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G4~wT:.B~t _ <br />`'~~~'~~` GAMING SITE AUTHORIZATION G - - - - - <br />w<'/ Site License Number <br />~(;.` ~`,~~~ OFFICE OF ATTORNEY GENERAL (Attorney General Use Only) <br />'~, ~ ~.. ~~ SFN 17996 (9-2008) <br />°~ NoY7N ~ <br />~tr~~,~~.- /-~1~,,,,~w 5~~~y ~~~„~~ t.~ ~~~~~ 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: ~~i%I~ ~~c ~ 13.x.- ~ ~y-~~ the address of which is: <br /> <br />(Street) (City) (Zip Code) (County) <br />Date(s) Authorized: Beginning 7 /- y 9 Ending ~ ' 30 - i v <br /> <br />Specific location where aames of chance will be co ducted and olaved at the site (reauired): <br />~L~4~~11t2fu1 ~ / ~:nf <br />Number of twenty-one tables (required)(if zero, enter "0"): <br />RESTRICTIONS: (to be completed ONLY if restrictions are set by the local governing body) <br />1. Days of week of gaming operations <br />2. Hours of gaming <br />3. List each specific game type prohibited <br />Attorney General Date Signature of City/Count~( Auditor <br />m,' rac1 one 1 ~ ~~ l~u ~~ r <br />PRINT Name / fficial Position of person signing above <br />INSTRUCTIONS: <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 />