Form Rb-1 - Bingo Tax Return - Illinois Department Of Revenue
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1Illinois Department of Revenue
REV 2
RB-1
E S ___/___/___
Bingo Tax Return
Station no. 531
NS
DP
CA
Step 1: Identify your organization
6
Check the appropriate box and complete the
information to indicate the tax period for
1
Illinois Business Tax number (IBT no.): ___ ___ ___ ___ - ___ ___ ___ ___
which you are filing this return:
(If applicable)
Quarter ending __ __/__ __ __ __
2
Bingo license number:
_______ - _______________________
Limited operator
3
Organization’s name:______________________________________________
7
Check here if your address has changed.
8
4
Address:________________________________________________________
Is this a final return?
yes
no
Number and street
"Final” indicates you no longer conduct bingo
gaming events. If "yes," tell us the date of your
5
_______________________________________________________________
final bingo game:___/___/____
City
State
ZIP
Step 2: Identify any supplier from whom you purchased bingo supplies during this reporting period
Supplier's license no.: BF –___ ___ ___ ___
Supplier's license no. BF –___ ___ ___ ___
Supplier's name: _______________________________________
Supplier's name________________________________________
Step 3: Provide information about your bingo gaming events during this reporting period
Regular operator
Limited or Special operator - Not state/county fairs
9a
9b
First gaming event: ____/____/____
Limited event:
____/____/____ to ____/____/____ Games played: ________
10a
10b
Last gaming event: ____/____/____
1
Special event:
____/____/____ to ____/____/____ Games played: ________
st
11a
11b
Total games played: _____________
2
Special event: ____/____/____ to ____/____/____ Games played: ________
nd
Step 4: Figure your tax due
12
12
Gross proceeds for weekly bingo gaming events - Regular operator only
__________|__
13
13
Gross proceeds for bingo gaming event - Limited or Special operator (Event 1)
__________|__
14
14
Gross proceeds for bingo gaming event - Special operator (Event 2)
__________|__
15
15
Gross proceeds for county or state fair bingo gaming events. Dates of the fair: ___/___/___ to ___/___/___
__________|__
16
16
Add Lines 12 thru 15. This is your total gross proceeds.
__________|__
17
17
Multiply Line 16 by 5% (.05). This is the tax amount due.
__________|__
18
18
Credit amount you wish to apply.
__________|__
19
19
Subtract Line 18 from Line 17. Please pay this amount.
__________|__
Make your check payable to "Illinois Department of Revenue."
Step 5: Figure your bingo expenditures of funds during this reporting period
20
Cash prizes awarded.
$_________________________
21
Subtract Line 20 from Step 4, Line 16. This is your net proceeds.
$_________________________
22
Deposits.
$_________________________
23
Beginning balance. This is the ending balance from your last reporting period.
$_________________________
24
Add Lines 21, 22, and 23. This is your total credits.
$_________________________
25
Charges from your bank or financial institution.
$_________________________
26
Rent paid (if applicable). If you paid no rent this reporting period - write “0”.
$_________________________
Premise provider’s license no. where your event(s) was held: ___________________
27
Total of other allowable expenses ( i.e., supplies, maintenance)
$_________________________
28
Add Lines 25, 26, and 27. This is your total expenses.
$_________________________
29
Subtract Line 28 from Line 24. This is your ending balance for this reporting period.
$_________________________
Step 6: Tell us the value of donations and non-cash prizes you awarded and the donations you made
30
Value of non-cash prizes and/or donations for prizes awarded this reporting period
$_________________________
31
Tell us the amount you donated to benefit the public this reporting period.
$_________________________
To whom or what did you make the donations. Attach a separate sheet if necessary:
__________________________________________________________________
__________________________________________________________________
Step 7: Sign below - officer of organization and the person completing the return
Under penalties of perjury, I state that I have examined this return and that it is true, correct, and complete. I further swear that I have read the rulebook and
have all information regarding each session in my books and records.
_____________________________________
____/___/_____
_____________________________________
____/___/_____
Officer's signature
Date
Paid tax preparer's signature
Date
Phone: (____)____ - ________
Phone: (____)____ - ________
This form is authorized by the Illinois Bingo License and Tax Act. Disclosure of this information is REQUIRED. Failure to
provide information could result in a penalty. This form has been approved by the Forms Management Center.
IL-492-2715
RB-1 (R-07/04)
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