Form Wv/bgo-3 - Super, Annual, Limited And State Fair Bingo 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/BGO-3
SUPER, ANNUAL, LIMITED & STATE FAIR BINGO FINANCIAL REPORT
rtL176 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 Date:
Check if Annual Report
TYPE OF LICENSE (CHECK ONE) AND NUMBER OF BINGO OCCASIONS
Number of Bingo
ANNUAL LICENSE
LIMITED LICENSE
Occasions this Period
ANNUAL SENIOR LICENSE
STATE FAIR LICENSE
ANNUAL LICENSE ($20,000 OR LESS)
SUPER LICENSE
CALCULATION OF ENDING BALANCE
1.
Total Receipts (From Schedule A Line 5)
.
2.
Total All Prizes (From Schedule B Line 5)
.
3.
Total Bingo Expenses (From Schedule C Line 8)
.
4.
Net Profit (Loss) for this Period (Line 1 minus Line 2 and Line 3)
.
5.
Beginning Balance (Unexpended Balance at End of Last Period)
.
6.
Deposits in Bingo Account
.
7.
Adjustments in Bingo Account (Attach Explanation)
.
8.
Amounts Contributed this Period:
.
9.
Ending Unexpended Balance (Line 4 + 5 +/- 6 +/- 7 - 8) (Must match checkbook)
.
CONCESSIONS
CONCESSION OPERATOR
1.
Receipts
.
2.
Expenses
.
3.
Net Profit (Loss) Line 1 minus Line 2
.
Complete page 2 and sign return where indicated. Complete detailed check listing on page 3.
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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