Form Gc-7q - Quarterly Statement Of Bell Jar Operations printable pdf download

GC-7Q

QUARTERLY STATEMENT OF

BELL JAR OPERATIONS

NYS RACING & WAGERING BOARD

1 Broadway Center, Suite 600

Schenectady, NY 12305-2553

Telephone (518) 395-5400 Fax (518) 347-1469

Jan 1 - Mar 31

Apr 1 - Jun 30

Jul 1 - Sep 30

Oct 1 - Dec 31 Year 20

For Quarter:

Instructions: Send original of this report to NYS Racing & Wagering Board, 1 Broadway Center, Suite 600,

Schenectady, NY 12305-2553, within 15 days after each calendar quarter. Retain a copy for your records.

Attach completed Schedules 1 and 2; the list of all checks written this quarter; and a copy of the three most recent

monthly bank statements of the special games of chance bank accounts (including interest-bearing account(s)).

Name of Organization

Street Address

City

Zip

County

GC-

NYS Identification Number

Municipal License Number

Examined By (OFFICE USE ONLY)

A. Quarterly Proceeds

1. Number of deals sold..............................................................................................................

2. Ideal handle/total value of tickets...............................

(from Schedule 1, column F)

3. Prizes (from Schedule 1, column G)....................

4. Unsold tickets (from Schedule 1, column H).......

5. Cost of deals (from Schedule 2, line D)...............

6. Add lines 3, 4, and 5..................................................

7. Subtract line 6 from line 2. This is the Ideal Net Proceeds

B. Net Profit or (Loss)

8. Enter 5% of line 7 "Additional License Fee" ....................

(make check payable to NYSRWB Bell Jar Collection Account)

9. Subtract line 8 from line 7. This is Total Net Profit or (Loss)

C. Statement of Net Proceeds

10. Unexpended balance of Net Proceeds from last

GC-7Q report................................................................

11. Interest earned this Quarter from any Bell Jar

Interest-Bearing Account(s) (special checking, CDs,

and/or savings accounts)..............................................

12. Add lines 10 and 11. This is the quarterly net proceeds

and interest..........................................................................

13. Adjustments. (Enter the + or - sign before the figure and

explain:

).....

14. Combine lines 12 and 13. This is adjusted net proceeds

and interest................................................................................

15. Add lines 9 and 14. This is the Total Net Proceeds........................

BJ-GC-7Q (Rev. 7/06)

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Form Gc-7q - Quarterly Statement Of Bell Jar Operations

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