Type Description of Prize Retail Va!u9 of <br /> Prize <br /> ß\na 0 M önf.VI $ 80 - /00 <br /> ...J a <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Game Type Description of Prize Retail Value or <br /> Prize <br /> $ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> (Linlt$12,OOO per year) <br /> Total: $ FJ50 <br /> - <br /> <br />Intended uses of gaming pr~ceeds: ,;)Cho~ \. ~O~~ ÒCJCLv1',L.£:Ùlèn. blll¡)Vì~ LVOLL\ð b<.... <br /> <br />U"ð(d toll" (>VlCLfUv- CtCt1u,Ti:eL <br /> <br />Does the organization presently have a state gaming license? ~ No 0 Yes - If "Yes," the organization is not eligible for a local permit or charity local <br />permit and .should call the Office of Attomey General at 1-800-326-9240. <br /> <br />Has the organization received a charity local permit from this or another city or county for the fiscal year July 1 through June 30? gg No 0 Yes - If "Yes," <br />the organization does not qualify for a local permit or charity local permit. <br /> <br />Has the organization received a local permit from this or another city or county for the fiscal year July 1 through June 30? ŒI No 0 Yes - If "Yes," <br />indicate the total value of all prizes previously awarded: $ . This amount is part of the total prize limit of$12,000 per year. <br /> <br /> <br />ecutive Official <br /> <br /> <br />Business Phone Number <br />lfl.5'-J/77 <br />