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<br />NllNNESOTA-REVENUE Schedule A <br />Gambling Receipts and Expenses by Site <br />Premises name license and Site permit number Month/year <br />The Blue Fox B-03074 029 04/2005 . <br /> A B C <br /> Gross receipts Prizes Net receipts <br /> Bingo. 1A 1B 1C 0,00 <br />2 Raffles 2A 2B 2C .00 <br />3 Paddletickets 3A 3B 3C 0.00 <br />4 Add Jines 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 ,00 6C 00 <br />7 Income from interest and dividends <br /> (see instructions, P9- 9) _ 7A 7C <br />8 Tipboards . 8A 8B 8C .00 <br />9 Pulltabs 9A 122,53900 9B 98,152.00 9C 24,387.00 <br />10 Add lines 6 through 9. Line 10C is 24,387,00 <br /> your gross profit for the month 10A 122,53900 10B 98,152,00 10C <br /> <br />There are no lines 11-17, <br /> <br />18 Beginning inventory (from line 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 distributors invoices) <br />20 Add rines 18 and 19 <br /> <br />21 Ending inventory (dollar value on the last day of the month - - do not include safes 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 payrolllaxes) on any <br />Form Gl or Form LG1010, Schedule e/D since beginning gambling activities <br />25 Advertising expenses (see instructions, pg.9) <br /> <br />26 Accounting services for lawful gambling tax tomlS, annual financial audit or review <br />qualifying legal work <br />27 Bank service charges, office supplies; cost tor authorized lawful gambling classes, <br />storage expenses and misceflaneous expenses <br />28 Purchase and/or repair expenses for office furnishings, 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 permitted for liability insurance <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 calculation (this is a negative amount; see ins!., pg. <br /> <br />36 Total allowable expenses (add lines 22 through 35) <br /> <br />(Rev 1i(02) <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 />511.62 <br />1,919,35 <br />2,430.97 <br /> <br />395.20 <br />~~.-_. <br />2,035,77 <br />5,137.56 <br /> <br />100.00 <br />337,15 <br /> <br />1,75000 <br /> <br />100,00 <br /> <br />124.00 <br /> <br />. <br /> <br />9,58448 <br />