c. Permits for raffle - Laserfiche WebLink

APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL ......... OFFICE OF ATI'ORNEY GENERAL SFN 9338 (02-2002) Application for. [] Local Permit *~ Charity Local Permit (one event per year) Name of Non-profit Organization I Date(s) of Activity Person Responsible for the Gaming Operation, Including Disbursement of Net Income I ThOle Business Phone Number Business Address City '-~ State Zip Code Mailing Address (if different) Zip Code Name of Site Where Game(s) will be Conducted Chec~ the Gam~(~) to be Condu~: ' ~okor, T~n~n~, and Paddle~ ma ~ Bingo ~Calendar Raffle , be Conducted only by a Chadty Local Permit. ~.Raffie [] Sports Pool [] Poker · [] Twenty-one ' [] Paddtawheels · ESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED Retail Value of Game Type Description of Prize Prize $ Retail Value of Game Type Description of Pdze Prize ! Total: $ / '~'5. OO Intended uses of gaming proceeds= ~ ,"~/~,~~i''~L0~19~''1~4. ~ ' ~/ Doe~the organization presently have a state gaming li~nse? ~ No ~ Yes - if"Yes," the organization is not eligible for a Ioml pe~it or ~ar~ pe~ and should ~11 the Offi~ of A~omey General at 1-800-326-9240. Has the o~anization re~ived a chad~ Io~1 pe~it from this or another ci~ or coun~ for the fis~l year July 1 through June 30? ~ No ~ Yes - if "Yes," the o~an~ation does not quali~ for a Io~1 pe~it or char~ Io~1 pe~. Has the organization re~ived a local pe~it from this or another c~ or ~un~ for the fis~l year July 1 through June 30? ~ No Yes if indi~te the total value of all prizes previously awarded: $ ~ ~ ~, g~ ~ . This amount is pa~ of the total pdze limit of $6,000 per year. Title I Business Phone Number. Signature of Organization's Top Executive Official SUGGESTED MOTION: Move to approve raffle permit for Nora Lutheran Church to be held October 5, 2002, at Nora Lutheran Church in Gardner, North Dakota.