Minnesota
Gambling Control Board
Main office:
Suite 300 South
1711 West County Road B
Roseville, MN 55113
651-539-1900
651-639-4032 (fax)
All forms sorted by form number
View miscellaneous forms and worksheets ›
Click on the tab within the number range to locate a form.
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LG100s
LG200s
LG300s
LG400s
LG500s
LG600s
LG700s
LG800s
LG900s
LG1000s
The LG100A, LG100C, and LG100F, including the optional LG100, are a part of one worksheet in the GCBREPORTS required monthly filing.
LG100A, Lawful Gambling Receipts and Expenses by Site
LG100C, Lawful Purpose Expenditures
LG100F, Lawful Gambling Fund Reconciliation
LG200A New Organization License Application
LG200B Organization Officers Affidavit
LG202 Internal Controls Worksheet
LG204 License Termination Plan
LG212 Gambling Manager Application
LG214 Premises Permit Application
LG215 Lease for Lawful Gambling Activity
LG216 Worksheet for Calculating Lawful Gambling Monthly Rent - Excel version
LG216 Worksheet for Calculating Lawful Gambling Monthly Rent - Manual version
LG220 Application for Exempt Permit
LG220A Exempt Permit Financial Report
LG230 Application to Conduct Off-Site Gambling
LG240B Application to Conduct Excluded Bingo
LG250 Fund Loss Request for Profit Carryover Adjustment
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 and Guidelines
LG267 Worksheet for Code 22 Real Property or Capital Assets and Guidelines
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
LG272 Request for Lawful Gambling Account Loan to General Account
LG275 Request to Transfer Gambling Funds to General Fund
LG281 Pull-Tab Dispensing Device - Key Log
LG282 Pull-Tab Dispensing Device Access Log
LG283 Point-of-Sale System Cash Count Report
LG284 Point-of-Sale System Discrepancy Report
LG285 Point-of-Sale System Monthly Reconciliation Report
LG400 Application for License to Distribute Gambling Equipment
LG410 Distributor Personnel Information
LG411 Distributor Salesperson License Application
LG412 Distributor Nonsales Employee Information
LG420 Distributor to Organization Lease Agreement for Pull-Tab Dispensing Device
LG422 Distributor License Termination Plan
LG423 Distributor to Organization Sales Agreement for Pull-Tab Dispensing Device
LG431 State Registration Stamp Order Form
LG432 Registration of Permanent Equipment
LG461 Delinquent Organization Report
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
LG600 Manufacturer License Application
LG610 Manufacturer Personnel Information
LG620 Manufacturer to Distributor Lease Agreement for Pull-Tab Dispensing Device
LG621 Manufacturer Returned Equipment Report
LG622 Manufacturer's License Termination Plan
LG623 Manufacturer to Distributor Sales Agreement for Pull-Tab Dispensing Device
LG633 Manufacturer to Distributor Sales Agreement for Electronic Pull-Tab System and Device(s)
LG661 Manufacturer's or Linked Bingo Game Provider's Report of Delinquent Distributor
LG808 Checkers 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
LG822 Monthly Raffle Summary Worksheet
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
LG852 Electronic Pull-Tab or Linked Bingo System Inspection Checklist
LG853 Pull-Tab Inspection Checklist
LG854 Pull-Tab Dispensing Device Inspection Checklist
LG855 Paddlewheel (without Paddlewheel Table) Inspection Checklist
LG856 Paddlewheel with Table Inspection Checklist
LG857 Tipboard Inspection Checklist
LG859 Bingo Inspection Checklist
LG861 Site Control/Tracking and Auditing of Pull-Tab Game
LG861e Daily Cash Bank Accounting for Electronic Pull-Tabs and Electronic Linked Bingo
- LG861e Video Tutorial (updated 8/7/19)
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
LG907 Bingo Game Prize Winner Sheet/Bingo Paper
LG908 Caller Verification Form/Bingo Paper
LG909 Bingo Occasion Summary/Bingo Paper
LG911 Monthly Bingo Summary Worksheet
LG914 Bingo Gift Certificate Tracking (Excel)
LG1004 Monthly Gambling Report to Members
LG1007 Profit Carryover Adjustment Request
LG1012 Worksheet for Lawful Purpose Rating
LG1015 Reporting Organization Information Changes
LG1016 Reporting Gambling Manager Information Changes
LG1017 Reporting Premises Permit Changes
LG1060 Inventory and Discounts Report (for manufacturers, linked bingo game providers, and distributors)
Quick Links
Miscellaneous forms and worksheets
Bingo Gift Certificate Internal Controls
Form I-9 (U.S. government-required employee form) (organizations must keep the I-9 with their gambling
records for 3-1/2 years)
Prize Receipt (one on a page) - Prize Receipt (four on a page)
Winner Verification Form (for electronic linked bingo prize of $600 or more; linked bingo prize of $600 or more, and progressive electronic pull-tab prize of $600 or more)
Worksheet - Electronic Game Occasion Deposits
Worksheet ELB - Calculation of Amounts Due Linked Bingo Game Provider
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