b. Permit for raffle/Sandhills - Laserfiche WebLink

O FFICE OF A'I-rORNEY GENERAL SFN 9338 (07-2003) Application for: Name of Non-profit Omaniza~on, Person Responsible for the Gaming Operation, Including Disbursement of Net Income ~usi~kp ^d~e,~ ,/ff o Mailing Address (if different) APPLICATION FOR A LOCAL pERMIT OR CHARITY LOCAL PERMIT Local Permit * [] Charity Local Permit (one event per year) Date(s) ofActivity C)'~t~r~Y~ ~j&~)¥ ~ ,~lttt4tr.~ Tire Business Phone Number S~ ~p Code Name of Site Where Game(s) ~11 be Conducte~ Site Address Check the Game(s) to be Conducted: * Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity LOCal PermiL [] Bingo [~Raffie []Calendar Raffle [] Sports Pool [] Poker * [] Twenty-one [] Paddlewheels * DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED Game Type Description of Prize Retail Value of Retail Value of Pdze Game Type Description of Prize .~- Prize Intended uses of gaming proceeds: "~ t~//¢ ~r (IJn~it $12,000 per ~ear) Does the organization presently have a state gaming license? [~No [] Yes - If 'Yes,' the organization is not eligible for a local permit or charity local permit and should call the Office of Attorney General at 1-800-326-9240. Has the organization received a chadty local permit from this or another city or county for the fiscal year July 1 through June 30? [~ No [] Yes - If 'Yes,' the organization does not qualify for a local permit or charity local permit. Has the organization received a local permit from this or another city or county for the fiscal year July 1 through June 30? [~No [] Yes - If 'Yes," indicate the total value of all prizes previot~sly awarded: $ . This amount is part of the totalpdze limit of $12,0OOrperyear. I Signa/~yrganiza~ecutive Official SUGGESTED MOTION: Move to approve a raffle permit for Sandhills Archers, Inc. on the dates of January 9, 2004 and February 28, 2004 at the Sandhills Archery Park, West Fargo, North Dakota. Date Tire