Form 04-833 - Games Of Chance And Contests Of Skill Permittee Annual Financial Statement - 1998 Page 5

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1998 Permittee Annual Financial Statement
Permittee Name
Permit Number
Federal EIN

SCHEDULE C: GAME-RELATED EXPENSES
Column A
Column B
Column C
Column D
Column E
Column F
Column G
Column H
Column I
Expense (1)
Bingo
Pull-Tabs
Raffles & Lottery
Dog Musher's
Fish Derbies
Contests of Skill
Other
Other
Total
1. Rental of Facility
2. Janitorial
3. Utilities
4. Insurance-Other than Bldg.
5. Contract Services
6. Professional Services
7. Accounting
8. Wages
9. Payroll Taxes
10. Printing Tickets
11. Pull-Tab Tax Paid
Cost of Pull-Tab Games
12.
(Schedule C-1)
13. Bingo Supplies
Cost of Bingo Cards
14.
(Schedule C-1)
15. Advertising (2)
16. Postage/Freight
17. Equipment Repairs
18. Non-Alcoholic Refreshments
19. Other Specify -
20. Equipment Purchases
21. Permit Fees
22. Supplies - Other than Bingo
23. Miscellaneous
24. Building R & M (3)
25. Building Depreciation (3)
26. Building Insurance (3)
27. TOTAL EXPENSES
28. Expense Limitation (1)
DEDUCTIBLE EXPENSE (line
29.
27 minus line 28)
(4)
(1) Total Expenses per activity are limited. See instructions for line 28.
(2) Advertising expenses are limited. Please refer to the regulations.
(3) Building expenses may be limited. See instructions.
04-833d (Revised 11/98)
Page 5
(4) Carry line 29 to Schedule AP, column E for each game type.

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