Lg907 Bingo Game Prize Winner Sheet/bingo Paper
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3MINNESOTA LAWFUL GAMBLING
5/06
Page 1 of 2
LG907 Bingo Game Prize Winner Sheet/Bingo Paper
Complete in ink.
Organization
License/premises permit number
Occasion and Prize Information
Occasion date ____________________ Starting cash $ _________________ Initials ___________
Occasion time ___________ a.m./p.m. Ending cash $ _________________ Initials ___________
Column 1
Column 2
Column 3
Column 4
Column 5
Prize amount
Game name
Number of
awarded to each winner
Total prize amount
Winning sheet faces
or
bingos
[do not include a linked
for game
number
Serial number
Face number
per game
bingo jackpot prize]
Col. 3 x Col. 4
Total prizes won,
in ink
Summary
[The summary information must be entered in ink.]
1. Total of prizes paid by check and the actual cost to
1. ______________________________
organization for merchandise prizes for this occasion.
[Do not include coupons or donated prizes.]
Also enter this amount on line 11a of LG909.
2. ______________________________
2. Contribution to linked bingo jackpot prize pool, if any.
Also enter this amount on line 11b of LG909.
3. ______________________________
3. Prizes paid by cash at this occasion.
4. Add lines 1, 2, and 3 to determine total prizes paid.
4. ______________________________
Also enter this amount on line 6 of the LG909.
Preparer’s Information
To the best of my knowledge, I declare that this information is accurate and complete
[pages ____ to _____]
Preparer’s signature, in ink ______________________________________ Date ___________________
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