d. Permit for poker & raffle - Laserfiche WebLink

1.'\, ~~~ \\;\ :~ z ~ : ~ \~t .. ii~/ '?J,I,"'~~ ~."L~:' 'rfoWili;'!\\,rJ LOCAL PERMIT OR CHARITY LOCAL PERMIT OFFICE OF ATTORNEY GENERAL SFN 17926 (09-2003) Type: o Local Permit * 0 Charity Local Permit Permit Number 412 Name of Organization Cass County Historical Society Contact Person Business Phone Number 8/18/2007 Bruce Whitmarsh (701) 282-2822 Mailing Address City P. O. Box 719 West Fargo Site Name Site Address Bonanzaville 1351 West Main Avenue City State Zip Code County West Fargo ND 58078 Cass Check the Game(s) Authorized: . Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Local Permit. Date(s) Authorized (Rea instruction 2) to 8/18/2007 Ending Zip Code 58078 o Bingo o Raffle D Calendar Raffle o Sports Pool o Poker. o Twenty-o e. D Paddlewheels. Restriction: Requirement: For a "Charity Local Permit," the organization must file a "Report on a Charity Local Permit" with the city or cou ty 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 rm. INSTRUCTIONS: After a city or county governing board has authorized an organization to receive a local permit 0 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 th 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 a 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 n 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 ermit,~nM 5. Make two copies of the completed form. Provide the original form to the organization, keep ne copy for the file and, within fourteen days of issuance, mail a copy to: OFFICE OF ATTORNEY GENERA; LICENSING SECTION; 600 E BOULEVARDAVE- DEPT 125; BISMARCK ND 58505-0040.