APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT
OFFICE OF ATTORNEY GENERAL
SFN9338 (07-2003)
Application for:       Local Permit      * Charity Local Permit (one event per year)
Name of Non-profit Organization
 Date(s) of Activity
 to 
Person Responsible for the Gaming Operation, Including Disbursement of Net Income
 Title
 Business Phone Number
Business Address
 City
 State
 Zip Code
Mailing Address (if different)
 City
 State
 Zip Code
Name of Site Where Game(s) will be Conducted
 Site Address
City
 State
 Zip Code
 County
Check the Games(s) to be Conducted: * Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Local Permit.
Bingo         Raffle         Calendar Raffle         Sports Pool         Poker *         Twenty-one *         Paddlewheels *

DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED
Game Type Description of Prize Retail Value of Prize
 
Game Type Description of Prize Retail Value of Prize
  Total:  (Limit $12,000/year)
$

Intended uses of gaming proceeds:


Does the organization have a state gaming license?
  No      Yes - If "Yes", the organization is not eligible for a local permit or charity local permit and should call the Office of Attorney General at 1-800-326-9240.

Has the organization received a charity local permit from this or another city or county for the fiscal year July 1 through June 30?
  No      Yes - If "Yes", the organization does not qualify for a local permit or charit local permit

Has the organization received a local permit from this or another city or county for the fiscal year July 1 through June 30?
  No      Yes - If "Yes", indicate the total value of all prizes previously awarded: $. This amount is part of the total prize limit of $12,000 per year.

E-Signature of Organizations's Top Executive Official (Info)
 Date
 Title
 Business Phone Number

   
PRIZE RESTRICTIONS:

A single cash prize cannot exceed $1,000 and total cash prized for a raffle cannot exceed $3,000 in one day.

The retail value of a merchandise cannot exceed $2,500.

The total of all cash prizes and retail value of all merchandise prizes for all games cannot exceed $12,000 in a fiscal year July 1 through June 30.

If the value of the planned cash and merchandise prizes exceeds $12,000, the organization must reduce the prizes to this limit or apply for a state license with the Office of Attorney General.

LOCAL PERMIT AND CHARITY LOCAL PERMIT:

The major difference between a local permit and charity local permit are:


Number of events per year

Must file an information report

May pay employees compensation

Must use chips as wagers

Use of net income

Games allowed 		Local Permit

Limited by prizes

No

Yes

No

Unrestricted

Bingo
Raffles
Sports Pools 		Charity Local Permit

One

Yes

No

Yes

Restricted

Bingo
Raffles
Sports Pools
Poker
Twenty-one
Paddlewheels
Compared to a "local permit," and organization with a "charity local permit" may conduct 3 more game types, but is restricted to 1 event per year, must file an information report with the city ro county and Office of Attorney General, and must disburse net income to eligible uses. These uses are described by North Dakota Centry Code § 99-01.3-14-02. Refer to the backside of the "Report on a Charity Local Permit" form for a general list of eligible uses.

For a charity local permit, one method to ensure that the total of all cash prizes and retail value of all merchandise prizes do not exceed $12,000 is to charge each player a standard amount at the start of the event for a certain number or value of chips. If a player loses all of the player's chips, the player may re-buy chips. The player would play games and, at the end of the event, the organization would auction merchandise prizes to the players. The player who bid the highest humber or value of chips for a prize would with that prize. For those players who have chips but did not successfully bid on a prize, the organization may redeem the chips for a predetermined cash value per chip. For this method, the value of player's chips redeemed for cash is not a prize.

INFORMATION REQUIRED TO BE PREPRINTED ON A STANDARD RAFFLE TICKET:

  1. Name of organization;
  2. Ticket number;
  3. Price of the ticket, including any discounted price;
  4. Prize, description of an optional prize selectable by a winning player, or option to convert a merchandise prize to a cash prize that is limited to the lesser of the value of the merchandise prize or one thousand dollars. However, if there is insufficient space on a ticket to list each minor prize that has a retail price not exceeding fifteen dollars, an organization may state the total number of minor prizes and their total retail price;
  5. For a licensed organization, print "office of attorney general" and license number. For an organization that has a permit, print the authorizing city or county and permit number;
  6. A statement that a person is not required to be present at a drawing to win;
  7. Date and time of the drawing or drawings and, if the winning player is announced later, date and time of that announcement. For a calendar raffle, if the drawings are on teh same day of the week or month, print the day and time of the drawing;
  8. Location and Street address of the drawing;
  9. If a merchandise prize requires a title transer involving the department of transportation, a statement that a winning player is or is not liable for sales or use tax;
  10. If a purchase of a ticket or winning prize is to a person of minimum age, a statement that a person must be at least "___" years of age to buy a ticket, or win a prize;
  11. A statement that a purchase of the ticket is not a charitable donation;
  12. If the secondary is an unguaranteed cash or merchandise prize, a statement that the prize is not guaranteed to be won and odds of winning the prize based on numbers of chances; and
  13. If a prize is live beef or dairy cattle, bison, sheep or pig, a statement that the winning player may convert the prize to a cash prize that is limited to the lesser of the value of the animal or one thousand dollars.