Form Wv/raf-3 Raffle - Super, Annual, Limited & State Fair Raffle Financial Report

ADVERTISEMENT

WEST VIRGINIA STATE TAX DEPARTMENT
WV/RAF-3
DUE 30 DAYS AFTER EXPIRATION
CHARITABLE BINGO/RAFFLE UNIT
REV. 02/05
PO BOX 1143
CHARLESTON WV 25324-1143
SUPER, ANNUAL, LIMITED & STATE FAIR RAFFLE FINANCIAL REPORT
WV IDENTIFICATION NUMBER, NAME, ADDRESS & TELEPHONE NUMBER
REPORT PERIOD
GROSS PROCEEDS
1
SALE OF RAFFLE TICKETS
$
2
DONATED PRIZES (VALUE)
$
3
CHILD CARE SERVICES
$
4
OTHER PROCEEDS
$
5
TOTAL GROSS PROCEEDS
$
PRIZE PAYOUTS
6
CASH OR CHECK
$
7
MERCHANDISE (VALUE)
$
8
DONATED PRIZES (VALUE)
$
9
DOOR PRIZES
$
10
TOTAL ALL PRIZES (ADD LINES 6 THRU 10)
$
11
RAFFLE REVENUE (LINE 5 MINUS LINE 10)
$
RAFFLE EXPENSES
12
RENTAL
$
13
SALARIES & RELATED PAYROLL TAXES
$
14
BAD CHECKS
$
15
UTILITIES
$
16
RAFFLE GAMES
$
17
CUSTODIAL, SECURITY, PERSONNEL, CHILD
$
18
MAINTENANCE & REPAIRS
$
19
OTHER (License Fee, Etc…)
$
20
TOTAL EXPENSES (LINES 12 THRU 19)
$
21
NET PROCEEDS (LOSS) SUBTRACT LINE 20 FROM11)
$
NAME OF BANK AND RAFFLE CHECKING ACCOUNT NUMBER:
22
BEGINNING BALANCE (UNEXPENDED BALANCE AT END OF LAST PERIOD)
$
23
NET PROCEEDS (LOSS) FOR THIS PERIOD (LINE 21)
$
24
OTHER DEPOSITS OR ADJUSTMENTS IN SPECIAL RAFFLE ACCOUNT
$
(Interest earned, etc. Must be explained in detail)
25
MONIES TRANSFERRED TO BINGO TO COVER LOSSES
$
26
NAMES OF ORGANIZATIONS & AMOUNTS CONTRIBUTED THIS PERIOD
$
(If necessary, attach additional sheets)
27
ENDING UNEXPENDED BALANCE (22+/-23+/-24-25-26=27)
$
28
YEAR-END INVENTORY (Dollar amount paid for games on hand)
$
PERCENTAGE USED TO PRO-RATE EXPENSES (IF APPL ICABLE)
CONCESSIONS
CONCESSION OPERATOR:
Proceeds
$
Expenses
$
Net Profit (Loss)
$
REVERSE SIDE: COMPLETE DETAILED CHECK LISTING AND SIGN RETURN WHERE INDICATED

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go
Page of 2