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<br /> MINNESOTA DEPARTMENT OF REVENUE LAWFUL GAMBLING ACTIVITY SUMMARY and TAX RETURN
<br /> Mail Station 3350
<br /> St.Paul, MN 55146 - 3350 License: 03800 Month: APRIL 1999
<br /> Premises: 3 Schedule 82 GAME COUNT: 72
<br /> Organization Name: Address:
<br /> Dead Broke Saddle Club 19680 Harrow Avenue North, Forest Lake MN 55025
<br /> Attached: Schedule A: 3, Schedule B2: 6, Schedule E: 1, Schedule F: 1
<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 750.00 725.00 25.00
<br /> 4 Income from Interest and Dividends 92.60 - -- 92.60
<br /> 5 SUB -TOTAL (Add Lines 1 through 4) 842.60 725.00 117.60
<br /> 6 Last Month Line 7C, if it was negative . . 0.00 - -- 0.00
<br /> 7 Adjusted Sub -Total (Line 5 minus Line 6) . 842.60 725.00 117.60
<br /> 8 Tipboards 0.00 0.00 0.00
<br /> 9 Pulltabs 157,686.00 125,783.00 31,903.00
<br /> 10 TOTALS (Add Lines 7,8,9) 158,528.60 126,508.00 32,020.60
<br /> 11 Gambling Tax (9.5% of Line 7C) 11.17
<br /> 12 Combined Receipts Tax (Schedule E, Line 9) 8,993.38
<br /> 13 PAY THIS AMOUNT (Line 11 plus Line 12) Check to Department of Revenue: 9,004.55
<br /> 14 Gambling Tax Paid to Distributors for Pulltabs & Tipboards 2,804.60
<br /> 15 TOTAL Gambling Tax (Add Lines 13 and 14) 11,809.15
<br /> 16 GROSS PROFIT, After Taxes (Line 10C minus Line 15) 20,211.45
<br /> 17 20,211.45
<br /> 18 Beginning Inventory (Last Month Line 21) . . 3,711.92
<br /> 19 Gambling Product Obtained, with Sales Tax. . 1,907.02
<br /> 20 Goods Available (Line 18 plus Line 19) . . . 5,618.94
<br /> 21 Ending Inventory (excludes Sales Tax). . . . 3,264.40
<br /> 22 Goods Used (Line 20 minus Line 21) 2,354.54
<br /> 23 Compensation and Payroll taxes 12,133.36
<br /> 24 Penalty or Interest on Taxes paid during the month . . . 0.00
<br /> 25 Advertising 0.00
<br /> 26 Accounting and Legal Services 275.00
<br /> 27 Miscellaneous Expenses, Supplies & Bank Charges 193.04
<br /> 28 Purchase /Repair of Furnishings or Devices for Gambling . 0.00
<br /> 29 Rent for the Purpose of Conducting Lawful Gambling . . . 2,350.00
<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( +) 368.00
<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) 17,673.94
<br /> 37 NET PROFIT (Line 17 minus Line 36) 2,537.51
<br /> 38 Prior Month Profit Carry -Over (Line 44 from Last Month) 53,486.18
<br /> 39 Approved Adjustments (Attach Letter and /or Add Line 6C if not zero). . 0.00
<br /> 40 BALANCE Sub -Total (Add Lines 37, 38 and 39) 56,023.69
<br /> 41 Lawful Purpose Expenditures (Line 11 Schedule C /D) . . . . 3,033.00
<br /> 42 Board - Approved Expenditures (Line 13 Schedule C /D) . . . . 0.00
<br /> 43 Total Expenditures (Add Lines 41 and 42) 3,033.00
<br /> 44 PROFIT CARRY -OVER (Line 40 minus Line 43) 52,990.69
<br /> 46 FUNDS BALANCE DIFFERENCE from Schedule F, Line 22 0.00
<br /> 47 Pulltab & Tipboard UNSOLD TICKETs this month 18,971.50
<br /> I declare that all information on t is summary and return is true, correct and complete.
<br /> r` -)
<br /> Chief Executiy�j •.: ,--' f Date Gambling Date
<br /> Officer: o f i � g Manager: �� L! / /F �
<br /> Prepared By ' CPW Date 612/464 -7225
<br /> Jc 9
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