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<br />1;~ij: <br /> <br />LOCAL PERMIT OR CHARITY LOCAL PERMIT <br />OFFICE OF ATTORNEY GENERAL <br />SFN 17926 (09-2003) <br /> <br />,~': > /":.ifi! I Permit Number <br />0; ~)R1\\ ';; Type: o Local Permit * 0 Charity Local Permit <br /> 408 <br />Name of Organization Date(s) Authorized (Read instruction 2) <br />Sandhills Archery Club <br />Contact Person Business Phone Number 2/24/2007 to 2/24/2007 <br />Jerry Langness (701) 239-9966 Beginning Ending <br />Mailing Address City I State I Zip Code <br />P. O. Box 1022 Fargo ND 58107 <br />Site Name Site Address <br />Sandhills Archery Club 3001 Sandhills Avenue <br />City State I Zip Code I County <br />West Fargo ND 58078 Cass <br />Check the Game(s) Authorized: . Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Local Permi!. <br />o Bingo o Raffie o Calendar Raffle o Sports Pool o Poker' o Twenty-one' o Paddlewheels' <br />Restriction: <br />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 <br />Attorney General within 30 days of the event <br />Date I Signature of: 0 City Auditor o County Auditor I Printed Name of City or County Auditor I Auditor Telephone Number <br />2/20/2007 Michael Montplaisir (701) 241-5600 <br /> <br />For a raffie or calendar raffle, read "Information Required to be Preprinted on a Standard Raffle Ticket" on the backside of the form, <br /> <br />INSTRUCTIONS: <br /> <br />After a city or county governing board has authorized an organization to receive a local permit or charity local <br />permit, the city or county auditor must complete this form, <br /> <br />1, Enter the city or county assigned "Permit Number." <br /> <br />2, Enter the beginning and ending date(s) for which the permit is authorized, <br /> <br />a. For a "one time" raffle, the beginning and ending dates for "Date(s) Authorized" is the date of the prize <br />drawing. <br /> <br />b, A local permit can be issued for one or more events per year. <br /> <br />c, If a local permit is issued for more than one event, enter the date of the first event as the "beginning" <br />date and the date of the last event as the "ending" date, <br /> <br />d. A charity local permit may be issued for only one event per year, <br /> <br />3, Enter any restriction placed on the organization, such as days of the week or designation of an area at a site <br />where games may be conducted. <br /> <br />4, Provide a "Report on a Charity Local Permit" form to the organization, (If a Charity Local Permit, only) <br /> <br />5, Make two copies of the completed form. Provide the original form to the organization, keep one copy for <br />the file and, within fourteen days of issuance, mail a copy to: OFFICE OF ATTORNEY GENERAL; LICENSING <br />SECTION; 600 E BOULEVARDAVE- DEPT 125; BISMARCK ND 58505-0040. <br /> <br />_._"'~---""..."--""- <br />