Laserfiche WebLink
<br />MINNESOTA * REVENUE <br />Lawful Gambling Monthly Summary and Tax Return <br /> <br />G-1 <br /> <br />r--' Organization Name <br />SPRING LAKE PARK LIONS CLUB <br /> <br />Organization License Number <br />00584 <br /> <br />a.I <br />a. <br />>- <br />I- <br />.... <br />o <br />+-' <br />c <br />&1 <br />I I <br />LI <br /> <br />Street (Address) <br />8433 CENTER DR. <br />City <br />SPRING LAKE <br /> <br />Zip Code <br />55432 <br /> <br />State <br />MN <br /> <br />Month and year reported <br />3 I 2003 <br /> <br />Number of premises <br />6 <br /> <br />o Filling extension (attach letter) <br /> <br />o Final return (attach approvalletler) <br /> <br />Number of pulltab and paddleticket games <br />reported on Schedule B-2s for the month: 870 <br />This return indudes (check): <br />o Schedule A (# of Pages 6 ) <br /> <br />Check all <br /> <br />that apply: <br /> <br />o Amended return <br />CI No gambling activity this month <br /> <br />o Schedule B-2 (# of Pages 61 ) <br /> <br />o Schedule F <br /> <br /> Column A <br /> gross receipts <br /> 1 Bingo 1 0.00 <br /> 2 Raffles (if tax-exempt raffles were conducted, <br /> check here 0 and complete Schedule ER) 2 384.00 <br /> 3 Paddletickets 3 365165.00 <br /> 4 Add lines 1 through 3 4 365549.00 <br />+-' 5 If line 6C of last month's G1 is negative, enter the <br />tt= <br />0 amount without parentheses in columns A and C 5 0.00 <br />.... <br />0.. <br />en <br />en 6 Subtract line 5 from line 4 6 365549.00 <br />0 <br />.... <br />(!) 7 Income from interest and dividends (enter <br /> the same amount in columns A and C) 7 0.00 <br /> 8 Tipboards 8 0.00 <br /> 9 Pulltabs 9 561673.00 <br /> 10 Add lines 6 through 9. Line 10C is your <br /> gross profits for the month 10 927222.00 <br />~ 11 Multiply line 6C by 8.5% (.085) <br /> (if line 6C is a negative number, enter zero) (effective 7-1-00) <br />12 Combined-receipts tax, if any (from line 9 of Schedule E) <br />L 13 Add lines 11 and 12 and PAY THIS AMOUNT. Make check payable to Minnesota Revenue <br /> (if exempt raffles were reported, pay amount on Schedule ER, line 6, instead) <br /> 14 Total 1. 7 percent tax paid during the month, if any (listed on distributors' invoices <br />en for pulltabs and tipboards) <br />III <br />x <br />lIS <br />I- 15 Add lines 13 and 14 <br />.... <br />III <br />~ 16 <br /><( Gross profits after state taxes (subtract line 15 from line 10C) <br /> Enter the result here and on line 17 on the back of this form. <br /> <br />III <br />.... <br />III <br />J: <br />c <br />Cl <br />(j) <br /> <br />J declare that all information on this summary and tax return is true, <br />Signature of chief executive officer Date <br /> <br />Column B <br />prizes <br /> <br />Column C <br />net receipts <br /> <br />0.00 <br /> <br />-_____-.-9;QL _ <br /> <br />0.00 <br /> <br />__184.QQ__ <br /> <br />317628.00 <br /> <br />47537.00 <br /> <br />317628.00 <br /> <br />47921.00 <br /> <br />0.00 <br /> <br />317628.00 <br /> <br />47921.00 <br /> <br />0.00 <br /> <br />0.00 ____~_._ <br /> <br />454377.00 ______.107?96.0<!___ _ <br /> <br />772005.00 _.__155217.00.____ <br /> <br />11 4073.29 <br /> <br />12 28645.32 <br /> <br />13___}P1~.~L _ <br /> <br />14__ ____J.1686.3Q. <br /> <br />15 ______144Q..4.~j__ <br /> <br />16 _u_ --_J..!9~J1..9il._. <br /> <br /> <br />arrect, and com lete. __._.____.. <br /> <br />ture of gambling ma~' ,I} /'/ Date . .Daytime Phone <br /> <br />.~Y1~3______ <br />_ ~--i Daytime Phone <br /> <br />Pre parer's signature <br /> <br />Name of firm <br /> <br />Mail Form G 1, schedules and any required attachments to <br />Minnesota Revenue. Mail Station 3350. Sf Palll MN fifi14n-:i::\!'iO <br />