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<br /> <br />APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT <br />OFFICE OF ATTORNEY GENERAL <br />SFN 9338 (07-2003) <br /> <br />Application for: <br /> <br />1f3ql <br /> <br />rn Local Permit <br /> <br />Name of Non-profit Organization <br /> <br />Close Up <br /> <br />* 0 Charity Local Permit (one event per year) <br />Date(s) of Activity <br /> <br /> <br />l, to <br /> <br /> <br />Person Responsible for the Gaming Operation, Including Disbursement of Net Income <br />Bruce Schede <br /> <br />Title <br />Advisor <br /> <br />Business Phon Number <br />428-3177 <br /> <br />zi5~od51 <br /> <br />Business Address <br />55 1st AVe S <br /> <br />Mailing Address (if different) <br /> <br />Name of Site Where G ame(s) will be Conducted <br />Kindred School <br /> <br />City <br />Kindred <br /> <br />City <br />Kindred <br /> <br />State <br />ND <br /> <br />City <br /> <br />Zip Code <br /> <br />State <br /> <br />Site Address <br />55 1st Avp. ~s <br /> <br />State <br />ND <br /> <br />County <br />Cass <br /> <br />Zip Code <br />58051 <br /> <br />Check the Game(s) to be Conducted: "Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Local Permit. <br />~Bingo IXI Raffle DCalendar Raffle DSports Pool 0 Poker" 0 Twenty-one" <br /> <br />DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> <br />Game Type <br /> <br />Description of Prize <br /> <br />Retail Value of <br />Prize <br /> <br /> <br />$~OO,Oo <br />3{',OO <br /> <br />tt) <br /> <br />o Paddlewheels" <br /> <br />Game Type Description of Prize Retail Value of <br />Prize <br /> $ <br /> (Linlt $12,000 per year) <br /> Total: $ '7,7'>'.00 <br /> <br />Intended uses of gaming proceeds: --r r 'f) TtJ Wi ~ j.., /V17i:J.Nl "DL <br /> <br />Does the organization presently have a state gaming license? ~ No 0 Yes - If "Yes," the organization is not eligible for a local permit or charity local <br />permit and should call the Office of Attomey General at 1-800-326-9240. <br /> <br />Has the organization received a charity local permit from this or another city or county for the fiscal year July 1 through June 30? 1!9 No 0 Yes - If "Yes," <br />the organization does not qualify for a local permit or charity local permit. <br /> <br />Has the organization received a local permit from this or another city or county for the fiscal year July 1 through June 30? rn No 0 Yes - If ''Yes,'' <br />indicate the total value of all prizes previously awarded: $ . This amount is part of the total prize limit of$12,000 per year. <br /> <br />