Form Wv/bgo-3 - Super, Annual, Limited And State Fair Bingo Financial Report Page 4

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WV/BGO-3
SUPER, ANNUAL, LIMITED & STATE FAIR BINGO FINANCIAL REPORT
rtL176 v 10-web
PLEASE USE BLUE OR BLACK INK ON ALL FORMS
THIS SCHEDULE MUST BE FILED WITH ALL BINGO AND SUPER BINGO FINANCIAL REPORTS
SCHEDULE 1
LIST ALL WINNERS
OVER $100.00 AT EACH BINGO OCCASION
SOCIAL
DOLLAR
DATE
NAME
ADDRESS
SECURITY
AMOUNT
WON
NUMBER
WON
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Page 4 of 4

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