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Person Responsible for the Gaming Operation, Including Disbursement of Net Income <br /> <br /> APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT ~"~Oo' <br /> OFFICE OF ATTORNEY GENERAL <br /> SFN 9338 (02-2002) <br /> <br /> Application for: [] Local Permit * [] Charity Local Permit (one event per yez:; '~' <br />Name of Nonprofit O~anizafion I Date(s) of Activity -- <br /> <br /> City ~1 .~ State ~ Zip Code <br /> <br />Matlin~ Aed re~ (if different) <br /> <br /> Name of Site Where Game(s) will be Conducted <br /> <br /> Check the Game(s) robe Con~: * Poker. Twenty-one, and Paddlewheels may be Conducted only by a Chadty Local Permit. <br /> [] Bingo ~:~R~ffie []Calendar Raffle [] Sports Pool [] Poker * [] Twenty-one · [] Padd[ewheels * <br /> <br />DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> <br />Game Type Description of Prize Retail Value of <br /> Prize Game Type Description of Pdze Retail Value of <br /> Prize <br /> Total: $ <br /> <br />Does the organization presently have a state gaming license? ~lqo [] Yes * If "Yes," the organization is not eligible for a local permit or charity local <br />permit and should ca$l the Office of Attorney General at 1-800-326-9240. <br /> <br />Has the organization received a chadty local permit from this or another city or county for the fiscal year Ju y through June 30? ~;;~--No [] Yes - if <br />"Yes," the organization does not qualify for a local permit or charity local permit. <br /> <br />Has the organization ceceived a local permit from this or another city or county for the fiscal year July 1 through June 30? [] No ~Tes - if '*Yes," <br />indicate the total value of all pre. es previously awarded: $ ~7/=~'O . This amount is part of the totalpdze limit of $6,0OOperyear. <br /> <br />Date Title <br /> <br />SUGGESTED MOTION: <br />Move to approve raffle permit for Four Corners Wildlife Club to be held November 25, <br />2002, at Embden Senior Center in Embden, North Dakota. <br /> <br /> <br />