Form 51b - Nebraska Schedule I - Bingo Occasion Activity Report
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1
2RESET FORM
NEBRASKA SCHEDULE
I
— Bingo Occasion Activity Report
FORM 51B
Schedule I
Attach to Form 51B.
Name as Shown on Form 51B
Nebraska ID Number
Tax Period
(A)
(B)
(C)
(D)
(E)
Check (✓)
Occasion Date
Bingo
Bingo
Number
Bingo Occasion
Bingo Occasion
Type of Occasion
Gross Receipts
Prizes
of Players
Promotional Prizes
Pickle Card Sales
No. Mo. Day Year Regular Limited
$
$
$
$
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
5 Total bingo gross receipts (enter
$
Column A amount on line 1,
00
Form 51B). . . . . . . . . . . . . . . . . . . . . . .
5
$
$
$
00
00
00
Totals for Columns B, C, D, and E . . . . . . . . . . . . . . . . . . . . . . . . . . . .
RETAIN A COPY FOR YOUR RECORDS.
6-2011
9-019-1987 Rev.
Supersedes 9-019-1987 Rev. 5-2009
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