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RENEWAL APPLICATION FOR BINGO DISTRIBUTORS KANSAS DEPARTMENT OF REVENUE Charitable Gaming Docking State Office Building - Room 214 FEE FOR OFFICE USE ONLY $500.00 Statutory Registration Fee DISTR.

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KANSAS SSN FEIN licensees BI-178 2004 DISTR APPR contendere subcontractors undersigned nolo DOB Facsimile SW salespeople SUBSCRIBED Enclose DISTRIBUTORS distributing applicant Notary Topeka Statutory therein RENEWAL particulars contractors Expires pleaded

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