Laserfiche WebLink
<br />" <br /> <br /> <br />ervi{[e <br /> <br />Organization Name: <br /> <br />Gambling Location: <br /> <br />MonthlYear: <br /> <br />CITY OF CENTERVILLE <br />Monthly Gambling Summary <br />S;"~l~K~ey<: LQ~' <br />/ <br />.t P !!J > k';HrVl -e v- <br />/Ltt~,~~ <br /> <br />-:200 ,./ <br /> <br />ff v dj" <br />C-fJ-A. -1 "'- IL-, .1!L.--t <br /> <br />Name ofIndividual Completing Form: <br /> <br />Ten Percent Net Profit Calculation <br /> <br />A. <br /> <br />Net Receipts - Total lines 2c, 3c, 8c, 9c <br />(per Schedule A if more than one (1 ) site) <br /> <br />g~30.6() <br /> <br />B. <br /> <br />457Lj.()Q <br /> <br />Sums of lines 22 thru 33 <br />(per Schedule A if more than one (1 ) site) <br /> <br />C. <br /> <br />Line a - line b <br /> <br />1;20-'6(,1 <br /> <br />Miscellaneous Deductions (for this site only) <br /> <br />Z 7CJeJ X ,tlll:::= S~Kd 0 <br />llc ("10 'X-' 6(, q -= ::2 t '2 tl. 0 0 <br /> <br />f;t,.cro )IJ lJ~fi? J jt,.Oo <br /> <br />1. <br /> <br />2. <br /> <br />Pulltab tax to distributor <br /> <br />8'2& <br /> <br />Combined receipts tax for this site <br /> <br />;R I Zl) <br /> <br />3. Federal Taxes (per schedule C/D) <br /> <br />4. <br /> <br />D. <br /> <br />State Gambling Tax (per line 11) <br /> <br />)6.60 <br /> <br />Total Miscellaneous Deductions for this site <br /> <br />3c);;.c;,() () <br /> <br />E. <br /> <br />Line c - line d <br /> <br />7(}'J ,()O <br /> <br />F. <br /> <br />Line e X 50% <br /> <br />3S'f",0C) <br /> <br />40% <br /> <br />10% <br /> <br />Signature: <br /> <br />AMOUNT DUE <br /> <br />/i/() <br /> <br />List Receivers offimds/or attach a <br />separate page ~~~ (!JJA~7d itaJ. 00 <br /> <br />PAYABLE TO THE CITY OF <br />CENTERVILLE *DVE ANNUALLY <br />ASPER ORDINANCE* <br /> <br />35 <br /> <br />[) -L~ r JiLA <br />