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MINNESOTA Department of Revenue G - Schedule E Combined Receipts Tax Starting with July 1998 activity, use this schedule to report gambling activity from July f through June 30 of the next year. Complete lines 1 through 10 of Form G -1 before completing this schedule. Keep this schedule for your records to use when Filling out Form al Schedule E for next month. Do not mail to the Minnesota Department of Revenue. Organization license number License number Month /year reported on this form Nat'l MS Society — MN Chapter A -00562 Mrteck jq '79 1 Income from interest and dividends (from column A, line 4, of this month's Form G -11 1 - n 0 p 2 Receipts from tipboard games (from column A, line 8, of this month's Form G-11 2 4 L J � 3 Receipts from pulltab games (from column A, line 9, of this month's Form G-1) 3 / / 9 G. e G , ;o9' �nr,�� /l a - • /!/a o� 4 Add lines 1 through 3 4 /. / °` /' q09 793 5 A mount from line 6 of last month's Schedule E. (F in zero if this is the Ju ly Schedule E) 5 r / / 6 Add lines 4 and 5. If the total is $500,000 or less, stop here. You do not owe combined receipts tax. Keep this schedule for use in filling out next month's Form G-1 6 / 7 If line 6 is over $500,000, go to the table below, determine the tax for line 6 and fill it in here 7 � a r U u/ 8 Line 7 of fast month's Schedule E. (Fill in zero if this is the July Schedule E) 8 fr/ 75 9 Combined receipts tax due (subtract line 8 from line 72 9 //3 4911 Fill in the result here and on line 12 of this month's Form G-1 1 1 Combined Receipts Tax Table If line 6 is: subtract from multiply over but no more than line 6 result by add *500,000 $700,000 1500,000 - 019(1.9 %) 3700,000 $900,000 *700,000 .038(3.8 %) 33,800 *900,000 1900,000 .057(5.7%) $11,400 All in the result on line 7 of this schedule. te30 P/9e)