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:;t-' LOCAL PERMIT OR CHARITY LOCAL PERMIT OFFICE OF ATTORNEY GENERAL SFN 17926 (09-2003) Type: o Local Permit * 0 Charity Local Permit Permit Number 396 Name of Organization Cass County Historical Society Contact Person Kim Baird Mailing Address Po Box 719 Site Name Bonanzaville City West Fargo Check the Game(s) Authorized: Date(s) Authorized (Read instruction 2) Business Phone Number 12/4/2006 (701) 282-2822 City West Fargo Site Address 1351 West Main Avenue State Zip Code NO 58078 to 12/4/2006 Ending Zip Code 58078 County Cass . Poker, Twenty-one, and Paddlewheefs may be Conducted only by a Charity Local Penn it. o Bin90 o Raffle D Calendar Raffle o Sports Pool o Poker" o Twenty-one. D Paddfewheels. Restriction: Requirement: For a "Charity Local Permit," the organization must file a "Report on a Charity Local Permit" with the city or county auditor and Office of Attorney General within 30 days of the event.. Date 5/15/2006 Printed Name of City or County Auditor Michael Montplaisir Auditor Telephone Number (701) 241-5600 For a raffle or calendar raffle, read "Information Required to be Preprinted on a Standard Raffie Ticket" on the backside of the form. INSTRUCTIONS: After a city or county governing board has authorized an organization to receive a local permit or charity local permit, the city or county auditor must complete this form. 1. Enter the city or county assigned "Permit Number." 2. Enter the beginning and ending date(s) for which the pemnit is authorized. a. For a "one time" raffle. the beginning and ending dates for "Date(s) Authorized" is the date of the prize drawing. b. A local permit can be Issued for one or more events per year. c. If a local permit is issued for more than one event, enter the date of the first event as the "beginning" date and the date of the last event as the "ending" date. d. A charity local permit may be issued for oniy one event per year. 3. Enter any restriction placed on the organization. such as days of the week or designation of an area at a site where games may be conducted. 4. Provide a "Report on a Charity Local Permit" fomn to the organization. (If a Charitv Local Permit,~ 5. Make two copies of the completed form. Provide the original form to the organization, keep one copy for the file and, within fourteen days of issuance, mail a copy to: OFFICE OF ATTORNEY GENERAL: LICENSING SECTION; 600 E BOULEVARDAVE- DEPT 125; BISMARCK NO 58505-0040.