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A Licensing Specialist is assigned to each county. Your Licensing Specialist is listed at www. mn.gov/gcb or call 651-539-1900. Mail to Minnesota Gambling Control Board Suite 300 South 1711 West County Road B Roseville MN 55113 Email addresses are private data under Minn. Stat. Make check payable to State of Minnesota. Copy of the gambling manager bond. Questions Call our Licensing Section at 651-539-1900. Signature of CEO must be CEO s signature designee may not sign Date AFFIDAVIT AND...

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Any individual or entity that is required to pay an annual fee of $100 as a non-refundable charge needs to fill out the form. This can include individuals applying for certain licenses or permits, businesses fulfilling regulatory requirements, or members of a particular organization or association.

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