Form Wv/raf-3 - Annual, Limited And State Fair Raffle Financial Report
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4STATE OF WEST VIRGINIA
State Tax Department, Charitable Bingo/Raffle Unit
P.O. Box 1143
Charleston, WV 25324-1143
Name
Address
Account #:
City
State
Zip
WV/RAF-3
ANNUAL, LIMITED & STATE FAIR RAFFLE FINANCIAL REPORT
rtL179 v 10-Web
Taxpayers required to file electronically will no longer receive returns for the tax types subject to the
mandatory requirement by mail. Please visit for additional information.
PLEASE USE BLUE OR BLACK INK ON ALL FORMS
Report Period:
to
Due 30 days after expiration of license
Check if Annual Report
CALCULATION OF ENDING BALANCE
1. Total Gross Proceeds (From Schedule A Line 4)
.
2.
Total All Prizes (From Schedule B Line 5)
.
3.
Total Raffle Expenses (From Schedule C Line 9)
.
4.
Net Profit (Loss) for this Period (Line 1 minus Line 2 and Line 3)
.
5.
Beginning Balance (Unexpended Balance at End of Previous Year)
.
6.
Other Raffle Deposits
.
7.
Adjustments in Raffle Account (Attach Explanation)
.
8.
Monies Transferred to Bingo to Cover Losses
.
9.
Amounts Contributed to Organizations this Year
.
10.
Ending Unexpended Balance
(Line 4 plus Line 5 plus Line 6 plus Line 7 minus Line 8 minus Line 9)
.
11.
Year End Inventory (Dollar amount paid for games on hand)
.
12.
Percentage Used to Pro-Rate Expenses (If Applicable)
.
NAME OF BANK AND RAFFLE CHECKING ACCOUNT NUMBER
NAME OF BANK
RAFFLE CHECKING ACCOUNT NUMBER
CONCESSIONS
CONCESSION OPERATOR:
1.
Receipts
.
2.
Expenses
.
3.
Net Profit (Loss) (Line 1 minus Line 2)
.
Complete Page 3 detailed check listing
MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
Charitable Bingo/Raffle Unit
P.O. Box 1143, Charleston, WV 25324-1143
FOR ASSISTANCE CALL (304) 558-8510
For more information visit our web site at:
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File online at https://mytaxes.wvtax.gov
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