Laserfiche WebLink
<br />~'W=--""0::'~' <br />t1:~;"..~..., .,,1':' <br />...........',.. <br />,~'';l'",;:::::'~'> '\} <br />'q<....~.~......".\.. <br />lijfi-:,:,. ~,.;e "\1'<' 'I <br />Ir':;€~}(r: hJ,!, <br />~\.&$,~~2:-i.'/ <br />~.._.7" :..5.W~..4" <br />"'~~..~%/, <br />'~!f1l.U <br /> <br />LOCAL PERMIT OR CHARITY LOCAL PERMIT <br />OFFICE OF ATTORNEY GENERAL <br />SFN 17926 (09-2007) <br /> <br />Type: <br /> <br />o Local Permit <br /> <br />* ~ Charity Local Permit <br /> <br />Permit Number <br />420 I <br /> <br />Name of Organization <br />Relay For Life <br />Contact Person <br />Tom Neameyer <br />Mailing Address <br />P. 0, Box 280 <br /> <br />o Bin90 <br /> <br />o Raffle <br /> <br />o Calendar Raffle <br /> <br />o Sports Pool <br /> <br />IRI Poker' <br /> <br />Date(s) Authorized (Read instruction 2) <br />I <br />4/26/2008 to 4/26/2008 <br />I Ending <br />Zip Code <br />5836~-0280 <br /> <br />I <br />I <br />I <br />o Paddlewheels' <br />I <br />I <br /> <br /> <br />Business Phone Number <br />(701) 371-8210 <br />City <br />Rolla <br /> <br />Site Name <br />Knickerbocker Liquor Locker <br />City <br />Hickson <br />Check the Game(s) Authorized: <br /> <br />Site Address <br />412 Main Avenue <br />State Zip Code County <br />ND 58047-0000 Cass <br />~ PC?ker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Local Permit: <br /> <br />o Twenty-one* <br /> <br />Restriction: <br /> <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 />Attorney General within 30 days of the event. I <br /> <br />Date ignature of: DCity Auditor [8] County Auditor Printed Name of City or County Auditor Auditor Telephone Number <br />3/17/2008 ~ Michael Montplaisir (701) 241~5600 <br /> <br />Please see the instructions on the backsid~ of this rm 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 />____~alongth~lin~________ ___ <br /> <br />~INGOEXCISE~X I <br /> <br />North Dakota Century Code 953-06.1-12(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 finai users. I <br /> <br />If the organization conducts bingo under a Local Permit or Charity Local Permit the organization must complete th~ "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 davs from the authorized ending date. . <br /> <br />Gaming Division. <br />.office of Attorney General <br />600 E Boulevard Ave. - Dept. 125 <br />Bismarck ND 58505-0040 <br /> <br />Please complete the form beiow and send with payment to: <br /> <br /> <br />I <br />BINGO EXCISE TAX RETURN FOR LOCAL PERMIT OR CHARITY LOCAL PERMIT <br />OFFICE OF ATTORNEY GENERAL I <br />SFN 56649 (08-2007) Permit Number I <br />undefined <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 />* Bingo Gross Proceeds <br /> <br />X .0291 = <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 699-01.3-01-01 .::In nrnrini7;;lti()n ic:: in""linihl"" f,.". ~ Ij"'onC'Q .....,. ....,..............;~ ;.r: H...~ M__~:__":. __ . <br />