G1
Lawful Gambling Monthly Tax Return
Organization name
Federal ID number (FEIN)
Minnesota tax ID number
License number
Address
Check if address changed
Email address
Check to subscribe to email Month/year reported
updates using this address
City
State
Zip code
Number of sites
Number of pull-tab (paper and electronic), tipboard
Check all
Amended return
Filing under extension (see instructions)
and paddleticket games reported
that apply:
on Schedule B2s for the month:
No gambling activity this month
Final return (see instructions)
This return includes (check all that apply):
Schedule B2
Schedule NRL
Schedule ER
Form G7430 (February only)
A
B
C
Gross Receipts
Prizes Paid
Net Receipts
1 Paper bingo (if linked paper bingo was
conducted, check here
) . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Raffles (if tax-exempt raffles were
conducted, complete Schedule ER) . . . . . . . . . . . . . . . . 2
3 Paddletickets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Add lines 1 through 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Interest and other income (including advertising or
sponsorship income; see instructions) . . . . . . . . . . . . . 5
6 Electronic linked bingo . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Tipboards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Paper pull-tabs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Electronic pull-tabs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Add lines 4 through 9 . Line 10C is your
gross profits for the month . . . . . . . . . . . . . . . . . . . . . . 10
11 Net receipts tax (multiply line 4C by 8.5% [0.085] . If negative, enter zero) . . . . . . . . . . . . . . . . . . . . . . . 11
12 Combined net receipts tax (from Worksheet E, line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Total tax before credits (add lines 11 and 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Net receipts tax credit used (from Schedule NRL, column E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Exempt raffle tax credit (from Schedule ER, line 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Total nonrefundable credits (add lines 14 and 15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
17 TOTAL TAX DUE. Subtract line 16 from line 13 . If negative, enter zero . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18 Monthly regulatory fee (multiply line 10A by 0.1% [.001]) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
19 Add lines 17 and 18 . PAY THIS AMOUNT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Continued
(Rev . 12/12)