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<br /> <br />GAMING SITE AUTHORIZATION <br />OFFICE OF ATTORNEY GENERAL <br />SFN 17996 (9-2005) <br /> <br />G-____(_ __)_ <br /> <br />Site License Number <br />(Attorney General Use Only) <br /> <br />~pd ~;UlV .J)U.JrYlYC ,SfVU;(Q S'+oUJ(jf,j;;t1..iS hereby authorized to conduct games of <br />(Name of Organization) <br />chance under the license granted by thE! Attorney General of the State of North Dakota <br />at the following location: lA..~Od qlc'i 6Ju i (1..-UJO the address of which is: <br />;lacs ~, \)SJld RiLl I NlJ 5<;/641 <br />(Street) . (City) <br />Date(s) authorized: Beginningl- 1- ()7 <br />Specific location of gaming within facility (required): SO(A..j.,h <br /> <br />(Zip Code) <br />Ending (, - 30 - (Jg <br />I 0 CQ... -l- i Oh... <br /> <br />(County) <br /> <br />Number of twenty-one tables (required)(if zero, enter "0"): /) tfe.. (I) <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 gam e type prohibited <br /> <br />Attorney General <br /> <br />Date <br /> <br />Signature of City/County Auditor <br /> <br />6~I-O~ <br />Date <br /> <br />PRINT Name / Official Position <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 Organization. <br /> <br />3. Organizations - Send the original, signed, Site Authorization to the Office of Attorney 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 />