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<br />}:~~$~~~i~~~i0' <br />.. 4. ':Mt! <br /> <br /> <br />LOCAL PERMIT OR CHARITY LOCAL PERMIT <br />OFFICE OF ATTORNEY GENERAL <br />SFN 17926 (09-2007) <br /> <br />\1;;~:,wii!1~'~C Type: 181 Local Permit * 0 Charity Local Permit I Permit Number <br /> 419 <br />Name of Organization Date(s) Authorized (Read instruction 2) <br />Minnkota Feline Club <br />Contact Person Business Phone Number 4/6/2008 to 4/6/2008 <br />UI Borg (701) 840-9850 Beginning Ending <br />Mailing Address City I State I Zip Code <br />10819 36th Street S. E. Valley City ND 58072-0000 <br />Site Name Site Address <br />Red River Valley Fairgrounds 1201 West Main Avenue <br />City State I Zip Code I County <br />West Fargo ND 58078-0000 Cass <br />Check the Game(s) Authorized: ' Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Local Permit. <br />o Bingo [8] Raffle o Calendar Raffle o Sports Pool o Poker' o Twenty-one' o Paddlewheels' <br />Restriction: <br />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 <br />Attomey General within 30 days of the event. <br />Date Signature of: 0 City Auditor 181 County Auditor Printed Name of City or County Auditor Auditor Telephone Number <br />3/3/2008 Michael Montplaisir (701) 241-5600 <br /> <br />Please see the instructions on the backside of this form on how to complete the Permit. <br />For a raffle or calendar raffle, read "Information Required to be Preprinted on a Standard Raffle Ticket" on the backside of the form. <br /> <br />cut along this line <br />-------------------------- <br /> <br />BINGO EXCISE TAX <br /> <br />North Dakota Century Code ~53-06,1-12(2) requires that organizations who conduct bingo pay an excise tax of three percent on <br />the gross proceeds from the sale at retail of bingo cards to final users. <br /> <br />If the organization conducts bingo under a Local Permit or Charity Local Permit the organization must complete the "Bingo <br />Excise Tax Return for Local Permit or Charity Local Permit" SFN 58649, and submit this form with payment of the Bingo Excise <br />Tax to the Office of Attorney General within 30 days from the authorized ending date. <br /> <br />Gaming Division <br />Office of Attorney General <br />600 E Boulevard Ave.. Dept. 125 <br />Bismarck NO 58505-0040 <br /> <br />Please complete the form below and send with payment to: <br /> <br /> <br />BINGO EXCISE TAX RETURN FOR LOCAL PERMIT OR CHARITY LOCAL PERMIT <br />OFFICE OF ATTORNEY GENERAL <br />SFN 58649 (08-2007) Permit Number <br />undefined <br /> <br /> <br />List the Permit Number assigned on the <br />Local Permit or Charity Local Permit <br /> <br />Bingo Excise Tax Due <br /> <br />$ <br /> <br />X .0291 = <br /> <br />, Bingo Gross Proceeds <br /> <br />* Report the total gross proceeds from the sale of bingo cards during the date(s) authorized on the Permit. <br /> <br />Name of Organization <br /> <br />Signature of Preparer <br /> <br />Per N,D. Admin. Code ~99-01.3-01-01, an organization is ineligible for a license or permit if the organization is delinquent in paying any tax, <br />