Form 04-844 - Operator Quarterly Report - 2007 Page 5
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52007 Operator Annual Report
Operator Name / dba
License Number
Page _____ of _____
SCHEDULE E: PAYMENTS TO PERMITTEES
DATE
CHECK NO
AMOUNT
- Total payments as reported on Schedule E
Quarter 1
- Total payments as reported on Schedule E
Quarter 2
- Total payments as reported on Schedule E
Quarter 3
- Total payments as reported on Schedule E
Quarter 4
ADDITIONAL PAYMENTS TO PERMITTEES
Subtotal (amounts from this page) ………………………..
TOTAL PAID TO PERMITTEES (include amounts from all pages, should agree with Page 1, Column G, Net Proceeds Paid) ………
Form 04-844 (Rev. 12/07) Page 5
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