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<br /> <br />LOCAL PERMIT OR CHARITY LOCAL PERMIT <br />OFFICE OF A TIORNEY GENERAL <br />SFN 17926 (02-2002) <br /> <br />Type: <br /> <br />0 Local Permit <br /> <br />I Permit Number <br />* 0 Charity Local Permit 368 <br />Date(s) Authorized (Read instruction 2) <br /> <br />Name of Organization <br />Michael Pfennig <br /> <br />Contact Person <br /> <br />Bruce Schauer <br />Mailing Address <br /> <br />205 Main Street <br />Site Name <br /> <br />Cancer Fund <br /> <br />Wild Rice Bar & Grill <br />City <br />Wild Rice <br />Check the Game(s) Authorized: <br /> <br />Business Phone Number <br />701-239-8470 <br />City <br />Wild Rice <br />Site Address <br />205 Main Street <br />State I Z.iP Code County <br />ND 58047 CaBS <br /> <br />* Poker, Twenty-one, and Paddlewheels may be Conducted only by a Chañty Local Permit <br /> <br />--1L-1 ..ll-I fliL- to 4 I 17 I 04 <br />Beginning - Ending- <br />I State I Zip Code <br />ND 58047 <br /> <br />0 Bingo <br /> <br />[1J: Raffle <br /> <br />0 Calendar Raffle <br /> <br />0 Sports Pool <br /> <br />0 Poker" <br /> <br />0 Twenty-one. <br /> <br />0 Paddlewheels* <br /> <br />Restriction: <br /> <br />Requirement: For a "Charity Local Permit," the organization must file a "Report on a Charity Local Permit" with the city or county auditor and Office of <br />Attorney General within 30 days of the event. <br /> <br />j S~,};. atur-: o~ g~udit/ J:~ c~unty Auditor I Printed Name of City or County Auditor I. Auditor Telephone Number <br /> <br />4 I 7 I 04 WI "c-</L-^'I 4-1c-J:¡¡? J¿ð,¿d-v Michael Montplaisir 701-241-5601 <br />y~ . <br />For a raffle or calendar raffle, read "Information Required to be Preprinted on a Standard Raffle Ticket" on the backside of the form. <br /> <br />Date <br /> <br />INSTRUCTIONS: <br /> <br />After a city or county governing board has authorized an organization to receive a local permit or charity local <br />permit, the city or county auditor must complete this form. <br /> <br />1. Enter the city or county assigned "Permit Number." <br /> <br />2. Enter the beginning and ending date(s) for which the permit is authorized. <br /> <br />a. <br /> <br />For other than a "calendar" raffle that may be authorized for January 1 to December 31, a local <br />permit or charity local permit cannot be authorized beyond June 30. <br /> <br />b, For a "one time" raffle, the beginning and ending dates for "Oate(s) Authorized" is the date of the <br />prize drawing. <br /> <br />c. A local permit can be issued for one or more events per year. <br /> <br />d. <br /> <br />If a local permit is issued for more than one event, enter the date of the first event as the <br />"beginning" date and the date of the last event as the "ending" date. <br /> <br />e. <br /> <br />A charity local permit may be issued for only one event within a fiscal year July 1 - June 30. <br /> <br />3. Enter any restriction placed on the organization, such as days of the week or designation of an area at a <br />site where games may be conducted. <br /> <br />4. Provide a "Report on a Charity Local Permit" form to the organization. (If a Charity Local Permit, only) <br /> <br />5. Mak~ two copies of the completed form. Provide the original form to the organization, keep one copy for <br />the file and, within fourteen days of issuance, mail a copy to: OFFICE OF ATTORNEY GENERAL; <br />LICENSING SECTION; 600 E BOULEV ARO AVE - OEPT 125; BISMARCK NO 58505-0040 <br />