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<br /> <br />GAMING SITE AUTHORIZATION <br />OFFICE OF ATTORNEY GENERAL <br />SFN 17996 (9-2005) <br /> <br />G-____<_ __>_ <br /> <br />Site License Number <br />(Attorney General Use Only) <br /> <br />u e.;Te t~N .s I N c..o R PO PA ,.. e.d <br />(Name of Organization) <br />chance under the license granted by the Attorney <br />at the following location: BRoNCO 8 A-R <br />KY1 mA-l~ .sf Ch~FFee <br />(Street) (City) <br />Date(s) authorized: Beginning ., - t-o 8 <br />Specific location of gaming within facility (required): Lt I <br /> <br />is hereby authorized to conduct games of <br /> <br />the address <br />:>80'1'1 <br />(Zip Code) <br />Ending 6-30 -0<::' <br />fR.cr"",8~ <br /> <br />General of the State of North Dakota <br />of which is: <br />CA$':> <br />(County) <br /> <br />Number of twenty-one tables (required)(if zero, enter "0"): 0 <br /> <br />RESTRICTIONS: (to be completed ONLY if restrictions are set by the local governing body) <br /> <br />1. Days of week of gaming operations <br />2. Hours of gaming <br />3. List each specific game type prohibited <br /> <br />Attorney General <br /> <br />Date <br /> <br />5,~ <br />Signature of City/County Auditor Date <br /> <br />YhitnCA~\ rnont~\a;SI(J Co.Sf a~ UW;\;W <br />PR NT Name / Official Position <br /> <br />INSTRUCTIONS: <br /> <br />1. City/County Auditors - Retain a copy of the Site Authorization for your files. <br /> <br />2. City/County Auditors - Return the original Site Authorization form to the Organization. <br /> <br />3. Organizations - Send the original, signed, Site Authorization to the Office of Attorney General with any <br />other applicable licensing forms for final approval. <br /> <br />RETURN ALL DOCUMENTS TO: <br /> <br />Office of Attorney General <br />Licensing Section <br />600 E Boulevard Ave, Dept. 125 <br />Bismarck, ND 58505-0040 <br />Telephone: 701-328-2329 OR 800-326-9240 <br />