c. Permits for raffle - Laserfiche WebLink

^.PUC^T O.OFF,Ct OF FO. ^ PE.M,T O. PE...n' SFN 9338 (02-2002) Application for: [] Local Permit * [~"Chadty Local Permit (o.e event per year) Name of Non-profit Organization Date(s) of Activity ~erso_n Responsible for the Gaming Operation, Including Disbursement of Net Income Title Business Phone Number Business Address City State Zip Code Malting Address (if different) City State Zip Cede Name of Site Where Game(s) will be Conducted Site Address State Zip Code Check the Game(s) to be Conducted: * Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Local Permit. [] Bingo [~Raffle []Calendar Raffle [] Sports Pool [] Poker * [] Twenty-one * [] Paddlewheels * DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED Retail Value of Game Type Description of Prize Prize , Retail Value of Game Type Description of Prize Prize $ (Limit $6,ono per year) Total: $ Intended uses of gaming proceeds: Does the organization presently have a state gaming license? ~"No [] Yes - If "Yes," the organization is not eligible for a local permit or charity local permit and should cell the Office of Attorney General at 1-80G-326-9240. Has the organization received a charity locai permit from this or another city or county for the fiscelyear July 1 through June 307 [~o r-]Yes- If "Yes," the organization does not qualify for a local permit or charity local permit. Has the organization received a IocaJ permit from this or another city or ceunbj for the fiscal year July 1 through June 30? ~ [] Yes - if "Yes," indicate the total value of all prizes previously awarded: $ . This amount is part of the total prize limit of $6,000 per year. Signature of Organization;s Top Executive Official Date B~hone Number SUGGESTED MOTION: Move to approve raffle permit for St. Peter's Lutheran WELCA to be held October 5, 2002, at St. Peter's Lutheran Church in Leonard, North Dakota. (over)