Laserfiche WebLink
<br /> <br />LOCAL PERMIT OR CHARITY LOCAL PERMIT <br />OFFICE OF ATTORNEY GENERAL <br />SFN 17926 (09-2007) <br /> <br />IY. -...{.'" I Permit Number <br />".",!"'" Type: o Local Permit * ~ Charity Local Permit <br /> 428 <br />Name of Organizalion Date(s) Aulhorized (Read instruction 2) <br />The Relay For Life <br />Conlact Person Business Phone Number 12/12/2008 to 12/14/2008 <br />Tom Neameyer (701) 477-3193 Beginning Ending <br />Mailing Address City I Stale I Zip Code <br />P. O. Box 280 Rolla NO 58367 -0280 <br />Sile Name Sile Address <br />Knickerbocker Liquor 412 Main Avenue <br />City Stale I Zip Code I County <br />Hickson ND 58047-0000 Cass <br />Check Ihe Game(s) Aulhorized: . Poker, Twenly-one, and Paddlewheels may be Conducted only by a Charily Local Permit. <br />o Bingo o Raffle o Calendar Raffle o Sports Pool ~ Poker' o Twenly-one' o Paddlewheels. <br />Reslriction: <br />Requirement: For a "Charily Local Permil:' the organization must file a "Report on a Charity Local Permit" with Ihe city or counly audilor and Office of <br /> Attorney General wilhin 30 days of Ihe event. <br />Date I Signalure of: Deity Auditor ~County Auditor I Prinled Name of Cily or Counly Audilor Auditor Telephone Number <br />11/17/2008 Michael Montplaisir (701) 241-5600 <br /> <br />Please see Ihe instruclions on the backside of Ihis form on how 10 complele Ihe Permit. <br />For a raffle or calendar raffle, read "Informalion Required 10 be Preprinted on a Slandard Raffle Ticket" on the backside of Ihe form. <br /> <br />cuI along this line <br />-------------------------- <br /> <br />BINGO EXCISE TAX <br /> <br />North Dakota Century Code ~53-06.1-12(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 final users. <br /> <br />If the organization conducts bingo under a Local Permit or Charity Local Permit the organization must complete the "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 days 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 below and send with payment to: <br /> <br /> <br />BINGO EXCISE TAX RETURN FOR LOCAL PERMIT OR CHARITY LOCAL PERMIT <br />OFFICE OF ATTORNEY GENERAL <br />SFN 58649 (08-2007) Permil Number <br />undefined <br /> <br /> <br />List Ihe Permjl Number assigned on Ihe <br />Local Permit or Charity Local Permil <br /> <br />Bingo Excise Tax Due <br /> <br />$ <br /> <br />X .0291 = <br /> <br />, Bingo Gross Proceeds <br /> <br />* Report the total gross proceeds from the sale of bingo cards during the date(s) authorized on the Permit. <br /> <br />undefined <br /> <br />Name of Organizalion <br /> <br />Signature of Preparer <br /> <br />Per N.D. Admin. Code 999-01.3-01-01, an organization is ineligible for a license or permit if the organization is delinquent in paying any tax. <br />