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NEBRASKA SCHEDULE
I
— County/City Lottery Activity Report
FORM 51C
Schedule I
Attach to Form 51C.
Name as Shown on Form 51C
Nebraska ID Number
Tax Period
Method of Accounting
Cash
Accrual
Other ________________________________________________
INCOME AND PRIZES (From Monthly Summary Reports or Similar Record)
00
5 Gross proceeds from lottery (Enter on line 1 of Form 51C) .....................................................
5
6 Prizes .......................................................................................................................................
6
7 Prize percentage paid (line 6 divided by line 5) .......................................................................
7
%
EXPENSES/DISBURSEMENTS
8 Lottery operator commissions ..................................................................................................
8
Itemization of line 9:
9 Other expenses/disbursements .............................................
_______________________________________________
_______________________________________________
_______________________________________________
Subtotal of line 9:
9
10 Total expenses/disbursements (line 8 plus line 9) .................................................................... 10
11 Percentage of expenses/disbursements (line 10 divided by line 5).......................................... 11
%
12 State lottery taxes .................................................................................................................... 12
13 License fees ............................................................................................................................. 13
14 Audit and legal fees .................................................................................................................. 14
15 Transfers for community betterment ......................................................................................... 15
DISBURSEMENTS FOR COMMUNITY BETTERMENT
Itemization of line 16:
16 Community betterment expenditures .....................................
_______________________________________________
_______________________________________________
_______________________________________________
Subtotal of line 16: 16
6-2011
9-124-1996 Rev.
Supersedes 9-124-1996 Rev. 2-2008