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OR ILLEGAL GAMBLING RELATED ACTIVITY ANONYMOUSLY TIP LINE: 1-888-314-2682 SUBMIT A TIP: WWW.MICHIGAN.GOV/MGCB This form is authorized under Public Act 69 of 1997, the Michigan Gaming Control and Revenue Act. Failure to provide information could result in rejection of or delay in the processing of this application. The Board will not process an application for an occupational license unless the application includes a written statement from a casino or supplier licensee that the applicant has b.

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