Laserfiche WebLink
GY'4A7 '8ptit <br />~~~~'~~ GAMING SITE AUTHORIZATION G - - - - - ~- - -~- <br />~!~'.. ! Site License Number <br />Cii~ /' OFFICE OF ATTORNEY GENERAL Attorne General Use Onl <br />~'c '~ s +~~ SFN 17996 (9-2008) ( Y Y) <br />~~ NoRTN C~ <br />`~'e--re r r~,'s j'`,~cr~~ A ~~ ~ is hereby authorized to conduct games of <br />(Full, Legal Name of Gaming Organization) <br />chance under the license granted by the Attorney General of the State of North Dakota <br />at the following location: _ !~Rs.Nt-c~ P~c+~...- the address of which is: <br />~t,~ m~+~~ .S'; Ch~F~~e S$u~ty GgsS <br />(Street) (City) (Zio Codel (County) <br />Date(s) Authorized: Beginning `l - r --t;~ ~ Ending ~ "3C~- ~ ~ <br />Soecific location where acmes of chance will be conducted and olaved at the site (reauiredl: ~ ~ F~~ ~~ <br />Number of twenty-one tables (required)(if zero, enter "0"): O <br />RESTRICTIONS: (to be completed ONLY if restrictions are set by the local governing body) <br />1. <br />2. <br />3. <br />Days of week of gaming operations _ <br />Hours of gaming <br />List each specific game type prohibited <br />Attorney General <br />INSTRUCTIONS: <br />Date <br />Signature of City/County Auditor <br />m. chae~ 1~br~%,ola~~S;{,_Ca,sS Cuu-~.iG~.ud ~~-~~ <br />PRINT Name / fficial Position of person signing above <br />1. City/County Auditors - Retain a copy of the Site Authorization for your files. <br />2. City/County Auditors -Return the original Site Authorization form to the Organization. <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 />RETURN ALL DOCUMENTS TO: <br />Office of Attorney General <br />Licensing Section <br />600 E Boulevard Ave, Dept. 125 <br />Bismarck, ND 58505-0040 <br />Telephone: 701-328-2329 OR 800-326-9240 <br />