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Bingo hard cards and bingo number selection devices may be borrowed from another organization <br />authorized to conduct bingo. Otherwise, bingo hard cards, bingo paper, and bingo number selection devices must <br />be obtained from a distributor licensed by the Minnesota Gambling Control Board. To find a licensed distributor, go <br />to www.gcb.state.mn.us and click on Distributors under the WHO'S WHO? LIST OF LICENSEES, or call <br />651-539-1900. Be sure to complete page 2 <br />LG240B Application to Conduct Excluded Bingo <br />6/13 Page 2 of 2 <br />CHIEF EXECUTIVE OFFICER'S SIGNATURE <br />The information <br />Chief executive <br />Print name <br />provided in this appcation is complete and accurate to the best of my knowledge. <br />officer's signature Date_ 06/12/2015 <br />Christine Montour <br />LOCAL UNIT OF GOVERNMENT ACKNOWLEDGMENT <br />On behalf <br />bingo activity <br />jurisdiction. <br />Print city <br />Signature <br />CITY APPROVAL for <br />a gambling premises <br />located within city <br />limits <br />of the city, I approve this application for excluded <br />at the premises located within the city's <br />i , <br />name �'� ''�� <br />COUNTY APPROVAL for <br />a gambling premises <br />located in a township <br />On behalf of the county, I approve this application for excluded <br />bingo activity at the premises located within the county's <br />jurisdiction. <br />Print county name <br />of city personnel <br />Signature of county personnel <br />Title? <br />Date € . <br />Title Date <br />Local unit ofgovernmenttn115 SILO <br />TOWNSHIP - If required by the approving county. <br />On behalf of the township, I acknowledge that the organization <br />is applying for excluded bingo activity within the township <br />limits. [A township has no statutory authority to approve or <br />deny an application, per Minnesota Statutes 349.166, Subd 2.] <br />Print township name <br />Signature of township officer <br />Title Date <br />MAIL APPLICATION AND ATTACHMENT <br />Fax the application and a copy of your proof of <br />nonprofit status to (651) 639-4032 or mail to: <br />Gambling Control Board <br />1711 West County Road B, Suite 300 South <br />Roseville, MN 55113 <br />You will receive a document from the Gambling Control Board <br />with your excluded permit number for the bingo activity. <br />Your organization must keep its bingo records for 3-1/2 years. <br />Questions? <br />Call the Licensing Section of the Gambling Control Board <br />at 651-539-1900. <br />This form will be made available in alternative format (i.e. large print, Braille) <br />upon request. <br />