Form Rb-41 - Bingo Supplier Quarterly Report
Download a blank fillable Form Rb-41 - Bingo Supplier Quarterly Report in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Rb-41 - Bingo Supplier Quarterly Report with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Use your 'Mouse' or the 'Tab key' to move through the fields and 'Mouse' or 'Space bar' to enable the checkboxes.
Illinois Department of Revenue
RB-41
Bingo Supplier Quarterly Report
Read this information first
All suppliers of bingo supplies and equipment must file this report
Mail your completed report to:
within 30 days after the end of any quarter during which the
OFFICE OF BINGO AND CHARITABLE GAMES
supplier’s license was in effect. This report is due by the deadline
ILLINOIS DEPARTMENT OF REVENUE
even if you had no sales or leases during the quarter.
PO BOX 19480
SPRINGFIELD IL 62794-9480
Bingo supplies and equipment is defined as “cards, boards, sheets,
markers, pads, and any other supplies, devices, and equipment
If you have any questions, call our Springfield office between
designed for use in the play of bingo.”
8:00 a.m. and 4:30 p.m. at 217 524-4164. You may also write to us at
the address above.
Quarters end on March 31, June 30, September 30, and December 31.
Step 1: Identify your business
1
3
Name _______________________________________________
Supplier license number
BF - __________________________
2
4
Address ______________________________________________
This report is for the quarter ending __ __/ __ __ __ __
Street address
Month
Year
_____________________________________________________
City
State
ZIP
Step 2: List your sales or leases
List below all sales or leases of bingo supplies and equipment you
which the equipment will be used in the appropriate columns. Attach
made in Illinois this quarter, even those made to persons or organiza-
additional sheets if necessary.
tions that are not licensed to conduct bingo games. For equipment
Note: If you did not make any sales or leases this quarter, write
you sold, write an “S” and the date of sale in the appropriate columns.
“none” on Line 1 and go to Step 3.
For equipment you leased, write an “L” and the dates of the events for
Organization purchasing or
Bingo
Gross proceeds
Sold (“S”)
Date of sale
leasing bingo equipment
license number
from sale or lease
leased (“L”)
or lease
1
$
__________________________________ B - ___________
____________________
______
__ __/ __ __/ __ __ __ __
Name
Month
Day
Year
__________________________________
Number and street
__________________________________
City, state, ZIP
2
$
__________________________________ B - ___________
____________________
______
__ __/ __ __/ __ __ __ __
Name
Month
Day
Year
__________________________________
Number and street
__________________________________
City, state, ZIP
3
$
__________________________________ B - ___________
____________________
______
__ __/ __ __/ __ __ __ __
Name
Month
Day
Year
__________________________________
Number and street
__________________________________
City, state, ZIP
4
$
__________________________________ B - ___________
____________________
______
__ __/ __ __/ __ __ __ __
Name
Month
Day
Year
__________________________________
Number and street
__________________________________
City, state, ZIP
Please turn this form over and continue completing Steps 2 and 3.
This form is authorized as outlined by the Bingo License and Tax Act. Disclosure of this information is REQUIRED. Failure to provide
RB-41 front (R-4/01)
information could result in a penalty. This form has been approved by the Forms Management Center.
IL-492-2903
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial