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<br />. <br /> <br />. <br /> <br />. <br /> <br />NUNNESOTA-REv}~UE <br />Gambiing Receipts and Expenses by Site <br /> <br />Schedule A <br /> <br />PremIses name <br /> <br />MonlhNear <br /> <br />License and Site permit nun-,ber <br /> <br />The Blue Fox <br /> <br />B-03074 <br /> <br />10/2005 <br /> <br />029 <br /> <br />Bingo <br /> <br /> A B C <br /> Gross receipts Prizes Net receipts <br />1A 1B 1C 0.00 <br />2A 2B 2C .00 <br />3A 3B 3C 0,00 <br />4A ,00 4B ,00 4C .00 <br /> <br />2 Raffles. <br /> <br />3 Paddlelickets <br /> <br />4 Add lines 1 through 3_ <br /> <br />5 if Hne 6e of iast t'rJonih's Form Gi is negaiive, <br />see instructions, pg. 9 <br /> <br />,00 <br /> <br />.00 <br /> <br />5C <br />.006C <br /> <br />.00 <br /> <br />5A <br />6A <br /> <br />.00 6B <br /> <br />6 Subtract fine 5 from line 4 <br /> <br />7 Income from interest and dividends <br />(see instructions, pg. 9) <br /> <br />7C <br />8C <br /> <br />7A <br />8A <br /> <br />8B <br /> <br />.00 <br /> <br />8 Tipboards_ <br /> <br />9 Pulltabs. <br /> <br />100,143,00 9C <br /> <br />126,110.00 9B <br /> <br />9A <br /> <br />25,967.00 <br /> <br />10 Add lines 6 through 9. Line i0e is <br />your gross profit for the month <br /> <br />100,143,00 10C <br /> <br />25,967.00 <br /> <br />126,110.00 10B <br /> <br />10A <br /> <br />There are no lines 11-17. <br /> <br />18 Beginning inventory (from line 21 oflas! month's Schedule A) <br /> <br />18 <br /> <br />19 <br />20 <br /> <br />866.21 <br />2,380.42 <br />3,246.63 <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 lines 18 and 19 <br /> <br />21 Ending inventory (dol/ar 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 />24 Penalty and interest paid on taxes (including payrolllaxes) on any <br />Form G1 or Form LG1010, Schedure C/O since beginning gambling activities <br />25 Advertising expenses (see instructions, pg.9) <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 />100,00 <br /> <br />(12,00) <br /> <br />1,089.75 <br />2,156.88 <br />5,494.08 <br /> <br />23 Compensation and payroll taxes <br /> <br />66.14 <br />1,545.79 <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 fOf authorized lawfur 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 />1,750,00 <br /> <br />30 Utilities and other related expenses <br /> <br />31 Theft insurance and the amount permitted for lIabilily 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 fong, 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 <br /> <br />35 Reimbursement for negative expense calculation (this is a negative amount; see inst, pg 9; <br /> <br />36 Total allowable expenses (add fines 22 through 35) <br /> <br />36 <br /> <br />11,10089 <br /> <br />(Rev 11/02) <br />