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<br />"v-" <br /> <br />MINNESOTA Department of Revenue <br /> <br />-.-----.-.---.-- - ..----.---- - -_..- ,-----.--. -.--. - <br /> <br />Receipts and Expenses Per Premises <br /> <br />OJ"D~H~'lation Ucense Numoer <br /> <br />Premises Name <br /> <br />Pre""'SES permil number <br /> <br />00584 <br /> <br />KELLY'S KORNER <br /> <br />S-00584~01 0 <br /> <br />Lines 1.10 correspond to Form G-i. <br />Bingo <br />2 Raffles <br /> <br />:) ?addletickets <br /> <br />4 Add lines 1 through 3 <br /> <br />5 If line 6c of last month's Fcrm G-1 Of <br />Schedule A is negative. li~t <br />(withoul parentheses) in columns A and C <br /> <br />6 SubtrilGt line 5 from line 4 <br /> <br />Column A <br />gross receipts <br />000 <br /> <br />i <br />2 <br />3 <br />4 <br /> <br />0.00 <br />72000 <br />72000 <br /> <br />5 <br />6 <br /> <br />0.00 <br />720.00 <br /> <br />7 income from interest and dividends (tjli <br />in same amount in columns A and C) <br /> <br />a Tipboards <br /> <br />9 Pul!labs <br /> <br />7 <br />a <br />9 <br /> <br />000 <br />000 <br />_.'~'_ _,,__.'._n_ <br /> <br />4288800 <br /> <br />10 Add lines 6 throu9h 9. LIne lOe is YOur <br />9fOSS profit for the month <br /> <br />10 <br /> <br />43608.0C <br /> <br />There are no lines 11-17. <br />lines 18.36 correspond to Form G-1. <br />18 Beginning inventory (from line 21 atlast month's Form G-1) <br /> <br />19 Cost of gambling equip:nent obtained during the month (Inclurje sales <br />tax, but do not include the 1.7 percent lax listed on distributor's irlVoices) <br /> <br />20 ~\dd lines 18 and 19 <br /> <br />21 Ending inventory (doiiar value on the last day of month, do not include sales <br />tax or i.7 percent tax listed or, distributor's invoices) <br /> <br />22 Total value of the gambling equipment sold (subtract line 21 from line 20) <br /> <br />23 Compensation and payrol! taxes <br /> <br />24 Penalty and interest you paid on taxes, including payroll taxes. on any <br />=orm G-1 or Schedule C since beginning gambl ing activitias <br /> <br />25 Advertising <br /> <br />25 Accounting services for lawful gambling tax forms, annual audit or review, <br />and qualifying legal work <br /> <br />27 Sank service charges, office supplies: lodging, meals ."!Old transportation for lawiu! <br />gambling classes conducted by state agencies; and miscellaneous expenses <br /> <br />26 Purchase and/or repair expenses for office furnishings and office equipment <br />used for gambling, and devices used fOf gambling <br /> <br />29 Rent for conducting lawful gambling <br /> <br />30 Utilities used for conducting lawful gambling <br /> <br />31 Theft insurance and the amcunt permitted for liability insurance <br /> <br />32 Local government investigation tee and cost for ~ew or renewed garnbling <br />rnanager's bond, gambling managers license and premise permits <br /> <br />33 Cash long or cash shOrl (If cash long, put parentheses around the amount) <br /> <br />34 Reimbur:sement for excess cash short (This is a negative amount) <br />35 Reimbursement for negative expense calculation (ThiS is a negative amount.! <br /> <br />36 TOTAL ALLOWABLE EXPENSES (add lines 22 through 35) <br /> <br />'3GGn'0 rRe\- "J7J8'-j) <br /> <br />Column a <br />prizes <br />0.00 <br /> <br />0.00 <br />528.00 <br />528.QO <br /> <br />52800 <br /> <br />000 <br />'_ _n __ .___. <br /> <br />34744.00 <br /> <br />352/2.00 <br /> <br />G-1 Schedule A <br /> <br />~- - <br />~,1crth ;:.lG year ,-ecortej <br /> <br />11 { 2002 <br /> <br />Column C <br />net :E'se'pts <br />0.00 <br /> <br />iJ 00 <br /> <br />~ 32 DC <br /> <br />1~2.00 <br /> <br />000 <br />192CC <br /> <br />0.00 <br /> <br />QJC <br />8i44QC1 <br /> <br />(33?6 00 <br /> <br />18 'J29.83 <br />19 48765 <br />20 1417.48 <br />21 85588 <br />"'I 5e~ 60 <br />4'-",,, <br />7"< 24"j5.83 <br />.." <br />24 0.00 <br />25 D.Ge <br />26 D.:.~C <br />27 399 56 <br />28 000 <br />29 1000QC: <br />30 Q 00 <br />31 G.CO <br />32 000 <br />33 i97.CC <br />34 GJLD) <br />35 0.00) <br />36 457?:?f!. <br /> Mlr,!1<?s.jl<; GST.::I;:> <br />