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<br />MINNESOTA DEPARTMENT Of REVENUE <br />LAWFUL GAMBLING ACTIVITY <br /> <br />At." <br /> <br />G-1 SCHEDULE A <br />RECEIPTS and EXPENSES PER PREMISE <br /> <br />Organ.license Premise Number Premise Name <br />03800 012 Wise Guys Pizza & Pub <br />Lines 1-10 and 18-36 correspond to Form G-l <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-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 Tipboards. . . . . . . . . 8 <br />9 Pu lltabs . . . . -. . . . . . . . . . 9 <br />10 TOTALS (Add Lines 6 - 9) . . . . . .10 <br /> <br />(A) Gross (B) <br />0.00 <br />0.00 <br />810.00 <br />810.00 <br />0.00 <br />810.00 <br />5.34 <br />0.00 <br />14,578.00 <br />15,393.34 <br /> <br />Report Month/Year <br />DECEMBER 2002 <br /> <br />Prizes (C) <br />0.00 <br />0.00 <br />783.00 <br />783.00 <br />783.00 <br />0.00 <br />12,031.00 <br />12,814.00 <br /> <br />18 Beginning Inventory (Last Month line 21) . <br />19 Gambling Product Obtained, with Sales Tax. <br />20 Goods Available (Line 18 plus line 19) . . . . . . <br />21 Ending Inventory (excludes Sales Tax). . . <br />22 Goods Used (Line 20 minus line 21) . . . . . . . . <br />23 Compensat i on and Payro 11 taxes . . . . . . . . . . <br />24 Penalty or Interest on Taxes paid during the month. <br />25 Advert is iog. . . . . . . . . . . . . . . . . . . . <br />26 Accounting and Legal Services. . . . . . . . . . . <br />27 Bank Charges and Miscellaneous Supplies & Expenses. . . <br />28 Purchase/Repair of Furnishings or Devices for Gambling. <br />29 Rent for the Purpose of Conducting lawful Gambling. <br />30 Ut i 1 it i es . . . . . . . . . . . . . . . . . . . . . . <br />31 Theft and Liability Insurance. . . . . . . . . . . . <br />32 Manager's Bond, Licenses, local Fee, Premises Permit. .... <br />33 Cash Long(-) or Cash Short(+). . . . . . . . . . . . <br />34 DEPOSIT REQUIRED, Excess Cash Short Reimbursement(-) <br />35 Deposited Amount, Excess Expense Reimbursement(-). . . . . . . <br />36 TOTAL ALLOWABLE EXPENSES (Add Lines 22 through 35) . <br /> <br />. . . . <br /> <br />. . 18 <br />. 19 <br />. . 20 <br />. 21 <br />22 <br />. 23 <br />. . 24 <br />25 <br />. . 26 <br />. 27 <br />. . 28 <br /> <br />. . . . 29 <br />30 <br />. 31 <br />. 32 <br />. . 33 <br />34 <br />35 <br />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 />27.00 <br />27.00 <br />0.00 <br />27.00 <br />5.34 <br />0.00 <br />2,547.00 <br />2,579.34 <br /> <br />230.10 <br />594.60 <br />824.70 <br />466.89 <br />357.81 <br />2,474.43 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />28.00 <br />0.00 <br />0.00 <br />2,860.24 <br />