Laserfiche WebLink
<br />. <br /> <br /> <br />, tervi[[e <br /> <br />'uw61Lo;/ied- IS..fl <br /> <br />Organization Name: <br /> <br />Gambling Location: <br /> <br />MonthlYear: <br /> <br />CITY OF CENTERVILLE <br />Monthly Gambling Summary <br />D~"" 'f2 ^ <-.<--? ,C1 '1 <br />./lWV'l..l GiJl,tJ!t{[.. .-Il"lkrLH;'i'c.- <..(."JO <br /> <br />~ <br />~) ;J <br /> <br />.-/" ~ <br />I rc--w J.-tJt-' <br />0/07.- <br /> <br />A') ,.-, .0 _". <br />.. bn..!:,..;'f vJ :C~L~J: /..,.T;., \'......r:' <br /> <br />Name ofIndividual Completing Form: <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 (I) site) <br /> <br />750,9 <br /> <br />Y<ZC;;5 <br /> <br />B. <br /> <br />S urns 0 f lines 22 thru 33 <br />(per Schedule A if more than one (I) site) <br /> <br />7.,3'1 <br /> <br />C. <br /> <br />Line a - line b <br /> <br />Miscellaneous Deductions (for this site only) <br /> <br />I. <br /> <br />2. <br /> <br />Pulltab tax to distributor <br /> <br />ID\~ <br />liS <br /> <br />Combined receipts tax for this site <br /> <br />3. Federal Taxes (per schedule CID) <br /> <br />4. <br /> <br />y <br /> <br />State Gambling Tax (per line 11) <br /> <br />D. <br /> <br />Total Miscellaneous Deductions for this site <br /> <br />I1S~ <br /> <br />AMOUNT DUE <br /> <br />CJ'1": <br />Sea <br /> <br />E. <br /> <br />Line c - line d <br /> <br />F. <br /> <br />Line e X 50% <br /> <br />40% <br /> <br />10% <br /> <br />. <br /> <br />Signature: <br /> <br />Yoo <br /> <br />List Receivers of funds/or attach a <br />separate page <br /> <br />) 00 PAYABLE TO THE CITY OF <br />CENTERVILLE *DUE ANNUALLY <br />AS PER ORDINANCE* <br /> <br />(~LJ~;t.tL~. <br />i <br />