Raffle Report Of Operations Form - New Jersey Department Of Law And Public Safety Page 2
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2Occasion 6
Date ________________________________
Time ________________________________
Type of raffle _________________________
No. of tickets sold ______________________
Ticket price $__________________________
Gross receipts $________________________
Cost of prizes $________________________
Rental $______________________________
Equipment costs $ _____________________
Other $_______________________________
Total Expenses $_______________________
Type of prize ___________________________________________________________________
Net Proceeds $_________________________
Total number of occasions ______________________________
Total number of tickets sold (1-6 combined) ________________
Price of tickets $______________________________________
Total gross proceeds (1-6 combined) $_____________________
Total expenses (1-6 combined) $__________________________
Total net proceeds (1-6 combined) ________________________
Please provide the name and address of the bank where the balance has been deposited:
Name
Address
Telephone number (include area code)
Description of Expenses
Please provide the name, address and amount paid to the providers of equipment, prizes or services. If additional space is
required, attach a separate sheet of paper.
Name
Address
Amount
Name
Address
Amount
Name
Address
Amount
Utilization of Net Proceeds
If additional space is required, attach a separate sheet of paper.
___________ _______________________________________________________________________
Date
Description of use
Check number
Amount
___________ ________________________________________________________________
_______
Date
Description of use
Check number
Amount
___________ _______________________________________________________________________
Date
Description of use
Check number
Amount
I hereby certify that all of the statements on the foregoing Report of Operations are true, accurate and complete
.
_______________________________________________ __________________________________________________
Name of officer (please print)
Signature
________________________________________________________________________________
____________________________________________________________________________________
Name of member in charge (please print)
Signature
Sworn and subscribed before me this _________ day of _____________________________________, ________________
_______________________________________________ __________________________________________________
Name of notary public (please print)
Signature
This form, if reproduced must be copied completely - both pages.
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