Form Cg-9 - Indiana Charity Gaming License - Single Event Financial Report

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Indiana Charity Gaming License
CG-9
SF-45388
Single Event Financial Report
(R2/7-05)
Do Not Write Above
This report must be filed by organizations having charity game licenses other than an Annual Bingo License.
It must be mailed to the Department within 10 days following the event.
Organization Name (Please type or print)
Street Address of Principal Office (Do not enter a P.O. Box Number)
City
State
Zip Code
County
Organization Telephone Number
Indiana Nonprofit Tax Registration Number
(
)
Contact Person for Your Organization
Contact Person's Phone Number
(
)
Report Information
Section A
Enter the single event license number ________________________________________
What kind of license was used for this single event? (Check One)
Special Bingo License
Raffle License
Festival License
Annual Door Prize
Door Prize License
Charity Game Night License
Calendar Raffle
Water Raffle
Beginning date of single event ______/______/______
This report should show all financial and accounting activity related to the single event license checked above. This includes income
and expenses related to raffles, door prizes, card or dice games, and the sale of pull tabs, punchboards, and tip boards sold at the event.
You must also include income and expenses related to the sale of food, novelties, etc. sold specifically at the event.
CG-9 (1)
(Turn the page)

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