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<br />MINNESOTA DEPARTMENT OF REVENUE <br />. lAWFUL GAMBLING ACTIVITY' <br /> <br />... <br /> <br />6-1 SCHEDULE A <br />RECEIPTS and EXPENSES' PER PREMISE <br /> <br />Organ. License Premise Number Premise Name <br />03800 008 The Trio Inn <br />Lines 1-10 and 18-36 correspond to Form G-l <br /> <br />(A) <br /> <br />1 B 1 ngo. . ..... . . . . . . . . . . . . . . 1 <br /> <br />2 Raffles [ ] Exempt, Schedule-ER . . . . . 2 <br />3 Paddlet ickets ........... . . . 3 <br />4 SUB-TOTAL (Add Lines 1 through 3). . . . . 4 <br />5 Proportional Part, Last Month G-l Line 6C. 5 <br />6 Adjusted Sub-Total (Line 4 minus Line 5) . 6 <br />7 Income from Interest and Dividends . . . . 7 <br />8 T i pboards. . . . . . . . . . . . . . 8 <br /> <br />9 Pulltabs . . . . . . . . . . . . . . . . . 9 <br /> <br />10 TOTALS (Add Lines 6 - 9) . . . . . . . . .10 <br /> <br />Gross (B) <br />0.00 <br />0.00 <br />1,830.00 <br />1,830.00 <br />0.00 ' <br />1,830.00 <br />2.97 <br />0.00 <br />31,816.00 <br />33,648.97 <br /> <br />Report Month/year <br />FEBRUARY 2003 <br /> <br />Prizes (C) <br />0.00 <br />0.00 <br />1~769.00 <br />1 ;769.00 <br /> <br />1,769.00 <br /> <br />0.00 <br />26,764.00 <br />28,533.00 <br /> <br />Net <br />0.00 <br />0.00 <br />61.00 <br />61.00 <br />0.00 <br />61.00 <br />2.97 <br />0.00 <br />5,052.00 <br />5,115.97 <br /> <br />18 Beginning Inventory (Last Month Line 21) . . . . . . . . . . . . 18 1,194.97 <br />19 Gambling Product Obtained, with Sales Tax. . . . 19 351.82 <br />20 Goods Available (Line 18 plus Line 19) . . . . . . . . . . 20 1,546.79 <br />21 Ending Inventory (excludes Sales Tax). . . . . . . . . ., . ..' 21 985.36 <br />22 Goods Used (Line 20 minus Line 21) . . . . . . . . . . . . 22 561.43 <br />23 Compensation and Payroll taxes . . . . . . . . . . . . . . . . . . 23 3,652.87 <br />24 Penalty or Interest on Taxes paid during the month. . . . . . . . 24 0.00 <br />25 Advert i sing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 0.00 <br /> <br />---- :~:ii~~;~::e:n:n~e~r ~c:fr:J;~~~', su.pp if~s.'&'. E~p;n;es-~-":- -:-~-:-~-~--: . ~. ,.:- '~~,...~'-_._~: :~~._._- -- '. <br /> <br />28 PurchasejRepair of Furnishings or Devices for Gambling . . . . . . 28 0.00 <br />29 Rent for the Purpose of Conducting lawful Gambling. . . 29 400.00 <br /> <br />30 . Ut 111 ties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 0.00 <br />31 Theft and Liability Insurance. . . . . . . . . . . .. . . . . . . 31 0.00 <br />32 Manager's Bond, Licenses, Local Fee, Premises Permit. . . . . . . . . 32 0.00 <br />33 Cash Long(-) or Cash Short(+). . . . . . . . . . . . . . . 33 -25.00 <br />34 DEPOSIT REQUIRED, Excess Cash Short Reimbursement(-) . . . 34 0.00 <br />35 Deposited Amount, Excess Expense Reimbursement(-). . . . . . 35 0.00 <br />36 TOTAL ALLOWABLE EXPENSES (Add Lines 22 through 35) . . . . . . . . . . 36 4,734.98 <br /> <br />Line numbers correspond to the Tax Return (Form G-l) line numbers. <br /> <br />Gss 7/99 <br />