Form G-1 Schedule A - Receipts And Expenses Per Premise
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1Receipts and Expenses Per Premise
G-1 Schedule A
Organization license number
Premise permit number
Premise name
Month and year reported on this form
column A
column B
column C
Lines 1-10 and 18-36 correspond to Form G-1
gross receipts
prizes
net receipts
1 Bingo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Raffles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Paddletickets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Income from interest and dividends (fill
in same amount in both columns A and C) . . . . . . . . . . . . . 4
5 Add lines 1 through 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 If line 7c of last month’s Form G-1 is a negative num-
ber, list it (without parentheses) in columns A and C . . . . . . 6
7 Subtrract line 6 from line 5. If you did not fill in
amounts on line 6, fill in amounts from line 5 . . . . . . . . . . . 7
8 Tipboards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Pulltabs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Add lines 7 through 9. The amount you list in
column C is your gross profit for the month . . . . . . . . . 10
18 Beginning inventory of gambling product (from line 21 of last month’s Schedule A) . . . . . . . . . . . . . . . . . 18
19 Cost of gambling product obtained during the month. (Include sales
tax, but do not include the 2 percent tax listed on distributors’ invoices) . . . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Add lines 18 and 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21 Ending inventory of gambling product (dollar value on the last day of the month) . . . . . . . . . . . . . . . . . . . 21
22 Subtract line 21 from line 20. The result is the total dollar
value of the gambling product you sold during the month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
23 Amount paid for compensation and payroll taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
24 Penalty and interest you paid during the month on any taxes, including payroll taxes, that
you listed on any Form G-1 or on any Schedule C since beginning gambling activities . . . . . . . . . . . . . . . 24
25 Amount paid for advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
26 Amount paid for accounting services for preparation of monthly lawful gambling
tax forms and for your annual financial audit or review, and for qualifying legal work . . . . . . . . . . . . . . . 26
27 Amount paid for bank service charges; office supplies; lodging, meals and transportation
for lawful gambling classes conducted by state agencies; and miscellaneous expenses . . . . . . . . . . . . . . . 27
28 Amount paid to purchase and/or repair office furnishings and office equipment
used for gambling, and to purchase and/or repair devices used for gambling . . . . . . . . . . . . . . . . . . . . . 28
29 Amount paid for rent for conducting lawful gambling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
30 Amount paid for utilities used for conducting lawful gambling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
31 Amount paid during the month for theft insurance and the amount
you are permitted to list for liability insurance paid during the month . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
32 Amount paid during the month for local government investigation fee, and new or
renewed: gambling manager’s bond, gambling manager’s license and premise permits . . . . . . . . . . . . . . 32
33 Cash long or cash short. (If cash long, put parentheses around the amount) . . . . . . . . . . . . . . . . . . . . . . . 33
34 Amount of reimbursement for excess cash short. (This is a negative amount) . . . . . . . . . . . . . . . . . . . . . . 34
35 Amount of reimbursement for negative expense calculation. (This is a negative amount) . . . . . . . . . . . . . . 35
36 Add lines 22 through 35. This is your total allowable expenses for the month . . . . . . . . . . . . . . . . . 36
6001010 (10/94)
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