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GY'8~.; "~f~C <br />r.:..:-; <br />1:;...;..:`...~. ~ <br />~'~ ~E. <br />~+ <br />`~~ ~,C foe <br />chance <br />at the <br />GAMING SITE AUTHORIZATION <br />OFFICE OF ATTORNEY GENERAL <br />SFN~17996 (9-2008) <br />(Full, Legal Name of Gaming t <br />under the license. granted <br />fQIlQwing, location: ~' ~( <br />G-----~- --~- <br />Site License Number <br />(Attorney General Use Only) <br />is hereby authorized to conduct games of <br />Attorn y General of the State of North Dakota <br />,a~~ G~-~ the address ofnwhich is: <br />(street) C' ) (i odel r, <br />Date(s) Authorized: Beginning ~ ~ ~ ~ Ending <br />~ge~ific location vKf]ere games of chance will be conducted and olaved at the site (reauiredl: <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 g i operaf s <br />2. Hours of gaming ~ - l`~ ~ _ , _ ti _0~ 1'~ or. - (!~ <br />3. List each specific game t~lple prohibited <br />Attorney General Date Signature of City/County Auditor <br />11~~~chaeQrn~n,-4~lai ~I'/, ~-~..~ Cuccc@~~'-~"o~/ <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 />