Form Fs-92 - Bingo Card Refund Request Page 3

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BINGO PAPER WORKSHEET SUMMARY
Organization Name:
License #
Authorized Person:
I.D.:
Page Number
Face Value Total
DOR Use Only
1
2
3
4
5
6
7
8
9
10
11
Carry to Page 1
12
Card Face Value Total
20812020

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Parent category: Financial
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