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r!>•' ~ ~ <br />~:li <br />r :.. <br />- (- ) - <br />Site License Number <br />(Attorney General Use Only) <br />SFN - 17996 <br />O~NORIN NORTH DAKOTA GAMES OF CHANCE <br />SITE ADTHORIZATION <br />i ~ <br />/i C ~ is hereby authorized to conduct games of <br />(Name of Organ zation) <br />chance under the license granted by ttg~~ General of the State of North <br />Dakota at t}~e~~~~n ~ipwn a ~~ff the dd e s of <br />which is: cam` JC ~7 <br />(Street) City (Zip Code) (County) <br />Date(s) authorized: Beginning ,/~~ Ending ~ ,30 ~/O <br />Specific location of gaffing opprations,,w~gthin facility: <br />Number of twenty-one tables: <br />RESTRICTIONS: (To be completed Q~ if rest <br />body) <br />1. Days of week of gaming operations <br />2. Hours of gaming <br />3. List each specific game prohibited <br />are set by local governing <br />(Attorney General) Date <br />rtg~l <br />(Signature of City/County Auditor) Date <br />Routing: White & Canary -Attorney General <br />INSTRUCTIONS: <br />Pink - To be retained by City/County <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 />