Laserfiche WebLink
APPLICATION FOR A LOCAL PERMIT OR RESTRICTED EVENT PERMIT <br />NORTH DAKOTA OFFICE OF ATTORNEY GENERAL LICENSING SECTION SFN 9338 (09-2021) <br />D Restricted Event Permit* D Raffle by a Political or Legislative District Party D Bingo D Raffle D Raffle Board � Calendar Raffle D Sports Pool D Poker* 0 Twenty-One* D Paddlewheels* <br />addlewhee s may e con ucted nly w,t a Restricted Event Permit. Only one permit allowed per year. <br />LOCAL PERMIT RAFFLES MAY NOT BE CONDUCTED ONLINE AND CREDIT CARDS MAY NOT BE USED FOR WAGERS. <br />Name of Organization or Group of People permit is issued to Hickson Community Club <br />Organization or Group Contact Person Mike Bice <br />Business Address 305 Seventh Street South Mailing Address (if different) <br />Site Name (where gaming will be conducted) Knickerbocker/Hickson Community Center Site Address 412 Main Avenue <br />D escnptIon an eaI aue o nzes to d R t 'IV I fP' Game Type <br />Raffle Meat <br />Add Row I Delete Row I <br />Intended Uses of Gaming Proceeds <br />e war e b A d d <br />If raffle, provide drawing date Dates of Activity 1/1/2022 to 06/30/2022 Fridays & Special Events <br />Title or Position Telephone Number Treasurer 701-212-8878 <br />City State ZIP Code Hickson ND 58047 <br />City State ZIP Code <br />City ZIP Code County Hickson ND 58047 <br />Description of Prize Retail Value of Prize <br />$20.00 <br />Jr otal (limit $40, 000 per year) I $20.00 <br />Kindred Dollars for Scholars, Kindred School Scholarships, Kindred School Lunch Program, Bret Larson Benefit, Packer Benefit (continued) Does the organization presently have a state gaming license? (If yes, the organization is not e/lgIbte tor a local permit or restncted event permit <br />and should call the Office of Attorney General at 1-800-326-9240) 0Yes �No <br />Has the organization or group received a restricted event permit from any city or county for the fiscal year July 1-June 30? (If yes, the <br />organization or group does not qualify for a local permit or restricted event permit) oves �No Has the organization or group received a local permit from any city or county for the fiscal year July 1-June 30? (If yes, ma,cate the total retail <br />value of all prizes previously awarded) I (This amount is part of the total prize limit of $40,000 per year) 0No � Yes -Total Retail Value:I $11,890.00 Is the organization or group a state political party or legislative district party? (If yes, the organization or group may only conduct a raffle and <br />must complete SFN 52880 "Report on a Restricted Event Permit" within 30 days of the event. Net proceeds may be used for political purposes.) OYes �No <br />Or anization or G rou Contact Person Name Title Jason Goodmanson President Telephone Number 701-793-4 793 Title President <br />E-mail Address <br />Date 12/8/2021