Laserfiche WebLink
<br />CASS COUNTY COURTHOUSE I4J 002 <br />. \i;. Sr.a.~mit ~lo. W UWllatrfOn 1fL'ftl}!!Ul!~~ <br />.' .' ~ ~ ()lIJttfA va:tJ4iJ1( <br />APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT WHh C: ...."wil AOtJl'cot'H\. <br />OFFICE OF ATIORNEY GENERAL D...,. r r I I <br />,. SFN 9338 (07-2003) <br /> <br />07/10/07 Tlm 15:39 FAX 701 241 5728 <br />--- ...-- -..-- <br /> <br /> <br />Application for: <br />Name of Non-proflt Organization IJ /\ ~ <br />t'l\ \f\)~~<3\-A Rr\,\~A~ \J\f.OOVc.ra..'1 \::)KOV fl <br />pe~n Responsible for the Gaming Operation. IncludIng Disbursement of Net Income <br />L'b~~ . l.C <br />BU$lness Address City <br />~ '>:> It 1 <N \.\ Q..<6 \ ~ lJ ~ rr Jf\("'(. <br />Mailing Address (If different) ?f City <br /> <br />· 0 Charity Local Permit (one event per year) <br />Date(s) of Activity ~ \, _ - <br />7. 'J..D ,., 0 to 11- llD-07 <br />.tle -* Business Phone Number "f <br />.. 1 -'[' 7OI-'jd.-b-7107 <br />State Zip Code <br />N~ 40 \ <br />State Zil) COde <br /> <br />. Local Permit <br /> <br />Name of Site Where Game{s) will be Conducted <br />L E.~~tZ.~ <br />City C <br />ffff <br /> <br /> <br /> <br /> <br />wtJ <br /> <br />Site Address <br />'07 MAV" ST <br />State Zip Code <br />N'J> '5~079 <br /> <br /> <br />Check the Game($) to be Conducted; . Poke'r, Twen'ty-one, and PaddJewheels may be Conducted only by a Charily LOCal Permll <br />o Bingo III Raffle DCalendar Raffle 0 Sports Pool 0 Poker. 0 Twenty-one · <br /> <br />DESCRIPTION AND RETAIL. VALUE OF PRIZES TO BE AWARDED <br />~ <br /> <br />Game Type <br /> <br />Description of Prize <br /> <br />Retail Value of <br />Prize <br /> <br />ffl..f::.. <br /> <br /> <br />o Paddlewheels' <br /> <br />Game Type Desoription of Prize Retail Value of <br />Prize <br /> $ <br /> (limit S12,000 pel' ~ <br /> Total: $ }'1 J5 <br /> <br />Intended uses Of gaming proceeds: 10 FUND Fvrv~ (.LufJ SfbN 50RkD EYctJ\5 <br /> <br /> <br />Does the organization presently have a state gaming license? !!I No 0 Yes . If -Yes,' the organization is not elIgible for a loc:all)etmit or charity local <br />permit and should call1he Office of AttOmey General .t 1-800..326-9240. ' <br /> <br />Has the organization received a charity local permit from this or another city Dr county for the fiscal year July 1 through June 307 HI No Dyes. If "Yes: <br />the organization does not qualify for a local I)ermit or charity local permit. <br /> <br />Has the organization received a local permit from this or another city or county for the fiscal year July" through June 30'? IIil No 0 Yes - If "Yes,. <br />indicate the total value of all prizes previously awarded: S . This amount i$ part of the total prizr: Umit of $12,000 per year. <br /> <br />Oate <br />7 -11--01 <br /> <br />. tio '$ Top Executlve Official <br /> <br />Title <br />tf~11f)<t../IIT <br /> <br />B\JSines$ Phone Number <br />10 ( -11JO --7 (0'1 <br /> <br />07/10/2007 TUE 15:53 [TX/RX NO 7421] ~002 <br />