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• C-1 Schedule A p Receipts and Expenses Per Premise P Organization license number Premise permit number Premise name Month and year reposed on this form 2- 00562 -459 Kelly's Komar MR 99 column A column 8 column C Lines 1 - 10 and 18 - 96 correspond to foes C.1 gross receipts prizes net receipts 1 Bingo 1 .00 .00 .00 2 Raffles 2 .00 An . AO 3 Paddletickets 3 .00 .00 .CC 4 Income from interest and dividends (fill in same amount in both columns A and C) 4 .00 .00 5 Add lines 1 through 4 . 5 '00 •00 .04 6 If negative, amount from line 7c of last month's form 00 .00 G -1, or portion of amount distributed to this premise 6 7 Subtract line 6 from line 5. If you did not fill in 00 400 .00 amounts on line 6, fill in amounts from line 5 . 7 8 Tipboards 8 448,00 210.00 238.00 9 Pulltabs 9 7Afl7t.00 'MIAMI? A705.00 10 Add lines 7 through 9. The amount you list in column C is your gross profit for the month 10 77949 04 7017A 00 A94.1 ef_ 18 Beginning inventory of gambling equipment (from line 21 of last month's schedule A) . . 18 273.11 19 Cost of gambling equipment obtained during the month. (Include sales tax, but do not include the 2 percent tax listed on distributors' invoices.) 19 973,67 20 Add lines 18 and 19 20 1148 21 Ending inventory of gambling equipment (dollar value on the last day of the month) . 21 600.86 22 Subtract line 21 from line 20. The result is the total dollar value of the gambling equipment you sold during the month 22 547.92 23 Amount paid for compensation and payroll taxes 23 2544.73 24 Penalty and interest you paid during the month on any taxes, including payroll taxes, that you listed on any form G -1 and on any schedule 0 since beginning gambling activities . . 24 .00 25 Amount paid for advertising 25 00 26 Amount paid for accounting services for preparation of monthly lawful gambling tax forms and tor your annual financial audit or review, and for qualifying legal work . . 26 - 9.t7 27 Amount paid for bank service charges; office supplies; lodging, meals and transportation for lawful gambling classes conducted by state agencies; and miscellaneous expenses . . 27 y en 28 Amount paid to purchase and /or repair office furnishings and office equipment used for gambling, and to purchase and /or repair devices used for gambling . . 28 1.4$ 29 Amount paid for rent for conducting lawful gambling 29 1000.00 30 Amount paid for utilities used for conducting lawful gambling 30 .00 31 Amount paid during the month for theft insurance and the amount you are permitted to list for liability insurance paid during the month 31 .00 32 Amount paid during the month for local government investigation fee, and new or renewed: gambling managers bond, gambling managers license and premise permits . . . 32 25.89 33 Cash long or cash short. Of cash long, put parentheses around the amount) 33 434 On 34 Amount of reimbursement for excess cash short. (This is a negative amount) 34 ( on ) 35 Amount of reimbursement for negative expense calculation. This is a negative amount) 35 ( 94 ) 36 Add lines 22 through 35. This is your total allowable expenses for the month . . 36 4542.34 6001010 (10194)