Form Inv - Annual Certified Physical Inventory And Cash Count By Site Page 2

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INV
Page 2
Annual Certified Physical Inventory and Cash Count by Site
(continued)
Organization Name
Site Name and Permit Number
Federal ID Number
Minnesota Tax ID Number
License Number
Part 1
(Must be completed by two individuals not involved
with the gambling operation or by a CPA)
Manufacturer ID
Part Number
Serial Number

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