Form 04-833 - Games Of Chance And Contests Of Skill Permittee Annual Financial Statement - 1998 Page 4

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1998 Permittee Annual Financial Statement
Permittee Name
Permit Number
Federal EIN
SCHEDULE AV: VENDOR ACTIVITY REPORT
Use this form to report pull-tabs sold at vendor locations registered in accordance with AS 05.15.188.
VENDOR INFORMATION


ABC License Number
Name of Vendor
Vendor 1
Vendor 2
Vendor 3
Vendor 4
Vendor 5
FINANCIAL INFORMATION






Column A
Column B
Column C
Column D
Column E
Column F
Column G
Column H
Column I
Gross Receipts
Taxes
Cost of Prizes
Adjusted Gross
Vendor
Cost of Pull-Tab
Pull-Tab
Total Expenses
Net Proceeds
Vendor Number
from schedule
Awarded
Income
Compensation*
Games*
Tax Paid*
above
(col A minus col B & C)
(add col E - G)
(col D minus col H)
1.
Vendor 1
2.
Vendor 2
3.
Vendor 3
4.
Vendor 4
5.
Vendor 5
(to page 1, line 7)
(to page 1, line 3)
(to Sch C-1, line 5)
Totals
6.
Form 04-833c (Revised 11/98)
Page 4
* Enter other expenses on Schedule C

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