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<br />Note: Applicant to complete an lines, except last two, which will be completed by issuing officer. <br />Enclose $2.00 permit fee in accordance with North Dakota Century Code 23-15-03 and <br />return to Cass County Auditor, P.O. Box 2806, Fargo, ND 58108. <br /> <br />APPLICA TION/PERMIT FOR FIREWORKS DISPLAY <br />FOR ENTERTAINMENT PURPOSES <br /> <br />COUNTY OF CASS, STATE OF NORTH DAKOTA <br /> <br />JI- / b ~ 0 'I <br />(Date of this Application) <br /> <br />,2004 <br /> <br />This permit is issued to: <br /> <br />JYNO <br />(Name) <br /> <br />/! L£X /I ko 5' <br /> <br />(rrul!. l1£fkoeif) <br /> <br />:58ðS ð~~ rJvf <br />(Street Address) <br /> <br />F,ìj-~ G-ö /v Ù S-~ I" V <br />(City, State, Zip Code) <br /> <br />"/0 f- 2 Y2-()3 ¡¡S- <br /> <br />s <br /> <br />(Telephone Number) <br /> <br />giV.ing them the right to shoot and display fireworks 0 n the , ( Þ1FrEæ.;) <br /> <br />Isl- . N 0' o-IO'()'Y:,fl( /jA-PC <br />day of /J?#Y , 20~ at /. 0 o'clock PM <br /> <br /> <br />at (location) !3c¡fòS 5~ '" ß A \J £. 5 <br /> <br /> <br />FARbO N[) S-?/ð<! <br /> <br />in said Cass County, North Dakota. <br /> <br />j)~ ~ <br /> <br />Signat1Íre of Applicant <br /> <br />~ <br /> <br />Ch:u'f, CMç CQW\ij CønJvúa-ì'ðf) <br /> <br />Title of Issuing Officer <br /> <br />By <br /> <br />Signature of Officer <br />Issuing Permit <br /> <br />J:\A UD ITOR\SCHEPP\FIREWORKSPERMIT. wpd <br />