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Mote: Applicant to complete all lines, except last two, which will be completed by <br />issuing officer. Enclose $2.00 permit fee in accordance with North Dakota <br />Century Code 23-15-03 and return to Cass County Auditor, P.O. Box 2806, <br />Fargo, ND 58108. <br />APPLICATION/PERMIT FOR FIREWORKS DISPLAY <br />FOR ENTERTAINMENT PURPOSES <br />COUNTY OF CASS, STATE OF NORTH DAKOTA <br />4/14/09 <br />(Date of Application) <br />This permit is issued to: <br />RF.~ =~~~ait~~ ntechni~s TnC /James & Sonya Carlson Residence <br />(Name) <br />21595 286th Street <br />(Street Address) <br />Belle Plaine, NIIV 56011 <br />(City, State, Zip Code) <br />952-873-3113 Erv Haman 612-418-7280 <br />(Telephone Number) <br />giving them the right to shoot and display fireworks on the 31st day of <br />May , 20 09 at Ap~rB~' o'clock PM at the location of <br />1649 Round Hill Drive, Fargo, ND 58104 <br />in said Cass County, North Dakota. <br />J <br />~-Y'1.-- <br />Signature of Applicant <br />Ti le f Issuing O 'cer <br />By <br />Sig ature of O Icer <br />Issuing Permit <br />Ct~rnn~+~iEh~ <br />K:\HEATHER\FIREWORKS PERMIT.doc <br />