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<br />" <br /> <br />"" <br /> <br /> <br />GAMING SITE AUTHORIZATION <br />OFFICE OF ATTORNEY GENERAL <br />SFN 17996 (9-2005) <br /> <br />G-____(_ __)_ <br /> <br />Site License Number <br />(Attorney General Use Only) <br /> <br />Al'ff. u/ ttJ. JOI2I"S /2Js-f 756 LI is hereby authorized to conduct games of <br />(Name of Organization) <br />chance under the license granted by the Attorney General of the State of North Dakota <br />at the following location:. -4.~ ..f?V("r 0<.//~.r ~,-/'fJ/'''''{I''P the address of which is: <br />6'.cl 7'7 IdOl rI.matn7fW: uIt ' II"Ll v 57.1}?? LAS..f <br />(Street) (C' ) (Zip Code) (County) <br />Date(s) authorized: Beginning JU It/. I, ,:/iJLJ6 Ending -:;;, n t:: 3,t) " ,;7&/7 <br />Specific location of gaming within facility (required): S'..e: u,rn.x,.- """+ &... /" .5"a/'A.'L,.; <br /> <br />Number of twenty-one tables (required)(if zero, enter "0"): <br /> <br />Go- <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 />Attorney General <br /> <br />Date <br /> <br />~~~-' -1C;:;N. <br />A'- .=" ~~" D' iJ 'UU' <br />Sign lure of City/C unty Auditor Date <br /> <br />t111(/\1tW.lYJDrtt~0h'bG CoWt6& Oudt--W <br /> <br />PRINT ame I Official Posilio <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 Attornev 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 />Teiephone: 701-328-2329 OR 800-326-9240 <br />