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Application f~r. ~ Local Permit *r-Ichadty Local Permit (one event peryear) <br /> Name of Non-profit.IDrga _~_~:atio~ <br /> <br />Person Responsible for the Gaming Operation, Including Dis~u~ement of Net Income Ti , Business Phone Num=er <br /> <br />Mailing Address (ifdifferent)J _ City <br />Name of lite V~ere <br /> <br />C,',ec~ the Game(s) to be C~nducted: ' Poker, Twenty-one, and P~Oc~lewneets"may bE Conducte~ only I~y a Charity L~cal Permit. ~ Bingo ~Raffle [~Calendar Raffle [] <br /> <br />DESC,'~IFT~ON AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> <br /> Game Type <br /> <br />'' <br /> <br />Description of Prize <br /> <br />Retail Value of <br />Prize <br /> <br />./dU uu <br /> <br />Game Type Description of Prize Retail Value of <br /> ' Pdze <br /> <br /> $ <br /> <br />(Limit $8,C00 per yeaq <br /> <br /> Coes ,'he organization presently have a state gaming license?~L~No [] Yes - If "Yes." the organization is not eligible for a local permit or chanty local <br /> permit and should call the Office of Attorney General a~ 1-800-3E6-9240. <br /> Has the organization received a charity local permit from this or another ~ty or county for the fiscal year July 1 through June 30? [~No [] Yes - If <br /> "Yes," the organization does not qualify for a local permit or charity local ;ermit. <br /> <br /> Has the organization received a local permit from this or another c~ or ccunty for the fiscal year July 1 througll June ,30? ~" No ~Yes - If"yes," <br /> in~i~te bhe total value of ail pdzes previously awarded: S Z~..~'O. Ot~ . ~--ni$ amountis part of the totalprize limit of $6,0OO~per year. <br /> <br />SJgnature.gf"Organizati~ Top Executive Offidal Oat~ <br /> <br /> I /... <br /> <br />SUGGESTED MOTION: <br />Move to approve raffle permit for Sandhills Archers, Inc. to be held March 1, <br />2003, at Sandhills Archery Club in West Fargo, North Dakota. <br /> <br /> <br />