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<br />MINNESOTA DEPARTMENT OF REVENUE <br />LAWFUL GAMBLING ACTIVITY <br /> <br />G-l 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 Pulltabs . ....... . 9 <br />10 TOTALS (Add Lines 6 - 9) .. .. .10 <br /> <br />(A) Gross (B) <br />0.00 ' <br />0.00 <br />570.00 <br />570.00 <br />0.00 <br />570.00 <br />10.00 <br />0.00 <br />19,078.00 <br />19,658.00 <br /> <br />18 Beginning Inventory (Last Month Line 21) . <br />19 Gambling Product Obtained, with Sal s 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 rompensation and Payroll ta:,2S . . . . . . . . . . <br />24 Penalty or Interest on Taxes paid during the month <br />25 Advert is i ng. . . . . . . . . . . . . . . . . . . . <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 Gamblin0 . <br />30 Utilities. . . . . . . . . . . . . . . . . . . . . . <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 ALLO~ABLE EXPENSES (Add Lines 22 through 35) . <br /> <br />Report Month/Year <br />NOVEMBER 2002 <br /> <br />Prizes <br />0.00 <br />0.00 <br />551.00 <br />551. 00 <br />551. 00 <br />0.00 <br />14,682.00 <br />15,233.00 <br /> <br />(C) <br /> <br />Net <br />0.00 <br />0.00 <br />19.00 <br />19.00 <br />0.00 <br />19.00 <br />10.00 <br />0.00 <br />4,396.00 <br />4,425.00 <br /> <br /> 18 189.86 <br /> 19 342.24 <br />. 20 532.10 <br /> ?l 230.10 <br /> 2 302.00 <br /> 2.3 2,188.20 <br /> 24 0.00 <br /> 25 0.00 <br /> 26 IfL 713 <br /> 27 0.00 <br /> 28 0.00 <br /> 29 100.00 <br /> 30 0.00 <br /> 31 0.00 <br /> 32 0.00 <br />. 33 84.00 <br /> 34 0.00 <br /> 35 0.00 <br /> 36 2,842.95 <br /> <br />Line numbers correspond to the Tax Return (Form G-l) line numbers. <br /> <br />Gss 7/99 <br />