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<br />MINNESOTA DEPARTMENT OF REVENUE <br />LAWFUL GAMBLING ACTIVITY <br /> <br />Organ. License <br />03800 <br />Lines 1-10 and <br /> <br />Premise Number Premise Name <br />008> The Trio Inn <br />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 />G-l SCHEDULE A <br />RECEIPTS and EXPENSES PER PREMISE <br />Report Month/Year <br />FEBRUARY 2002 <br /> <br />(A) Gross <br />0.00 <br />0.00 <br />1,260.00 <br />1,260.00 <br />0.00 <br />1,260.00 <br />10.64 <br />0.00 <br />42,233.00 <br />43,503.64 <br /> <br />18 Beginning Inventory (Last Month Line 21) . <br />19 Gambling Product Obtained, with Sales 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 Compensation and Payroll taxes . . . . . . . . . . <br />24 Penalty or Interest on Taxes paid during the month <br />25 Advert ising. . . . . . . . . . . . . . . . . . . . <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 Gambling. <br />30 Ut il it ies. . . . . . . . . . . . . . . . . . . . . . <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 ALLOWABLE EXPENSES (Add Lines 22 through 35) . <br /> <br />(B) Prizes <br />0.00 <br />0.00 <br />1,218.00 <br />1,218.00 <br /> <br />1,218.00 <br /> <br />0.00 <br />33,897.00 <br />35,115.00 <br /> <br />Line numbers correspond to the Tax Return (Form G-l) line numbers. <br /> <br />Gss 7/99 <br /> <br />... <br /> <br />18 <br />19 <br />20 <br />21 <br />22 <br />23 <br />24 <br />25 <br />26 <br />27 <br />28 <br />29 <br />30 <br />31 <br />32 <br />33 <br />34 <br />35 <br />36 <br /> <br />(C) <br /> <br />Net <br />0.00 <br />0.00 <br />42.00 <br />42.00 <br />0.00 <br />42.00 <br />10.64 <br />0.00 <br />8,336.00 <br />8,388.64 <br /> <br />1,185.04 <br />393.10 <br />1,578.14 <br />1,067.30 <br />510.84 <br />3,649.01 <br />0.00 <br />0.00 <br />132.50 <br />0.00 <br />0.00 <br />350.00 <br />0.00 <br />0.00 <br />0.00 <br />107.00 <br />0.00 <br />0.00 <br />4,749.35 <br />