Lg220A Form PDF Details

In the state of Minnesota, organizations that host lawful gambling events under an exempt permit need to navigate through a detailed financial reporting process, as outlined by the LG220A Exempt Permit Financial Report form. This necessity stems from the state law requirement for these organizations to submit a comprehensive financial report to the Gambling Control Board within 30 days following each gambling occasion, in accordance with Minnesota Statutes, section 349.166, subd. 2(a)(6). The LG220A form is designed to capture critical data ranging from the organization's information to detailed financial activities conducted during the event, including gross receipts and net profits, alongside a precise account of the expenses incurred. It also requires listing the total value of prizes, whether purchased, donated, or cash, and if applicable, information about gambling equipment distributors. Moreover, the form serves as a legal document that must be authenticated by the organization’s Chief Executive Officer, ensuring that all provided financial information is true, accurate, and complete. Organizations are mandated to retain records and reports related to the exempt raffle for a period of 3-1/2 years, safeguarding compliance with state regulations. The form, once filled and submitted, becomes public information and plays a pivotal role in determining an organization's adherence to laws and rules governing lawful gambling activities in Minnesota. This comprehensive approach underlines the state's commitment to ensuring transparency and accountability in gambling events, contributing to the responsible conduct of such activities within the community.

QuestionAnswer
Form NameLg220A Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesceo, subd, roseville, lg220a exempt permit financial reporting form

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MINNESOTA LAWFUL GAMBLING

8/18

 

LG220A Exempt Permit Financial Report

By state law, organizations that received an exempt permit (using the LG220 application form) are required to submit a financial report within 30 days of each gambling occasion (Minn. Statutes, section 349.166, subd. 2(a)(6)).

Complete the information below. Email, fax or mail to the Gambling Control Board within 30 days of the gambling activity date.

Your organization must keep all exempt raffle records and reports for 3-1/2 years (Minn. Statutes, section 349.166, subd. 2(f)).

ORGANIZATION INFORMATION

Organization Name: ________________________________________________________________________________________

Mailing Address: ____________________________________ City: ______________________ State: _____ Zip: ____________

Activity Dates: _____________________ to _____________________ Exempt Permit Number X_____________________

FINANCIAL REPORT

Activity conducted

 

Expenses, including

Net profit

Gross receipts

cost of purchased and

(subtract expenses

for each activity

cash prizes

from gross receipts)

Total Value of Prizes

-Purchased (full retail value even if discounted)

-Donated (full retail value)

-Cash (total face value of dollars awarded)

Bingo

Raffle

Paddlewheel

Tipboard

Pull-Tabs

DISTRIBUTOR INFORMATION

If paddlewheels, tipboards, or pull-tabs are conducted, list the licensed distributor from whom the gambling equipment was purchased.

Distributor: ___________________________________________________ Date of Purchase: ____________________________

ACKNOWLEDGMENT OF CHIEF EXECUTIVE OFFICER (CEO)

I declare that all financial information is true, accurate, and complete.

Print Name of Current CEO: __________________________________________________ Phone: _________________________

Signature of Current CEO: ___________________________________________________ Date Signed: ____________________

Email: ___________________________________________________________________________________________________

MAIL OR FAX TO:

Minnesota Gambling Control Board

1711 W County Road B, Suite 300 South

Roseville, MN 55113

EMAIL: gcb.financialreports@state.mn.us

FAX: 651-639-4032

DATA PRIVACY NOTICE:

The information on this form and any attachments will become public information when received by the Board and will be used to determine your compliance with Minnesota statutes and rules governing lawful gambling activities.

Questions? Contact the Licensing Specialist assigned to your county by calling 651-539-1900.

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