Form Le-21 - Quarterly Report - 2002 Page 5
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5Quarter:_______________________
SCHEDULE E: LE - 21
8/2002
License No.:___________________
Progressive Games Summary
Org.:_________________________
1 Progressive Bingo Gross Receipts
(LE - 34a /Line 31d)
$__________________
2 Progressive Bingo Cash Payouts (LE - 34a /Line 31h)
$__________________
3 Progressive Pull Tab Sales @ Bingo Occasions (LE - 31a /Line 39e)
$__________________
$
4
Progressive Pull Tab Payouts @ Bingo Occasions (LE - 31a /Line 39h & 39l)
____________________
5 Progressive Pull Tab Sales @ Bar and Clubroom (LE - 31a /Line 39e) $__________________
$
6
Progressive Pull Tab Payouts @ Bar and Clubroom (LE - 31a /Line 39h & 39l)
___________________
7
Supplies and other costs:
Progressive Bingo Supplies Only:
a. Description:_____________________________ Total Expense
$________________
Vendor: ________________________________
b. Description:__ ___________________________ Total Expense
$________________
Vendor: ________________________________
Progressive Pulltab Supplies at Bingo Occasions Only:
a. Vendor:________________________________
Total Expense
$_______________
b. Vendor:________________________________
Total Expense
$_______________
Progressive Pulltab Supplies at Bar/Clubrooms Only:
a. Vendor:________________________________
Total Expense
$_______________
b. Vendor:________________________________
Total Expense
$_______________
(report additional purchases of bingo and/or pulltab supplies on another sheet following this format)
____________________________________________________________________________
8 Grand Total of all items listed under line 7.
$_______________
(Note: All above expenses incurred during the quarter must be reported per Rule 18.5)
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