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~, ~f:. ! <br />~~~~~ GAMING SITE AUTHORIZATION <br />~ia~ ~' OFFICE OF ATTORNEY GENERAL <br />~'+~'~ ~',r~+~~e SFN17996(9-2008) <br />Op NOYTN ~ <br />Dokken ~; Schrocd~.r Post 0'~3 <br />.. a. <br />(Full, Legal Name of Gaming Organization) <br />G-----~- --~- <br />Site License Number <br />(Attorney General Use Only) <br />is hereby authorized to conduct games of <br />chance under the license granted by the Attorney General of the State of North Dakota <br />at the following location: Tt.ain St. ~~rie Tv.D~.k. the address of which is: <br />r,:ain St. F~rie 0~9 _ Ociss <br />(Street) (City) io o e) (County) <br />Date(s) Authorized: Beginning Endin <br />o cific ocati where as s of Nance will be conducted and slaved at th site (reauiredl: <br />~~~~~semen I:.n~ire loti°~er level of br~semen~ <br />Number of twenty-one tables (required)(if zero, enter "0") <br />0 <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 Date <br />INSTRUCTIONS: <br />Signature of City/County Auditor <br />PRINT Name / O cial 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 />