Form Gc-7q - Quarterly Statement Of Bell Jar Operations - Nys Gaming Commission - Division Of Charitable Gaming
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1
2GC- 7Q Quarterly Statement of Bell Jar Operations
CALENDAR YEAR: _________
st
– March 31
st
st
– June 30
th
st
– September 30
th
st
– December 31
st
January 1
April 1
July 1
October 1
Name of Organization: ________________________________________________________________________
Games of Chance ID: _____________________________________________________
Street Address: ______________________________________ ____________________________ _____________
Street
City
Zip Code
Instructions: Submit this report to the New York State Gaming Commission within 15 days of the end of each calendar quarter.
Send a list of all checks written during the respective quarter and copies of the three monthly bank statements of the special games of
chance checking account. Veterans organizations must also include copies of the minutes of their membership meetings if
authorizing any expenditures pursuant to games of chance rule 4624.21(c)(4) and (d). If licensed, this report must be filed even if no
tickets were sold. Mail to: The New York State Gaming Commission, P.O. Box 7500, Schenectady, NY 12301-7500.
A. QUARTERLY PROCEEDS
Total number of closed deals (
)
__________________
A1.
from Schedule 1, Box T
A2. Ideal handle/total ticket value (
)
$_________________________
from Schedule 1, Box Q
A3. Total cash prizes (
)
$_________________________
from Schedule 1, Box R
A4. Total value of unsold tickets (
)
$_________________________
from Schedule 1, Box S
A5. Cost of deals, coin boards and/or merchandise boards (
) $_________________________
purchased this quarter only
A6. Add lines A3, A4 and A5
$_________________________
A7. Ideal Net Proceeds (
)
$_________________________
subtract line A6 from line A2
B. NET PROFIT (or loss)
B8. Enter 5% Additional License Fee (
)
$_______________________
line A7 x 5%
(Make your check payable to: NYS Gaming Commission)
B9. Total Net Profit or Loss (
)
$________________________
subtract line B8 from line A7
C. STATEMENT OF NET PROCEEDS
C10. Unexpended balance of Net Proceeds from last GC-7Q report (l
)
$________________________
ine D17
C11. Interest earned in this quarter
$________________________
C12. Quarterly Net Proceeds and Interest (
)
$________________________
add lines C10 and C11
C13. Adjustments:(
)$________________________
needs prior approval from the Gaming Commission before including it on this form
Adjustment Explanation:
………. $_______________________
C14. Adjusted Net Proceeds and Interest (
)
add lines C13 and C12
C15. Total Net Proceeds (
)
$_______________________
add lines B9 and C14
D. UNEXPENDED BALANCE OF NET PROCEEDS
…..……
D16. Total Disbursements (
)
$_______________________
excluding cost of deals and 5% fee
D17. Total Unexpended Balance of Net Proceeds (
)
$_______________________
subtract line C16 from line C15
Page 1 of 2
(rev. 6/2015)
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