Laserfiche WebLink
<br /> <br />tervi{{e <br /> <br />'L..,lIJ6{i.slicd'IS5;- <br /> <br />,'; <br />~ <br /> <br />f)fnl~~) <br />~;i/,.h~lI., <br /> <br />CITY OF CENTERVILLE <br />M9nth1y Gambling Summary <br />1\ /,1., <: /' <br />Organization Name: _VtA'O vf1,l51C~ d~ lL-\.'6 <br /> <br />Gambling Location: <br /> <br />IAt-c-"'tt- (-;,1)"1$ P:czzA <br />}Olo<..- <br /> <br />MonthlYear: <br /> <br />Name ofIndividual Completing Form: <br /> <br />t:(1 ~tJl eJ fl,\ V,i:"}'~ C 1:4- <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 />Z:S '-{L..- <br /> <br />8. <br /> <br />Sums of lines 22 thru 33 <br />(per Schedule A if more than one (l) site) <br /> <br />l.-'l<g'1 <br /> <br />c. <br /> <br />Line a - line b <br /> <br />'\ lot-Ill <br /> <br />Miscellaneous Deductions (for this site only) <br /> <br />1. <br /> <br />Pulltab tax to distributor <br /> <br />ZOb, <br /> <br />2. <br /> <br />Combined receipts tax for this site <br /> <br />5,?:g <br /> <br />3. Federal Taxes (per schedule CID) <br /> <br />4. State Gambling Tax (per line II) <br /> <br />F. <br /> <br />Line e X 50% <br /> <br />AMOUNT DUE <br /> <br />~ <br />< \'Sq; 1.. ') <br /><011/ <br /> <br />D. <br /> <br />Total Miscellaneous Deductions for this site <br /> <br />E. <br /> <br />Line c - line d <br /> <br />40% <br /> <br />(ion; <br /> <br />List Receivers offundslor attach a <br />separate page <br /> <br />10% <br /> <br />< ~~ '; <br /> <br />Signature: <br /> <br />PAYABLE TO THE CITY OF <br />CENTERVILLE *DUE ANNUALLY <br />~ AS PER ORDINANCE* <br /> <br />4fi/G-, <br />