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<br />- MINNESOTA DEPARTMENT OF REVENUE <br />'LMFUl GMBLItIi ACTIYI,TY <br /> <br />, G-l$CHPUlE; A <br />RECEIPTS and EXPENSEs PER PREMISE <br /> <br />Organ. license Premise Number Premise Name <br />038qf) 012 IIise Guys Pi774! I Pub <br />Lines 1-10 and 18-36 correspond to Fo~ G-l <br /> <br />Report Month/year <br />JANUARY 2~ <br /> <br />(A) <br /> <br />1 Bingo. . · . ~ . . . . . . . . . . . . . . 1 <br />2 Raffles [ ] Exempt, Schedule-ER . . . . . 2 <br />3 Paddletickets . . . . .. . .. . . . . .. . . 3 <br />4 SUB-TOTAL (Add Lines 1 through 3). . . . .. 4 <br />5 Proportional Part, Last Month G-1 Line 6C. 5 <br />6 Adjusted Sub-Total (line 4 minus line 5) .. 6 <br />7 IncOme from Interest and Dividends. . 1 <br />8 Tipboards. . . . . . . . .. . . . . . 8 <br />9 Pulltabs . .. .. . .. . . .. . . . . . 9 <br />10 ,TOTALS (Add Lines 6 ... 9) . '.o .. . . . . .10 <br /> <br />Gross (8) <br />0.00 <br />0.00 <br />660.00 <br />660.0Q <br />0.00 <br />660.00 <br />4.30 <br />0.00 <br />9,218.50 <br />9,882.80 <br /> <br />Prizes (C) <br />.0.00 <br />0.00 <br />638.. 00 <br />638.0Q <br /> <br />638.00 <br />0.00 <br />8,857.00 <br />9,495.00 <br /> <br />18 Begino109 Inventory (Last Montb Line 21) . . . . . . . .. . 18 <br />19 Gambling Prpduct Obtained, with Sales Tax. . . . . .. . . . . . . 19 <br />20 Goods Available (line 18 plus line 19) . . . .. . . .. . .. . . 20 <br />21 Ending Inventory (ex~ludes Sales Tax). . '. . . . . . . .. . . . . . 21 <br />22 Goods Used (Line ~O minus Line 21) . . . . . . . . . . . . . . . . 22 <br />23 Compensation and Payroll taxes. . . . . . .. .' . .. . . . . . . . . .23 <br />24 Penalty or Interest on Taxes paid during the month. . . . .. . . . 24 <br />25, Advert i sing ~ .. . " . · . ~ ,. .. .o. . . ..'. . . . . . .. .. . . . . . . . 25 <br />26 Accounting and Legal Services. . . . . . . . . . . . .. .. . . . .26 <br />27 Bank Charges and Miscellaneous Supplies I Expenses . . .. . . . 27 <br />28 Purchase/Repair of Furnishings or Devices for. Gambling. . . . . .. .. . 28 <br />29 Rent for the Purpo~e of Conducting Lawful Gambling.. . . . . . . . 29 <br /> <br />30 Ut i lit ies.. · . .. .. .. .. . . . . . .. . . . . .. .. .. . .. . . . . . .. .. 30 <br /> <br />31 Theft and Liability Insurance. . .. . .. . . . . . . . .. . . .. . . 31 <br />32 Manager's Bond, Licenses. local fe~, Premises Permit. . . . . . . 32 <br />33 Cash Long( -) or Cash Short ( +). . . . .. ..o'. . .. . . . . . . . . . . . . 33 <br />34 DEPOSIT REQUIRED, Excess Cash Short Reimbursement(-) . . . . . . . . . 34 <br />35 Deposited Amount, Excess Expense Reimbursement(-). . . . .. . 35 <br />36 TOTAL ALLOIIABLE EXPENSES (Add Lines 22 through 35J . . . . . . . . . .. 36 <br /> <br />'Line numbers correspond to the Tax Return (Form G-l) line numbers. <br /> <br />Gss 7/99 <br /> <br />Net <br />0.00 <br />0.00 <br />22.00 <br />22.00 <br />0.00 <br />22.00 <br />4.30 <br />0.00 <br />361. 50 <br />387.80 <br /> <br />466.89 <br />350.33 <br />'817.22 <br />513.34 <br />303.88 <br />2,309.86 <br />0.00 <br />0.00 <br />66.25 <br />193. 77 <br />, 0.00 <br />200.00 <br />0.00 ' <br />0.00 <br />0.00 <br />-6.50 <br />0.00 <br />0.00 <br />3,067.26 <br />