c. Permits for raffle - Laserfiche WebLink

LOCAL PERMIT OR CHARITY LOCAL PERMIT OFFICE OF A TIORNEY GENERAL SFN 17926 (09-2003) Type: o Local Permit * D Charity Local Permit Permit Number 411 Name of Organization Nora Lutheran Church Contact Person Connie Oullum Mailing Address 17021 15th Street S. E. Site Name Nora Lutheran Church Date(s) Authorized (Read instruction 2) Business Phone Number (701) 484-5535 City Gardner Site Address R.R. 10/6/2007 to 10/6/2007 Ending Zip Code 58036 City State Zip Code County Gardner NO 58036 Cass Check the Game(s) Authorized: > Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Local Permit. o Bingo o Raffle D Calendar Raffle D Sports Pool D Poker> D Twenty-one> D Paddlewheels> Restriction: 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 Attorney General within 30 days of the event. Date Signature of: DCity Auditor o County Auditor Printed Name of City or County Auditor Michael Montplaisir Auditor Telephone Number (701) 241-5600 8/6/2007 For a raffle or calendar raffle, read "Information Required to be Preprinted on a Standard Raffle Ticket" on the-backside of the form. INSTRUCTIONS: After a city or county governing board has authorized an organization to receive a local permit or charity local permit, the city or county auditor must complete this form. 1. Enter the city or county assigned "Permit Number." 2. Enter the beginning and ending date(s) for which the permit is authorized. a. For a "one time" raffle, the beginning and ending dates for "Date(s) Authorized" is the date of the prize drawing. b. A local permit can be issued for one or more events per year. c. If a local permit is issued for more than one event, enter the date of the first event as the "beginning" date and the date of the last event as the "ending" date. d. A charity local permit may be issued for only one event per year. 3. Enter any restriction placed on the organization, such as days of the week or designation of an area at a site where games may be conducted. 4. Provide a "Report on a Charity Local Permit" form to the organization. (If a Charity Local Permit,~ 5. Make two copies of the completed form. Provide the original form to the organization, keep one copy for the file and, within fourteen days of issuance, mail a copy to: OFFICE OF ATTORNEY GENERAL; LICENSING SECTION; 600 E BOULEVARDAVE - DEPT 125; BISMARCK ND 58505-0040.