c. Raffle permit-Sandhills Arch - Laserfiche WebLink

SFN 9338 (Rev, 12-971 Page 2 Has your organization received authorization to conduct raffles or bingo or professional sports pools by local governing bodies (city/county) during the period beginning July I through June 30 of the current fiscal year? [] No [] Yes-If" es"Ii Y st the value of those prizes awarded:$ THIS VALUE I$ PART OF THE ACCUMUUI TED $6,000. TOTAl. Al.l.OWED [see number 2 under RESTRICTIOIV$) *RESTRICTIONS: 1) The value of a single cash or merchandise prize cannot exceed one thousand dollars ($1,000.). 2) The total value of al__l the cash and merchandise prizes for raffles and/or bingo and/or professional sports pools cannot exceed six thousand dollars ($6,000.) in a fiscal year (July 1 through June 30) or, for a calendar raffle, in a calendar year. .3? Total cash prizes for a raffle cannot exceed three thousand ($3,000) in one day. ~nization's planned prizes will exceed the above allowed amounts, either the prizes wiJ need to be reduced to stay within the limits provided by law *or discontinue the "local permit" process and contact the Office of Attorney General (701-328-2329) for instructions on applying for a STATE GAMING LICENSE. ~ AFFIDAVIT: Name of responsible party ~ ~Teleohone Number Title I declare that I am responsible for the conduct of games of chance and disbursement of gaming net proceeds. I declare that,the information containe '~ ., .......... ~, aha complete ~- ~----------_ contained in thi,s,,el3phcation '; tru~ ~llege or university fraternity or sorority must use s · ~AppJication For Local Permit To Conduct Bin~o/R-~. .... ~a~e apphcat~on form, SFN 17927 , Sorority Or Fraternity ~ ~--~/~roTesslonaJ Spots Pools. INFORMATION REQUIRED TO BE PRINTED ON RAFFLE TICKETS (ND Administration Code 99-O1.2-O5_04) 1. Name of organization; 2. Ticket number; 3. Price of the ticket, including any discounted price; 4. Prize description of an opt onal prize seJectable by a w nning player, and or option to convert a merchandise pr!ze to a cash prize. However, if there is insufficient space on a ticket to list each minor prize that has a retail price not exceeding ten dollars, an organization may state the total number of minor prizes and their total retail price; 5. For a licensed organ zatJon rJ " · has a Ioca permit, pr n~ the Pci~tor°cffoiuCent~fatnhee, iaotcta°lrneeYmg~neral" and license number. For an organization that P t number. 6. A statement that a person is not required to be present at a drawing to win; 7. Date and time of the drawing and, if ' ' · For a calendar raffle, if the drawings the w~nmng player ~s announced later, date and time of that announce drawing; , ~,..L u~e aay and time of the are on a same day of the week or month ~-;-*-~ ~ . ment. 8. Location and address of the drawing; and 9. If .a r~erchandise prize requires a title transfer involving the department of transportation, a statement that a wmmng player is or is not liable for sales or use tax. 10..{f a purchase of a ticket is restricted to a person of minimum age, a statement that a person, must be at least _ _" years of age to purchase a ticket. 11. A statement that a purchase of the ticket is not a charitable donation.