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MINNESOTA DEPARTMENT OF REVENUE SCHEDULE A <br /> LAWFUL GAMBLING ACTIVITY RECEIPTS and EXPENSES PER PREMISE <br /> Organ.License Premise Number Premise Name Report Month /Year <br /> 03800 008 The Trio Inn JANUARY 1999 <br /> (A) Gross (8) Prizes (C) Net <br /> 1 Bingo 0.00 0.00 0.00 <br /> 2 Raffles 0.00 0.00 0.00 <br /> 3 Paddletickets 0.00 0.00 0.00 <br /> 4 Income from Interest and Dividends 31.89 31.89 <br /> 5 SUB -TOTAL (Add Lines 1 through 4) 31.89 0.00 31.89 <br /> 6 Proportional Part of Last Month G -1 Line 7C 0.00 - -- 0.00 <br /> 7 Adjusted Sub -Total (Line 5 minus Line 6) . 31.89 0.00 31.89 <br /> 8 Tipboards 0.00 0.00 0.00 <br /> 9 Pulltabs 28,184.00 23,000.00 5,184.00 <br /> 10 TOTALS (Add Lines 7,8,9) 28,215.89 23,000.00 5,215.89 <br /> 18 Beginning Inventory (Last Month Line 21) . 0.00 <br /> 19 Gambling Equipment Obtained, with Sales Tax 1,468.62 <br /> 20 Goods Available (Line 18 plus Line 19) . . 1,468.62 <br /> 21 Ending Inventory 986.28 <br /> 22 Goods Used (Line 20 minus Line 21) 482.34 <br /> 23 Compensation and Payroll taxes 3,092.35 <br /> 24 Penalty or Interest on Taxes paid during the month . . . 0.00 <br /> 25 Advertising 0.00 <br /> 26 Accounting and Legal Services 227.67 <br /> 27 Bank Charges and Miscellaneous Supplies & Expenses . . . 809.35 <br /> 28 Purchase /Repair of Furnishings or Devices for Gambling . 2,252.19 <br /> 29 Rent for the Purpose of Conducting Lawful Gambling . . . 300.00 <br /> 30 Utilities 0.00 <br /> 31 Theft and Liability Insurance 0.00 <br /> 32 Manager's Bond, Licenses, Local Fee, Premises Permit . . 0.00 <br /> 33 Cash Long( -) or Cash Short( +) -58.00 <br /> 34 DEPOSIT REQUIRED, Excess Cash Short Reimbursement( -) . . 0.00 <br /> 35 Deposited Amount, Excess Expense Reimbursement( -) 0.00 <br /> 36 TOTAL ALLOWABLE EXPENSES (Add Lines 22 through 35) 7,105.89 <br /> Line numbers correspond to the Tax Return (Form G -1) line numbers. <br /> Gss 10/94 <br />