b. Permit for bingo-Cass Co. Historical Society

~~~tl~;1~i ~?F?th)~~~~J~N~~ ~E~~~lr LOCAL PERMIT ",'~ "1 SFN 17926 (09-2003) '~,,~"! I Permit Number ~~f.f,]Ffij.t/Y Type: D Local Permit . 0 Charity local Permit 398 Name of Organization Date(s) Authorized (Read instruction 2) Cass County Historical Society Contact Person Business Phone Number 8/19/2006 to 8/20/2006 Joyce Yexley (701) 282-2822 Beainnin Ending Mailing Address City State I Zip Code Po Box 719 West Fargo NO 58078 Site Name Site Address Bonanzavil1e 1201 West Main Avenue City State I Zip Code I County West Fargo ND 58078 Cass Check the Game(s) Authorized: .. Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Local Permit. ~ Bingo D Raffle o Calendar Raffle D Sports Pool D Poker' D Twenty-one" D Paddlewheels' 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 Signature of: DCity 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 goveming 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 "Oate(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 locai 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 Permit' form to the organization. (If a Charitv_Local Penn it, onlv) 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 BOULEVAROAVE - DEPT 125; BISMARCK NO 58505-0040.