a. Raffle permits-St Benedict's Catholic, Nora Lutheran Church

ti#jif,~~i}~(\i ~~F9tEL J~~~N~~ cfE~~~lIY LOCAL PERMIT \\'J\'~~i';J1JJ SFN 17926 (09.2003) ,.~ ~ \, '),.5,. ,; I Permit Number "'" , "',.t.If"-~ 1\ .,' Type: o Local Permit . 0 Charity Local Permit ,...~~,,:.<" 400 Name of Organization Date(s) Authorized (Read instruction 2) Nora Lutheran Church Contact Person Business Phone Number 10/7/2006 to 10/7/2006 Ona Ellenson (701) 484.5535 Beginnin Endina Mailing Address City Stale 1 Zip Code 1702115th Street S E Gardner ND 58036 Site Name Site Address Nora Lutheran Church RR City State I Zip Code I County Gardner NO 58036 Cass Check the Game(s) Authorized: * Poker, Twenty.one, and Paddlewheels may be Conducted only by a Charity Local Permit. o Bingo o Raffle o Calendar Raffle o Sports Pool o Poker' o Twenty-one- o Paddlewheels. Restriction: Requirement: For a ~Charity Local Permit," the organization must file a "Report on a Charity Local Permif' with the city or county auditor and Office of Attorney General within 30 days of the event. Date Signature of: 0 City Auditor o County Auditor Printed Name of City or County Auditor Auditor Telephone Number 7/17/2006 Michael Montplaisir (701) 241-5600 For a raffle or calendar raffle, read "Information Required to be Preprinted on a Standard Raffle 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 permit 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 only 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 Permif form to the organization, (If a Charity Local Pennit,J!!!!y) 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 BOULEVARD AVE- DEPT 125; BISMARCK ND 58505-0040,