Form G1 - Lawful Gambling Monthly Tax Return Page 2

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G1 P2
Lawful Gambling Monthly Tax Return (continued)
Organization name
Federal ID number (FEIN)
Minnesota tax ID number
License number
20 Lawful purpose expenditures (from Schedule C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21 Total lawful purpose expenditures (add lines 19 and 20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Allowable expenses (total of all Schedule A's) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
23 a Starting cash banks per books (total of all Schedule A's) . . . . . . . . . . . . . 23a
b Unreimbursed starting cash banks (total of all Schedule A's). . . . . . . . . . 23b
End-of-month cash balance in starting banks (subtract line 23b from 23a) . . . . . . . . . . . . . . . . . . . . . . . 23
I declare that all information on this summary and tax return is true, correct and complete.
Chief executive officer (print)
Chief executive officer signature
Date
Daytime phone
Check if change to CEO
Gambling manager (print)
Gambling manager signature
Date
Daytime phone
Check if change to GM
Preparer (print)
Name of firm
Preparer signature
Date
Daytime phone
Mail Form G1, schedules and any required attachments to:
Minnesota Revenue, Mail Station 3350, St . Paul, MN 55146-3350

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