All Forms by License or Alpha

Minnesota Gambling Control Board
1711 West County Road B, Suite 300 South
Roseville, Minnesota 55113
651-639-4000

The five forms of lawful gambling are
raffles, bingo, pull-tabs, tipboards, and paddlewheels.

Forms for Licensed Organizations.
To return to the Minnesota Gambling Control Board home page, click here.
Forms on this site require Adobe Acrobat Reader 7.0.5.
Click on the Get Acrobat Reader icon to download a free copy.

For non-numbered forms, schedules, worksheets, tax forms, and
miscellaneous forms, click here.

G1

Lawful Gambling Monthly Tax Return.

G7430

Lawful Gambling Fund of Tax Paid on Unsold Pull-tab and Tipboard Tickets.

LG200A

New Organization License Application.

LG200B

Organization Officers Affidavit.

LG200C

501(c)(3) organization and 501(c)(4) festival organization. LG200C Information.

LG202

Internal Controls Worksheet.

LG204

License Termination Plan.

LG209

Registration/Termination of Paid Gambling Employee.

LG212

Gambling Manager Application.

LG214

Premises Permit Application.

Before the Gambling Control Board can issue a premises permit, the local unit of government where the premises is located (city or county) must give prior approval of the application.

To give prior approval, the local unit of government must:
1. sign the application,
2. record the date the application was approved by resolution, and
3. record the resolution number.
The approval must be within 90 days of the date the application is received by the Gambling Control Board.

LG215

Lease for Lawful Gambling Activity.

LG216

Worksheet for Calculating Lawful Gambling Monthly Rent.
Use landscape print setting.

LG230

Application to Conduct Off-site Gambling.
(NOTE: This form is not used by exempt or excluded organizations.)

LG250

Fund Loss Request for Profit Carryover Adjustment.

LG251

Rule Variance Request.

LG262

Request to Replace Building Destroyed or Made Uninhabitable by Fire or Other Catastrophic Event.

LG263

Request to Replace Building Taken or Sold Under Eminent Domain Proceeding.

LG266

Request for Real Property or Capital Assets Used Exclusively for Lawful Purpose.

LG267

Worksheet for Code A22 Real Property or Capital Assets. Optional form to track Code A22 expenditures, if any. Use Landscape print setting.

Guidelines for Real Property and Capital Assets Used Exclusively for Lawful Purpose.

LG268

Request for Replacement Building Meeting ADA Requirements.

LG269

Request to Exceed Annual Limit for Code A22.

LG270

Request to Contribute Gambling Funds to Another Licensed Gambling Organization.

LG281

Pull-tab Dispensing Device - Key Log.

LG282

Pull-Tab Dispensing Device Access Log.

LG283

Cash Register Cash Count Report.

LG284

Cash Register Discrepancy Report.

LG285

Cash Register Monthly Reconciliation Report.

LG286

Pull-Tab Dispensing Device Game Receipts Tracking.

LG287

Pull-tab Dispensing Device Cash Bank Reconciliation.

LG470

Progressive Pull-tab or Tipboard Jackpot Tracking Record.

LG471

Progressive Pull-tab or Tipboard Contact Information.

LG472

Progressive Pull-tab or Tipboard Jackpot Prize Receipt.

LG473

Progressive Pull-tab or Tipboard Audit Record.

LG474

Progressive Pull-tab or Tipboard Jackpot Monthly Worksheet.

LG500

City or County Annual Report, Lawful Gambling Regulatory Tax.

LG510

City or County Annual Report, 10% Lawful Gambling Contribution Fund.

LG555

Government Approval or Acknowledgment for Use of Gambling Funds.

LG750

Paddlewheel with Table - Daily Report.

LG751

Paddlewheel with Table - Daily Sales Report.

LG752

Paddlewheel with Table - Operator's Percentage of Hold.

LG807

Bingo Hard Card Sales.

LG808

Checker�s Record/Hard Cards.

LG809

Checker's Prize Winner Record/Hard Cards.

LG810

Caller Verification Form/Hard Cards.

LG811

Bingo Occasion Summary/Hard Cards.

LG820

Raffle Inventory and Sales Log.

LG821

Physical Inventory/Raffles.

LG830

Merchandise Prize Perpetual Inventory.

LG844

Perpetual Inventory/Pull-Tabs, Tipboards, and/or Paddletickets.

LG846

Physical Inventory/Pull-Tabs, Tipboards, and/or Paddletickets Monthly Report.

LG847

Current Site Inventory List.

LG853

Pull-tab Inspection Check List.

LG854

Pull-tab Dispensing Device Inspection Check List.

LG855

Paddlewheel (Without Paddlewheel Table) Inspection Check List.

LG856

Paddlewheel with Table Inspection Check List.

LG857

Tipboard Inspection Check List.

LG859

Bingo Inspection Check List.

LG861

Site Control/Tracking and Auditing of Pull-tab Game.

LG900

Perpetual Inventory Control/Bingo Paper.

LG901

Perpetual Inventory Control/Commingled Bingo Paper.

LG902

Perpetual Inventory Control/Bingo Paper Packages.

LG903

Physical Inventory Control/Bingo Paper Monthly Summary.

LG904 and LG905

Admission Sales/Summary of Bingo Paper.

LG906

Floor Sales/Bingo Paper.

LG907

Bingo Game Prize Winner Sheet/Bingo Paper.

LG908

Caller Verification Form/Bingo Paper.

LG909

Bingo Occasion Summary/Bingo Paper.

LG913

Bingo Program Check List.

LG920

Bar Bingo Paper Sales. LG920 instructions.

LG930

Linked Bingo Paper Perpetual Inventory. LG930 instructions.

LG1004

Monthly Gambling Report to Members.

LG1005

Request for Mentoring.

LG1010

The LG1010 was revised and renamed as Schedule C.

LG1012

Worksheet for Lawful Purpose Rating.
Optional form to track and monitor lawful purpose rating.
Use Landscape print setting.

LG1014

Organization Annual Report (financial summary).
Submit by September 1.

LG1015

Reporting Organization Information Changes.

LG1016

Reporting Gambling Manager Information Changes.

LG1017

Reporting Premises Permit Changes.

ALPHABETICAL LIST OF NON-NUMBERED FORMS, SCHEDULES, WORKSHEETS, TAX FORMS, AND MISCELLANEOUS FORMS.

All tax forms

Link to Department of Revenue website.

Barcode Label Sheet

CC

Annual Certified Cash Count for Games in Play by Site.

CI

Annual Certified Physical Inventory and Cash Count Summary.

INV

Annual Certified Physical Inventory by Site.

Payments Journal

Record of payments for lawful purpose expenditures and allowable expenses.

Prize receipt

Used in the conduct of pull-tabs, bingo, paddlewheels, and tipboards.

Schedule A

Lawful Gambling Receipts and Expenses by Site.

Schedule B2

Lawful Gambling Report of Barcoded Games.

Schedule C

Lawful Purpose Expenditures. Fill-in form, calculates total.
Use Landscape print setting.

Schedule ER

Lawful Gambling Tax Credit for Exempt Raffles.

Schedule F

Lawful Gambling Fund Reconciliation.

Schedule NRL

Net Receipts Loss.

Worksheet CS

Cash Shortages.
Special one-time form for July 2011 to June 2012.

Worksheet E

Lawful Gambling Combined Receipts Tax.

Worksheet P - Manual version
Worksheet P - Excel version

Site Profitability. Optional.
Use with tax reports for January 2012 and after.

Questions? Contact a specialist at the Gambling Control Board.

To return to the Minnesota Gambling Control Board home, click here.

	Minnesota Gambling Control Board 1711 West County Road B, Suite 300 South Roseville, Minnesota 55113 651-639-4000 The five forms of lawful gambling are raffles, bingo, pull-tabs, tipboards, and paddlewheels.
Forms for Licensed Organizations. To return to the Minnesota Gambling Control Board home page, click here. Forms on this site require Adobe Acrobat Reader 7.0.5. Click on the Get Acrobat Reader icon to download a free copy.
For non-numbered forms, schedules, worksheets, tax forms, and miscellaneous forms, click here.
G1
Lawful Gambling Monthly Tax Return.
G7430
Lawful Gambling Fund of Tax Paid on Unsold Pull-tab and Tipboard Tickets.
LG200A
New Organization License Application.
LG200B
Organization Officers Affidavit.
LG200C
501(c)(3) organization and 501(c)(4) festival organization. LG200C Information.
LG202
Internal Controls Worksheet.
LG204
License Termination Plan.
LG209
Registration/Termination of Paid Gambling Employee.
LG212
Gambling Manager Application.
LG214
Premises Permit Application. Before the Gambling Control Board can issue a premises permit, the local unit of government where the premises is located (city or county) must give prior approval of the application. To give prior approval, the local unit of government must: 1. sign the application, 2. record the date the application was approved by resolution, and 3. record the resolution number. The approval must be within 90 days of the date the application is received by the Gambling Control Board.
LG215
Lease for Lawful Gambling Activity.
LG216
Worksheet for Calculating Lawful Gambling Monthly Rent. Use landscape print setting.
LG230
Application to Conduct Off-site Gambling. (NOTE: This form is not used by exempt or excluded organizations.)
LG250
Fund Loss Request for Profit Carryover Adjustment.
LG251
Rule Variance Request.
LG262
Request to Replace Building Destroyed or Made Uninhabitable by Fire or Other Catastrophic Event.
LG263
Request to Replace Building Taken or Sold Under Eminent Domain Proceeding.
LG266
Request for Real Property or Capital Assets Used Exclusively for Lawful Purpose.
LG267
Worksheet for Code A22 Real Property or Capital Assets. Optional form to track Code A22 expenditures, if any. Use Landscape print setting. Guidelines for Real Property and Capital Assets Used Exclusively for Lawful Purpose.
LG268
Request for Replacement Building Meeting ADA Requirements.
LG269
Request to Exceed Annual Limit for Code A22.
LG270
Request to Contribute Gambling Funds to Another Licensed Gambling Organization.
LG281
Pull-tab Dispensing Device - Key Log.
LG282
Pull-Tab Dispensing Device Access Log.
LG283
Cash Register Cash Count Report.
LG284
Cash Register Discrepancy Report.
LG285
Cash Register Monthly Reconciliation Report.
LG286
Pull-Tab Dispensing Device Game Receipts Tracking.
LG287
Pull-tab Dispensing Device Cash Bank Reconciliation.
LG470
Progressive Pull-tab or Tipboard Jackpot Tracking Record.
LG471
Progressive Pull-tab or Tipboard Contact Information.
LG472
Progressive Pull-tab or Tipboard Jackpot Prize Receipt.
LG473
Progressive Pull-tab or Tipboard Audit Record.
LG474
Progressive Pull-tab or Tipboard Jackpot Monthly Worksheet.
LG500
City or County Annual Report, Lawful Gambling Regulatory Tax.
LG510
City or County Annual Report, 10% Lawful Gambling Contribution Fund.
LG555
Government Approval or Acknowledgment for Use of Gambling Funds.
LG750
Paddlewheel with Table - Daily Report.
LG751
Paddlewheel with Table - Daily Sales Report.
LG752
Paddlewheel with Table - Operator's Percentage of Hold.
LG807
Bingo Hard Card Sales.
LG808
Checker�s Record/Hard Cards.
LG809
Checker's Prize Winner Record/Hard Cards.
LG810
Caller Verification Form/Hard Cards.
LG811
Bingo Occasion Summary/Hard Cards.
LG820
Raffle Inventory and Sales Log.
LG821
Physical Inventory/Raffles.
LG830
Merchandise Prize Perpetual Inventory.
LG844
Perpetual Inventory/Pull-Tabs, Tipboards, and/or Paddletickets.
LG846
Physical Inventory/Pull-Tabs, Tipboards, and/or Paddletickets Monthly Report.
LG847
Current Site Inventory List.
LG853
Pull-tab Inspection Check List.
LG854
Pull-tab Dispensing Device Inspection Check List.
LG855
Paddlewheel (Without Paddlewheel Table) Inspection Check List.
LG856
Paddlewheel with Table Inspection Check List.
LG857
Tipboard Inspection Check List.
LG859
Bingo Inspection Check List.
LG861
Site Control/Tracking and Auditing of Pull-tab Game.
LG900
Perpetual Inventory Control/Bingo Paper.
LG901
Perpetual Inventory Control/Commingled Bingo Paper.
LG902
Perpetual Inventory Control/Bingo Paper Packages.
LG903
Physical Inventory Control/Bingo Paper Monthly Summary.
LG904 and LG905
Admission Sales/Summary of Bingo Paper.
LG906
Floor Sales/Bingo Paper.
LG907
Bingo Game Prize Winner Sheet/Bingo Paper.
LG908
Caller Verification Form/Bingo Paper.
LG909
Bingo Occasion Summary/Bingo Paper.
LG913
Bingo Program Check List.
LG920
Bar Bingo Paper Sales. LG920 instructions.
LG930
Linked Bingo Paper Perpetual Inventory. LG930 instructions.
LG1004
Monthly Gambling Report to Members.
LG1005
Request for Mentoring.
LG1010
The LG1010 was revised and renamed as Schedule C.
LG1012
Worksheet for Lawful Purpose Rating. Optional form to track and monitor lawful purpose rating. Use Landscape print setting.
LG1014
Organization Annual Report (financial summary). Submit by September 1.
LG1015
Reporting Organization Information Changes.
LG1016
Reporting Gambling Manager Information Changes.
LG1017
Reporting Premises Permit Changes.
ALPHABETICAL LIST OF NON-NUMBERED FORMS, SCHEDULES, WORKSHEETS, TAX FORMS, AND MISCELLANEOUS FORMS.
All tax forms
Link to Department of Revenue website.
Barcode Label Sheet

CC
Annual Certified Cash Count for Games in Play by Site.
CI
Annual Certified Physical Inventory and Cash Count Summary.
INV
Annual Certified Physical Inventory by Site.
Payments Journal
Record of payments for lawful purpose expenditures and allowable expenses.
Prize receipt
Used in the conduct of pull-tabs, bingo, paddlewheels, and tipboards.
Schedule A
Lawful Gambling Receipts and Expenses by Site.
Schedule B2
Lawful Gambling Report of Barcoded Games.
Schedule C
Lawful Purpose Expenditures. Fill-in form, calculates total. Use Landscape print setting.
Schedule ER
Lawful Gambling Tax Credit for Exempt Raffles.
Schedule F
Lawful Gambling Fund Reconciliation.
Schedule NRL
Net Receipts Loss.
Worksheet CS
Cash Shortages. Special one-time form for July 2011 to June 2012.
Worksheet E
Lawful Gambling Combined Receipts Tax.
Worksheet P - Manual version Worksheet P - Excel version
Site Profitability. Optional. Use with tax reports for January 2012 and after.
Questions? Contact a specialist at the Gambling Control Board.
To return to the Minnesota Gambling Control Board home, click here.