g. Permit for poker-Relay for Life benefit

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,Jmly) 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 BOULEVARD AVE - DEPT 125; BISMARCK ND 58505-0040. INFORMATION REQUIRED TO BE PREPRINTED ON A STANDARD RAFFLE TICKET: 1. Name of organization; 2. Ticket number; 3. Price of the ticket, including any discounted price; 4. Prize, description of an optional prize selectable by a winning player, or option to convert a merchandise prize to a cash prize that is limited to the lesser of the value of the merchandise prize or four thousand dollars. However, if there is insufficient space on a ticket to list each minor prize that has a retail price not exceeding twenty dollars, an organization may state the total number of minor prizes and their total retail price; 5. For a licensed organization, print "office of attorney general" and license number. For an organization that has a permit, print the authorizing city or county and permit number; 6. A statement that a person is not required to be present at a drawing to win; 7. Date and time of the drawing or drawings and, if the winning player is to be announced later, date and time of that announcement. For a calendar raffle, if the drawings are on a same day of the week or month, print the day and time of the drawing; 8. Location and street address of the drawing; 9. If a merchandise prize requires a title transfer involving the department of transportation, a statement that a winning player is or is not liable for sales or use tax; 10. If a purchase of a ticket or winning prize is restricted to a person of minimum age, a statement that a person must be at least " " years of age to buy a ticket, or win a prize; 11. A statement that a purchase of the ticket is not a charitable donation; 12. If a secondary prize is an unguaranteed cash or merchandise prize, a statement that the prize is not guaranteed to be won and odds of winning the prize based on numbers of chances; and 13. If a prize is live beef or dairy cattle, horse, bison, sheep or pig, a statement that the winning player may convert the prize to a cash prize that is limited to the lesser of the market value of the animal or four thousand dollars.