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<br /> <br />MINNESOTA DEPARTMENT OF REVENUE <br />LAWfUL GAMBLING ACTIVITY <br /> <br /> <br />G-I SCHEDULE F <br />GAMBLING FUND RECONCILIATION <br /> <br />Organi7ation Name License Number <br />Dead Broke S ad! 1 e Club 03800 <br />GamblinQ checking account <br />1 End-of-month checking account balance from statements <br />2 Deposits made during the month not included in line 1 <br />3 Add lines 1 and 2 . . . . . . . . . . . . . . . <br />4 Checks written during the month not included in line 1. <br />S RECONCILED BANK BALANCE (line 3 minus line 4) .... <br /> <br />Other funds not included in Checkinq Balance <br />6 Starting banks for games . . 6a 8,300.00 <br />Reimbursment after monthend. 6b 0.00 <br />Monthend cash balance in starting banks. <br /> <br />7 Total ending inventory (G-l lin~ 21) . . <br />8 Deposit after month-end for G1mes in G-l <br /> <br />9 Total in Savings & Other' -i'unds . . . . <br /> <br />10 F '~ess shortages (G-l, 34) and prior <br />I imbursement due for excess shortages <br /> <br />11 a ____.O_=--9Jl <br />lIb __.~"-,~.Q. <br />11 c ____Q-'-.Q.Q <br />11 d ___~Q.Q <br />lIe ___Q-,QQ <br />Tot<i 1 11 <br />12 Add lines 6, 7, 8, 9, 10, 11 . . . . . . <br />13 Add 1 i nes 5 and 12 . . . . . . . . . . . <br /> <br />11 Fund Loss. (LG-2~;O) . . . . <br />Refund Due (''':-7430) . . . . <br />Open-Game prizes,by check. <br />Prizes bought, not awarded. <br />Other additions <br /> <br />Unpaid Oblig~ions and Opel'! Gar?- Oeposit~ <br />14 Tax from G-l line 13 and any <br />prior months taxes. . . . . <br /> <br />15 Deposits for games still in pl._y <br /> <br />6 8,300.00 <br />7 2,857.17 <br />8 0.00 <br />9 ___~=--OO <br />10 ____Q.OQ <br /> <br />U.oo <br /> <br />14 _13~59.92 <br /> <br />15 <br /> <br />0.00 <br /> <br />16 Loaned amounts included in bank statement. 16 0.00 <br /> <br />17 Product part of unpaid invoices. <br /> <br />18 Other subtractions. <br /> <br />17 _______JLilQ <br /> <br />18 <br /> <br />O.OQ <br /> <br />19 Add Lines 14 through 18. <br /> <br />GAMBLING FUNDS RECONCILIATION <br />20 GAMBLING FUND BALANCE (line 13 minus 19) . . . . . <br />21 PROFIT CARRY-OVER (from Form G-l line 44), . . . . <br /> <br />22 FUND BALANCE equals PROFIT CARRY-OVER, Difference. <br /> <br />Signature 1?~~ <br />of Preparer ~4J-.\ W \l-~-,-,lJ(;", <br />Gss 7/99 <br /> <br />~ate <br />)--2~ ha a-I....-- <br /> <br />Report Month/Year <br />NOVEMBER 2002 <br />1 __ 88,414.02 <br />2 13,742.00 <br />3 ---LQh156. 02 <br />4 24,159.96 <br />5 77 ,996.06 <br /> <br />1 2 ~L 1 s Z..-,--,lZ <br />13 _-.89, 151"2~ <br /> <br />19 ---1.3,259.92 <br /> <br />20 _~~93.31 <br />21 75,893.31 <br /> <br />22 <br /> <br />0.00 <br /> <br />612/464-7225 <br />