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<br /> <br />JUN 0 9 2003 <br /> <br />'Estafj{islied' 1857 <br /> <br />CITY OF CENTERVILLE <br />Monthly Gambling Summary <br /> <br />Ten Percent Net Profit Calculation <br /> <br />A. <br /> <br />B. <br /> <br />c. <br /> <br />Net Receipts - Total lines 2c, 3c, 8c, 9c <br />(per Schedule A ifmore than one (1) site) <br /> <br />Sums of lines 22 thru 33 <br />(per Schedule A if more than one (1 ) site) <br /> <br />Line a - line b <br /> <br />Miscellaneous Deductions (for this site only) <br /> <br />D. <br /> <br />E. <br /> <br />F. <br /> <br />1. <br /> <br />Pulltab tax t,o distnbutor <br /> <br />2. <br /> <br />Combined receipts tax for this site <br /> <br />3. Federal Taxes (per schedule Cm) <br /> <br />4. <br /> <br />State Gambling Tax (per line 11) <br /> <br />Total Miscellaneous Deductions for this site <br /> <br />Line c - line d <br /> <br />Line e X 50% <br /> <br />AMOUNT DUE <br /> <br />" <br /> <br />e~7CJ, IJ() <br /> <br />r; t." 5"3, 0 (J <br /> <br />:2 9 I 7 i cJO <br /> <br />Et-vo, (/(1 <br /> <br />j z r., 1).1")0 <br /> <br />IF'G,,()(;J <br /> <br />:2 J,~q J. C) (] <br /> <br />:J2Cs,.00 <br /> <br />Ils.()O <br /> <br />40% 11 (0 2-. tJ CJ List Receivers of funds/or attach a <br />separate page <br /> <br />10% / /, 0 tl <br /> <br />PAYABLE TO THE CITY OF <br />CENTERVILLE *DUE ANNUALLY <br />AS PER ORDINANCE* <br /> <br />r\ <br />/'\) <br />Signature: tI.../ A" A:L...... <br /> <br />. "Q <br />[l_Lt j/~_ <br />