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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 />)C <br /> <br />is hereby authorized to conduct games of <br /> <br />(Name of Organization) <br />chance under the license granted by the Attorney General of the State of North Dakota <br />at the following location: ' . 0 J the address of which is: <br /> <br />(S;r~l~' ~-' <br />Date(s) authorized: Beginning <br />Specific location of gaming within facility (required): <br /> <br />"1- <br />~.-. -. <br /> <br />J <br /> <br />(City) <br /> <br />(Zip Code) <br />Ending <br /> <br />(County) <br /> <br />J.: '.'.}.',_, <br /> <br />.... .J <br /> <br />_'L'..' <br /> <br />Number of twenty-one tables (required)(if zero, enter "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 />Signature of City/County Auditor <br /> <br />ml'ch '~'i( fuSs <br /> <br /> <br />~-/I~/Df <br />~~t~ { <br />uual'~( <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 />