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<br />MINNESOTA - REVENUE Schedule A <br />Gambling Receipts and Expenses by Site <br />Premises name license and Site permit number Monih/year <br />The Blue Fox B-03074 029 02/2005 . <br /> A B C <br /> Gross receipts Prizes Net receipts <br /> Bingo. 1A 1B 1C 0,00 <br />2 Raffles. 2A 28 2C .00 <br />3 Paddletickets 3A 3B 3C 0,00 <br />4 Add lines 1 through 3 . 4A .00 4B ,00 4C ,00 <br />5 If line 6c of last month's Form G1 is negative, <br /> see instructions, pg. 9 5A .00 5C .00 <br />6 Subtract line 5 from line 4 _ 6A .00 6B .006C ,00 <br />7 Income (rom interest and dividends <br /> (see instructiDns, P9- 9) . 7A 7C <br />8 Tipboards 8A 8B 8C .00 <br />9 Pulltabs. 9A 110,934.00 9B 87,652.00 9C 23,282,00 <br />10 Add lines 6 through 9. Line 10C is 23,282.00 <br /> your gross profit for the month 10A 110,934.00 10B 87,652.00 10C <br /> <br />There are no lines 11-17. <br /> <br />1 B Beginning inventory (from Fine 21 of last month's Schedule A) <br /> <br />19 Cost of gambling product obtained during the month (include sales tax and <br />freight charges, but do not include the 1_7 percent tax listed on distributor's invoices) <br />20 Add fines 18 and 19 <br /> <br />21 Ending inventory (dollar value on the last day of the month - - do not include sales tax, <br />freight charges or the 1. 7 percent tax on distributor's invoices) <br />22 Total value of gambling products sold (subtract line 21 from line 20) <br /> <br />23 Compensation and payroll taxes <br /> <br />24 Penalty and interest paid on taxes (including payroll taxes) on any <br />Fonn G1 or Fonn LG1010, Schedule C/O since beginning gambling activities <br />25 Advertising expenses (see instructions, pg.9) <br /> <br />26 Accounting services for lawful gambling tax forms, annual financial audit or review <br />qualifying legal work <br />27 Bank service charges, office supplies; cost for authorized la'vVtul gambling classes, <br />storage expenses and miscellaneous expenses <br />28 Purchase and/or repair expenses for office fumishings, office equipment <br />and devices used for gambling <br />29 Rent for conducting lawful gambling <br /> <br />30 Utilities and other related expenses <br /> <br />31 Theft insurance and the amount penniHed for liability jnsurance <br /> <br />32 Local government investigation fee, and costs for new or renewed gambling <br />manager's bond <br />33 Cash long or cash short (if cash long, put parentheses around the amount) <br /> <br />34 Reimbursement for excess cash short (this is a negative amount; see instructions, pg. 8) <br /> <br />35 Reimbursement for negative expense calculaHon (this is a negative amount; see inst., pg. <br /> <br />36 Total allowable expenses (add lines 22 through 35) <br /> <br />(Rev. 11102) <br /> <br />18 <br />19 <br />20 <br />21 <br />22 <br />23 <br />24 <br />25 <br />26 <br />27 <br />28 <br />29 <br />30 <br />31 <br />32 <br />33 <br />34 <br />35 <br />9) <br />36 <br /> <br />. <br /> <br />307,09 <br /> <br />1,869.70 <br /> <br />2,176.79 <br /> <br />346,86 <br />1,829.93 <br />5,353.97 <br /> <br />33472 <br /> <br />260,84 <br /> <br />1,750.00 <br /> <br />33,00 <br /> <br />9,562.46 <br /> <br />. <br />