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<br />led River H.mm E'erviCES Fam:latim <br />(Name of Organization) <br />chance under the license granted by the Attorney <br />at the following location: Wild RiCE Ear arrl Grill <br /> <br />205 Mrln, Wild RiCE, NO 5R047 <br />(Street) <br />Date(s) authorized: Beginning 7-1-05 <br />Specific location of gaming within facility (rsquired): <br /> <br />..::0.", __ <br /> <br /> <br />GAMING SITE AUTHORIZATION <br />OFFICE OF ATTORNEY GENERAL <br />SFN 17996 (9-2005) <br /> <br />G-____(_ __l_ <br /> <br />Site License Number <br />(Attorney General Use Only) <br /> <br />is hereby authorized to conduct games of <br /> <br />General of the State of North Dakota <br />the address of which is: <br /> <br />(City) <br /> <br />r':::l= <br />(County) <br /> <br />(Zip Code) <br />Ending f>-3)....()7 <br />S:uth lCXBtim <br /> <br />Number of twenty-one tables (required)(if zero, enter "0"): 'l:E' (1) <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 /> <br />~- <br /> <br />5--)ff/DII <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 Oroanization. <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, ND 58505.0040 <br />Telephone: 701-328-2329 OR 800-326-9240 <br /> <br />8e.nJ. +0 ; <br />Lo ( i<;;'Sa.. Leru-tz;. <br />J-~oG 3Srt- Ave.J, <br />~ 1'10 g~\027 <br />