Form 04-843 - Operator Quarterly Report - 2002 (Page 3 of 5) in pdf

Form 04-843 - Operator Quarterly Report - 2002 Page 3

2002 Operator Quarterly Report

Permit Number

Permittee Name

License Number

Operator Name / dba

This form is also available on the Internet at

Quarter (check one)

1st

2nd

SCHEDULE C-1: COST OF PULL-TAB GAMES AND BINGO CARDS

3rd

4th

Inventory Method for Pull-Tab Games

Unopenend Games

Percent Completed

Pull-Tab Games

Bingo Cards

Cost of inventory of unused cards/unopened games at beginning of quarter.

(If different from last year's ending inventory, attach explanation.)

……………………….

Cost of bingo cards or pull-tab games purchased.

……………………………………………….. 2

Add line 1 and line 2.

…………………………………………………………………………………………. 3

Cost of inventory of unused cards/unopened games at end of quarter.

………………… 4

Line 3 minus line 4 (enter on Schedule C, line 15, pull-tab).

………………………………… 5

Line 3 minus line 4 (enter on Schedule C, line 15, bingo).

……………………………………………………………….. 6

Form 04-843 (Rev10/01) Page 3

Form 04-843 - Operator Quarterly Report - 2002 Page 3