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Name of Non-profit Organization <br /> <br /> II~o$ <br /> <br />APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT" <br />OFFICE OF ATTORNEY GENERAL <br />SFN 9338 (02-2002) <br /> <br /> Applicatio, for: J~[ local Permit '~.[Charity Local Permt one evem peryeary'~-~2.2~qb <br /> Date(s) of Activity.~ <br /> <br /> Title ~ ~ ~ ~ BusJn~ Phone <br /> <br />Name of Site Where Game(s) will be Conducted <br /> <br />Check the Game(s) to be Conducted: * Poker, Twenty-one, and Paddlewheets m; <br /> <br />Site Address <br /> II 705- 3Z~ <br /> <br />State Zip Code <br /> <br /> [] Bingo [] Raffle [--lCalendar Raffle <br /> <br />DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> <br />i rate Z~p Cede <br /> <br /> CountT/) <br /> <br /> ~ be Conducted onty by a Charity Local Pe m~ P~ <br />[] Sports Pool [] Poker ' [] Twenty-one ' [] Paddlewheels ' <br /> <br />Game Type Description of Prize Retail Value of <br /> Pdze Game Type Description of Prize Retail Value of <br /> Prfze <br /> r <br /> (Limit $6.000 per year} <br /> Total: J$/~ ~4/, 4 o <br /> <br />Does the organization presently have a s~ta gaming li~nse? ~ No ~ Yes - If"Yes." the organization is not eligible for a Io~1 pe~it or chad~ Io~1 <br />pe~ and should ~11 the Offi~ of AEorney General at 1-800-326-9240. <br /> <br />Has the organization re~[ved a ~ari~ Io~1 pe~it from this or another d~ or ~un~ for the fls~J year July 1 through June 307 ~ No ~Yes- If <br />"Yes." the organ~ation does not quaii~ for a Io~1 pe~it or chad~ Io~1 perm,. <br /> <br />Hasthe~rganizat~nre~eda~pe~t~mth~s~ran~erci~rc~un~f~rthe~sca~yearJu~y1thr~ughJune3~? ~No ~Yes- If"Yes," <br />indicate the total value of all prizes previously awarded: $ . ~is amount s par of the total prize limit of $6,000 per year. <br /> <br />S~~aticATc~'ve Official <br /> <br />.3 <br /> <br />SUGGESTED MOTION: <br />Move to approve raffle permit for St. Benedict Catholic Church to be held September <br />15, 2002, at St. Benedict Catholic Church in Horace, North Dakota. <br /> <br /> <br />