Form 04-833 - Games Of Chance And Contests Of Skill Permittee Annual Financial Statement - 1998 Page 2

Download a blank fillable Form 04-833 - Games Of Chance And Contests Of Skill Permittee Annual Financial Statement - 1998 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 04-833 - Games Of Chance And Contests Of Skill Permittee Annual Financial Statement - 1998 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

1998 Permittee Annual Financial Statement

Permittee Name

Permit Number

Federal EIN

Name of Operator or MBP

Operator License

MBP Permit Number

SCHEDULE AO: OPERATOR/MULTIPLE-BENEFICIARY PERMITTEE ACTIVITY REPORT

List only that income received as a direct result of the games, or sale of gaming equipment.

Food booth receipts and other income should not be included in this report.

If your organization

Column A

Column B

Column C

Column D

Column E

Column F

contracted with more than

Total Gross

Cost of Prizes

Adjusted Gross

Game-Related

one operator, or is an MBP

Receipts

Taxes

Awarded

Income

Expenses

Net Proceeds

member, see instructions.

(col. A less B & C)

(col. D less E)

1. Bingo

2. Pull-Tabs

3. Pull-Tab Sales by Vendors

4. Raffles and Lotteries

5. Dog Musher's Contest

6. Fish Derbies

7. Contests of Skill

Other -

Specify

9. Sale of Equip. and Supplies

(to page 1, line 1)

(to page 1, line 5)

10. Total

Schedule BO: FAIR MARKET VALUE OF PRIZES AWARDED BY THE OPERATOR/MBP (see instructions)

Enter the fair market value of all prizes which were donated to your organization and awarded as a prize by your operator or MBP during the reporting period.

These amounts should not be included in column C above.

The value of donated prizes is part of the total prize limitation.

Column A

Column B

Column C

If your organization contracted with more than one operator during the reporting

Services and

Total

period, see instructions.

Merchandise

Real Estate

Prizes