RAFFLE INFORMATION
Organization name: ___________________________________________________________________ License/premises permit number: ____________________________
Name of raffle: ______________________________ Person in charge of raffle: ___________________________ Date of raffle: _____________ Time: ________ a.m./p.m.
Location of raffle: ___________________________________________________ Attach a copy of a complete raffle ticket or certificate of
participation for each price level
TICKET OR CERTIFICATE INFORMATION
Supplier of tickets or certificates: ______________________________ Invoice date: _____________ Invoice number: ________________ Total number printed: _________
Actual cost of tickets or certificates (not including sales tax and freight): $______________________
Column 1 Column 2 Column 3 Column 4 Column 5 Column 6 Column 7 Column 8 Column 9
Date Seller’s name and phone number
Quantity and
sequential
numbers to sell
Quantity and
sequential
numbers returned
Quantity
sold
Price of each
ticket or
certificate
Total gross
receipts
Col. 5 x Col. 6
Actual dollar
amount
received
Cash long or
<short>
Col. 8 - Col. 7
Totals from other pages for raffle
TOTALS
Record on the LG100A
line 7A line 22
MINNESOTA LAWFUL GAMBLING Page 1
LG820 Raffle Inventory and Sales Log 7/15
Resume Templates 1210 Document(s)
