c. Permit for raffle-Red River Radio Amateurs

~ .I :-,^;y', ~ .Job r ,~~~ 1} .., fIrNQRY1\..~~", APPLICATION FOR A LOCAL OFFICE OF ATTORNEY GENERAL SFN 9338 (10-2007) Application for: ~cu~ab )~ -~ Cis LLn~ `~Z PERMIT OR CHARITY LOCAL PERMIT y~/; ~y~ G~rY~~ l e~~ G~l ~~Cc~-~~ 6 ~( Local Permit ;'~ Charity Local Permit (one event per year) Name of Non-profit Organization Date(s ) of Activity ''- ' i v 11 d %O ' ,rte / ~ ?7 r: / ~ 8~ ~~ On ~a/ Person esponsible for the Gaming Operation, Including Disbursement of Net Income Title Business Phone Number ~~ ~oa~~~ c~~,~ ~~~-~~~-s8s Business Address a~ ,~~ ~ Ciry .~~~~ State D Zip Code ~~~ Mailing Address (if different) City State Zip Code Name of Site Where Game(s) will b ~ R Q; ~ e Conducted l~ Site Address % ~ ~ l ~ a ~,, ,~ . ;y u; s s , u; City State Zip Code Co ty t5 r ~'D? ~t 55 Check the Game(s) to be Conducte d: "Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Local Permit. ^ 8ingc Raffle Calendar Raffle ^ Sports Pool ^ Poker' ^ Twenty-one' ^ Paddlewheels' DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED Game Type Description of Prize Retail Value of Prize e ~ ~ a;l ~ ~~ I is J Ob ~ ~0 Irrtended uses of gaming proceeds: Does the organization presently have a state gaming license?,'~No ^ Yes - If "Yes," the organization is not eligible for a local permit or charily local permit and should call the Office ofAttomey General at 1-800-326-9240. Has the organization received a charity local permit from this or another city or county for the fiscal year July 1 through June 30?~No ^ Yes - If "Yes," the organization does not qualify for a local permit or charity local permit. Has the organization received a local permit from this or another city or county for the fiscal year July 1 through June 30? ~] No ^ Yes - If "Yes," indicate the total value of all prizes previously awarded: $ .This amount is part of the total prize limit of $12,000 per year. Signat of Organ' ation's p xecutive Official Date Titl Business Phone Number