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<br /> <br />LOCAL PERMIT OR CHARITY LOCAL PERMIT <br />OFFICE OF ATTORNEY GENERAL <br />SFN 17926 (02-2002) <br /> <br />Type: <br /> <br />!XI Local Permit <br /> <br />I Permit Number <br />* 0 Charity Local Permit 371 <br />Date(s) Authorized (Read instruction 2) <br /> <br />Name of Organization <br />Norman Lutheran Church <br /> <br />Contact Person <br />Alletta Smeby <br />Mailing Address <br />PO Box 96 <br /> <br />Business Phone Number <br />701-484-3244 <br />City <br />Kindred <br /> <br />~/~/~ to <br />Beginn¡nl <br />State <br />ND <br /> <br />8 I 22 I 04 <br />- Ending- <br /> Zip Code <br />I 58051-0096 <br /> <br />Site Name <br />Norman Lutheran Church <br /> <br />City <br />Kindred <br /> <br />Check the Game(s) Authorized: <br /> <br />Site Address <br />16803 52nd Street SE <br /> <br />State I Zip Code I County <br />ND 58051 Cass <br /> <br />. Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Local Permit. <br /> <br />0 Bingo <br /> <br />6a 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 />Attomey General within 30 days of the event. <br /> <br />Date Signature ot 0 City Auditor ~ County Auditor Printed Name of City ~AUditor Auditor Telephone Number <br /> <br />7 I 6 104 Michael Montplaisir 701-241-5601 <br /> <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 />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 authorizedo <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 "Date(s) Authorized" is the date of the <br />prize drawing. <br /> <br />c. <br /> <br />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. Make 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 BOULEVARD AVE - DEPT 125; BISMARCK NO 58505-0040 <br />