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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 />(Attomey General Use Only) <br /> <br />The Arc, Upper Valley, Inc. <br />(Name of Organization) <br />chance under the license granted by the Attorney General <br />at the following location: Club 94 <br />15568 37th St SE <br />(Street) <br />Oate(s) authorized: Beginning 7-1-07 <br />Specific location of gaming within facility (required): <br />west wall <br /> <br />Number of twenty-one tables (required)(if zero, enter "0"): <br /> <br />is hereby authorized to conduct games of <br /> <br />(City) <br /> <br />of the State of North Dakota <br />the address of which is: <br />58012 Cass <br />(Zip Code) (County) <br />Ending 6-30-08 <br /> <br />Casselton <br /> <br />Onp <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 game type prohibited <br /> <br />Attorney General <br /> <br />Date <br /> <br />Signature of City/County Auditor <br /> <br />Date <br /> <br />PRINT Name / Official Position <br /> <br />------------------------- <br /> <br />INSTRUCTIONS: <br /> <br />1. <br /> <br />2. <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, Oept. 125 <br />Bismarck, NO 58505-0040 <br />Telephone: 701-328-2329 OR 800-326-9240 <br />