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<br />MlNNESOT A - REVENUE Schedule A <br />Gambiing Receipts and Exp~nses by Site <br />Premises namG. License- and Site permit number Month/year <br />The Blue Fox B-03074 029 08/2005 . <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 lines 1 through 3 . 4A 00 4B ,00 4C .00 <br />5 If line 6c of last month's Form 131 is r,egative, <br /> see instructions, pg_ 9 5A ,00 5C .00 <br />6 Subtract line 5 from tine 4 . 6A ,00 6B .00 6C .00 <br />7 Income from interest and dividends <br /> (see instructjons, pg. 9) . 7A 7C <br />8 Tipboards 8A 8B 8C ,00 <br />9 Puiltabs 9A 114,299.00 9B 90,742.00 9C 23,557.00 <br />i D Add Jines 6 through 9 Line 10C is <br /> your gross profit for the month lOA 114,299,00 10B 90,742,00 10C 23,557.00 <br /> <br />There are no lines 11-17. <br /> <br />18 Beginning inventory (from line 21 of last month's Schedule A) <br /> <br />18 <br /> <br />19 <br />20 <br /> <br />669.64 . <br />2,31183 <br />2,981.47 <br /> <br />19 Cost of gambling product obtained during the month (include sales lax and <br />freight charges, but do not include the 1.7 percent lax listed on distributor's invoices) <br />20 Add lines 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 distnbutor's invoices) <br />22 Total value of gambling producls sold (subtract line 21 from line 20) <br /> <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 /> <br />882.01 <br />2,099.46 <br />6,368.52 <br /> <br />23 Compensation and payrolllaxes <br /> <br />24 Penalty and interest paid on laxes (including payroll taxes) on any <br />Form G1 or Form LG1010, Schedule C/O since beginning gambling activities <br />25 Advertising expenses (see instructions, P9.9) <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 lawful gambling classes, <br />storage expenses and miscellaneous 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 />64,66 <br />221.41 <br /> <br />1,750,00 <br /> <br />30 Utilities and other related expenses <br /> <br />31 Theft insurance and the amount permitted for liability insurance <br /> <br />39,00 <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 fang, put parentheses around the amount) <br /> <br />40,00 <br /> <br />34 Reimbursement for excess cash shorl (this is a negative amouN: see instructions. pg. 8) <br /> <br />35 <br /> <br />. <br /> <br />35 Reimbursement for negotive expense calculation (this is a negative amount; see ins!., pg. 9) <br /> <br />36 Total allowable expenses (add fines 22 through 35) <br /> <br />36 <br /> <br />10,583.05 <br /> <br />(Rev. 11/02) <br />