State Form 48682 - Cg-Inv, Charity Gaming Ending Inventory Statement

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CG-INV, CHARITY GAMING ENDING INVENTORY STATEMENT
State Form 48682 (R5 / 6-11)
INDIANA GAMING COMMISSION
INSTRUCTIONS: Use to enter the ending inventory of your pull tabs, punchboards and tip boards as of the last day of your quarterly accounting period. For
annual licensees, attach the CG-8. For single event licensees, attach to your CG-9. Attach additional sheets if necessary.
Organization name (please type or print)
Federal Identification number (FID)
Address (number and street)
Email address
City
State
ZIP code
County
Annual Licenses - Enter Financial Licensing Period: From ____________________ To ____________________
Single Event Licenses - Attach to CG-9
Enter License number ____________________
Name of Game
Number of Boxes
Serial Number of Game
Gross
Payout
Name of Distributor
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