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<br />,~ <~ <br /> <br />G-____(_ __)_ <br /> <br /> <br />GAMING SITE AUTHORIZATION <br />OFFICE OF ATTORNEY GENERAL <br />SFN 17996 (9-2005) <br /> <br />Site License Number <br />(Attorney General Use Only) <br /> <br />Arl/t.t-V U/ 3tJne5 Ibs-f 15~1 is hereby authorized to conduct games of <br />(Name of Organization) , <br />chance under the license granted. by the Attorney Genpral of the State of North Dakota <br />at the follOWing location: Re;J /:VI"/ i&./Iep. 6.:"gl"tJ,<.-t? the address of which is: <br />8&.:1-' '?'711d.b11V.rrt[,nfNl. wes./ fi?~ Alii -p 5'W1.? CASS <br />(Street) :JivV J1) IIR . /)(JJI; ( y) (Zip Code) (Coun\y) <br />Date(s) authorized: Beginning ~ "l,) Ending::::r~ ~ 2006 <br />Specific location of gaming within facHi (required): S.f J;..chzl~ of.. 7?",,/- Wi ,..,A ^ <br /> <br />Number of twenty-one tables (required)(if zero, enter "0"): 0- <br /> <br />RESTRICTIONS: (to be completed ONLY if restrictions are set by the local governing body) <br /> <br />1. Days of week of gaming operations <br />2. Hours of gaming <br />3. List each specific game type prohibited <br /> <br /> <br />c-" ~ <br />Sign ture of City/County Auditor Date <br /> <br />m i c.hadmonhlllliSl,OJll.n-f1 f GMttiQL <br />PRINT N"1;;e I Official P~ <br /> <br />5,\6.011 <br /> <br />Attorney General <br /> <br />Date <br /> <br />- - - - - - -- - - - - - -- - - - - - - - - - - -- <br /> <br />INSTRUCTIONS: <br /> <br />1. City/County Auditors - Retain a copy of the Site Authorization for your files. <br /> <br />2. City/County Auditors - Return the original Site Authorization form to the Organization. <br /> <br />3. Organizations - Send the original, signed, Site Authorization to the Office of Attorney General with any <br />other applicable licensing forms for final approval. <br /> <br />RETURN ALL DOCUMENTS TO: <br /> <br />Office of Attorney General <br />Licensing Section <br />600 E Boulevard Ave, Dept. 125 <br />Bismarck, NO 58505-0040 <br />Telephone: 701-328-2329 OR 800-326-9240 <br />