Nebraska Bingo Tax Return
FORM
• Returns must be filed every tax period even when no tax is due.
51B
• Read instructions on reverse side.
Nebraska Identification Number
PLEASE DO NOT WRITE IN THIS SPACE
Tax Period
RESET FORM
NAME AND LOCATION ADDRESS
NAME AND MAILING ADDRESS
BINGO TAX (Nonprofit organizations and volunteer fire companies should complete lines 1 through 4 and Schedule I.)
$
1 Gross receipts from bingo this quarter (from line 5, Column A, Schedule I) ......................................
1
00
$
2 Tax due (line 1 multiplied by .03) ........................................................................................................
2
00
3 Previous balance with applicable interest at
$
3% per year and payments received through
3
$
4 BALANCE DUE (line 2 plus or minus line 3). Pay in full with return ...................................................
4
00
Under penalties of law, I declare that I have examined this return, including accompanying schedules and statements, and to the best
of my knowledge and belief, it is correct and complete.
sign
here
Signature of Organization Officer, Utilization of Funds
Date
Signature of Preparer Other Than Taxpayer
Date
Member, or Duly Authorized Representative
Title
Telephone
Address
E-Mail Address
TH
THIS RETURN IS DUE ON OR BEFORE THE 30
DAY OF THE MONTH FOLLOWING THE TAX PERIOD INDICATED ABOVE.
Mail the return and remittance to:
NEBRASKA DEPARTMENT OF REVENUE, CHARITABLE GAMING DIVISION, P.O. BOX 94855, LINCOLN, NE 68509-4855
Make a copy for your file.
7-2010
9-168-1999 Rev.
Supersedes 9-168-1999 Rev. 6-2008