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<br />; <br /> <br /> <br />JUN 0 9 2003 <br /> <br />'Esta6{isheJ: 1857 <br /> <br />CITY OF CENTERVILLE <br />Monthly Gambling Summary <br /> <br />Ten Percent Net Profit Calculation <br /> <br />A. <br /> <br />Net Receipts - Total lines 2c, 3c, 8c, 9c <br />(per Schedule A if more than one (1) site) <br /> <br />? ~ "? CJ .I)(J <br /> <br />B. <br /> <br />Sums of lines 22 thru 33 <br />(per Schedule A if more than one (1) site) <br /> <br />!: ~ 5"3, 0 (;J <br /> <br />C. <br /> <br />Line a - line b <br /> <br />:2 R ) 7 ' r)('} <br /> <br />Miscellaneous Deductions (for this site only) <br /> <br />1. <br /> <br />Pull tab tax ~o distn"butor <br /> <br />!J't.jo, O(J <br /> <br />2. <br /> <br />Combined receipts tax for this site <br /> <br />j g (;, 5: rJ() <br /> <br />3. Federal Taxes (per schedule C/D) <br /> <br />4. <br /> <br />State Gambling Tax (per line 11) <br /> <br />jpl",~() <br /> <br />D. <br /> <br />Total Miscellaneous Deductions for this site <br /> <br />:2 r.,-Cf J. 0 () <br /> <br />E. <br /> <br />Line c - line d <br /> <br />;)')~. 00 <br /> <br />F. <br /> <br />Line e X 50% <br /> <br />AMOUNT DUE <br /> <br />I J3.o0 <br /> <br />40% tI (0 ~. 8 CJ List Receivers of funds/or attach a <br />separate page <br /> <br />10% <br /> <br />/ 1,0 C <br /> <br />PAYABLE TO THE CITY OF <br />CENTERVILLE *DUE ANNUALLY <br />AS PER ORDINANCE* <br /> <br />Signature: <br /> <br />[) -fJ ...-tL-.. A <br /> <br />. n Q <br />Ie LtrL_ <br />