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<br />I
<br />
<br />MINNESOTA' REVENUE
<br />
<br />2001 Refund for Tax Paid on Unsold Pulltab
<br />and Tipboard Tickets
<br />
<br />....
<br />'. ..
<br />.......
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<br />G7430
<br />
<br />Use this form to claim a tax refund on unsold tickets reported during the 2001 calendar year.
<br />Fiie it with your February G-1 return due March 20. Read the instructions on the back before completing.
<br />
<br />License number
<br />r; - (:) ~OO
<br />
<br />organization name
<br />'D ~ 'bu.\<.;. >CO<-€.. C..v,~
<br />
<br />
<br />111..1::'<;"
<br />
<br />,'~:'~:':F; 1 For each month. enter the January 2.'1,/I~ Juiy Y':"Ol.J-:'
<br />',;',j';;; total dollar value of unsold ~Io, 1.'1'1 <-(I , '\11
<br />",,".,._,' February August
<br />,,:','G) pulltab and tipboard tickets
<br />,-,',:::Z "2., '552. 3'2., 'bioS"
<br />;S'l reported on line 47 of March I September
<br />0,
<br />C1J~'; Form G-l. (Do not include ~\,lI5 5D , 5 i~
<br />5.1' April October
<br />.. paddletickets.) '2.'51'5"'J3 "33, "2..S5'
<br />;.ri;~j! May November
<br /> June -:'7.,1"13 December ~9,"1tl
<br />
<br />
<br />
<br />
<br />(Rev. :2/02)
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<br />2 Add amounts on line 1 ........................,............,...,........... 2
<br />
<br />3 If you filed a fund loss report in 2001 (Form LG-250) and reported the affected games at ideal
<br />value, enter the value of any unsold tickets in your possession that are not included on line 2 3
<br />
<br />4 If you filed a request to destroy games (Form G-7420) and received approval in 2001, enter
<br />the value of the unsold tickets of the games destroyed that are not included on line 2 .,.". 4
<br />
<br />5 Add lines 2 through 4 ...................................................... 5
<br />
<br />6 If you filed a defective game report in 2001 (Form G.7410) and received a refund,
<br />enter the value of any unsold tickets from the game that are included on line 2 '.,.'"",. 6
<br />
<br />7 Subtract line 6 from line 5 ""....,..."".,..."....,....".,...,.,.".",. 7
<br />
<br />8 Multiply line 7 by 1.7% (.017) ...................,......... _ . . . . . . . . . . . . . . . . . . 8
<br />Enter this amount as a negative number on your February Form LG.l010 Schedule C/O,
<br />and as a positive number on line l1b of Schedufe F for February only,
<br />
<br />9 Amount from line 13 of February Form G.t . ' , . , . . . . . . . . , . . , , . . , . . , , , , , . , . . . , . , . . , 9
<br />
<br />10 If line 9 is more than line 8, subtract line 8 from line 9. This is the tax you owe for February
<br />minus your refund. Pay this amount instead of the amount on line 13 of Form G.l.
<br />Make check payable to Minnesota Revenue. . , . . , . . . . . . . . . . . . , , . . , . . . . . . . . . . , . , , 10
<br />
<br />U If line 8 is more than line 9, subtract line 9 from line 8. You 'It receive a check for this
<br />amount. Do not pay the amount on line 13 of Form G-1 ............,............... U
<br />Enter this amount on Schedule F, line llb, for March and each succeeding month untit
<br />you receive your refund check. You must deposit the refund in your organization s gambling
<br />account no fater than four business days after receiving it.
<br />
<br />Date _ Sjg~?~l,.Ir,e_ Of~m~g:ma
<br />v'L-'l,----J.,'/'7-l~ ? ;';:/;! _--€.,~,-
<br />Minnesota tax ID, SSN or PTIN
<br />\\I'1S~D
<br />
<br />ger".
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<br />
<br />Date
<br />~11~D1-
<br />
<br />February Form Ga1 and mail to:
<br />0,51. Paul, MN 55146-3350
<br />
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<br />'310. l{l,
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<br />Date , >
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<br />Daytime phone
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