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<br /> <br />G-____<_ __>_ <br /> <br />Site License Number <br />(Attorney General Use Only) <br /> <br />is hereby authorized to conduct games of <br /> <br />of the State of North Dakota <br />the address f which is: <br /> <br />Number of twenty-one tables (required)(if zero, enter "0"): B' <br /> <br />RESTRICTIONS: (to be completed ONLY if restrictions are set by the local governing body) <br /> <br />1. Days of week of g~pe'Stiops ~ ~ ~ <br />2. Hours of gaming . - (ttul tkM. - 'J.(J.." . <;) "" - ((~ <br />3. List each specific game pe prohibite ) <br /> <br />Attorney General <br /> <br />Date <br /> <br />6-/t1-0t <br /> <br />Signature of City/County Auditor Date <br /> <br />1fucJ1 M1 ~ IdA {, {(fi1~ CourriJ.J- fhAJJ 17;( <br />PRIN Name / Ofhcial 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, N D 58505-0040 <br />Telephone: 701-328-2329 OR 800-326-9240 <br />