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<br />chance <br />at the <br /> <br /> <br />GAMING SITE AUTHORIZATION <br /> <br />G-____<_ -->- <br /> <br />Site License Number <br />(Attorney General Use Only) <br /> <br />is hereby authorized to conduct games of <br /> <br />the State of North Dakota <br /> <br />the address of which is: <br /> <br />/L <br /> <br />(Z~e) ~ &J1ty) <br />Ending t.1I2 e I../'--' I d <br />, <br /> <br /> <br />Number of twenty-one tables (required)(if zero, enter "0"): <br /> <br />-e- <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 />~-'Iq/tfl <br />Signature of City/County Auditor Date <br /> <br />Wi (nQ{i Y)1D~(JAS';'r;Gt\J UurJ-Lj aud,~y' <br />PRIN Name I Official Position <br /> <br />------------------------- <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 />