Laserfiche WebLink
<br />, <br /> <br /> <br />tervi{{e <br /> <br />'[sta61'isI;el{ I85i' <br /> <br />CITY OF CENTERVILLE <br />Monthly Gambling Summary <br />Organization Name: l)0,\) tQ::l~;;:'~;{ Ct..~ <br />Gambling Location: lJJH,,- Gv'-'\s \':;;7.:Z..,A. <br />MonthlYear: Ia I 0 (... <br /> <br />Name ofIndividual Completing Form: <br /> <br />~--;.,.w,- w iZu~,.z" CP:A <br /> <br />Ten Percent Net Profit Calculation <br /> <br />A. <br /> <br />Net Receipts - T otallines 2c, 3c, 8c, 9c <br />(per Schedule A if more than one (1) site) <br /> <br />-z.. \ ::, ~ <br /> <br />B. <br /> <br />Sums of lines 22 thru 33 <br />(per Schedule A if more than one (1) site) <br /> <br />:)V1,-\ <br /> <br />C. <br /> <br />Line a - line b <br /> <br />< \ IS\.,/ <br /> <br />Miscellaneous Deductions (for this site only) <br /> <br />2. <br /> <br />Combined receipts tax for this site <br /> <br />3\1- <br />5\<& <br /> <br />1. <br /> <br />Pulltab tax to distributor <br /> <br />3. Federal Taxes (per schedule CID) <br /> <br />4. State Gambling Tax (per line ll) <br /> <br />D. <br /> <br />Total Miscellaneous Deductions for this site <br /> <br />"6~o <br /> <br />F. <br /> <br />Line e X 50% <br /> <br />AMOUNT DUE <br /> <br />< \ '1 S;l;, ! <br /><9'Y':,) <br /> <br />E. <br /> <br />Line c - line d <br /> <br />40% <br /> <br />< iC\.'1 f <br /> <br />List Receivers of funds/or attach a <br />separate page <br /> <br />10% <br /> <br />< \~o.:1 <br /> <br />PAYABLE TO THE CITY OF <br />CENTERVILLE *DUE ANNUALLY <br />AS PER RDINANCE* <br /> <br />Signature: <br /> <br />