Form Rcg-24 - Charitable Games Supplier Quarterly Report

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Illinois Department of Revenue
RCG-24
Charitable Games Supplier Quarterly Report
Read this information first
All suppliers of charitable games supplies and equipment must file
Quarters end on March 31, June 30, September 30, and December 31.
this report within 20 days after the end of any quarter during which
Mail your completed report to:
the supplier’s license was in effect. This report is due by the deadline
OFFICE OF BINGO AND CHARITABLE GAMES
even if you had no sales or leases during the quarter.
ILLINOIS DEPARTMENT OF REVENUE
Charitable games equipment is defined as “any supplies, devices,
PO BOX 19480
equipment, products, or materials designed for use or used in the
SPRINGFIELD IL 62794-9480
playing of charitable games including, but not limited to, cards, dice,
If you have any questions, call our Springfield office between
pull tabs, and any related type of gambling ticket, chips, representa-
8:00 a.m. and 4:30 p.m. at 217 524-4164. You may also write to us at
tions of money, and wheels.”
the address above.
Step 1: Identify your business
1
3
Name _______________________________________________
Supplier license number
CS - __________________________
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 charitable games equipment you
ment will be used in the appropriate columns. Attach additional
made in Illinois this quarter. For equipment you sold, write an “S” and
sheets if necessary.
the date of sale in the appropriate columns. For equipment you
Note: If you did not make any sales or leases this quarter, write
leased, write an “L” and the dates of the events for which the equip-
“none” on Line 1 and go to Step 3.
Organization purchasing or
Charitable games
Gross proceeds
Sold (“S”)
Date of sale
leasing charitable games equipment
license number
from sale or lease
leased (“L”)
or lease
,
1
$
________________________________
CG - ___________
____________________
______
__ __/__ __
__ __/__ __ __ __
Name
Month
Day(s)
Year
________________________________
Number and street
________________________________
City, state, ZIP
,
2
$
________________________________
CG - ___________
____________________
______
__ __/__ __
__ __/__ __ __ __
Name
Month
Day(s)
Year
________________________________
Number and street
________________________________
City, state, ZIP
,
3
$
________________________________
CG - ___________
____________________
______
__ __/__ __
__ __/__ __ __ __
Name
Month
Day(s)
Year
________________________________
Number and street
________________________________
City, state, ZIP
Step 3: Sign below
Under penalties of perjury, I state that I have examined this report, and to the best of my knowledge, it is true, correct, and complete.
________________________________________________________________________________________________________________
Officer’s signature
Title
Date
This form is authorized as outlined by the Charitable Games Act. Disclosure of this information is REQUIRED. Failure to provide
RCG-24 (R-5/97)
information could result in a penalty. This form has been approved by the Forms Management Center.
IL-492-2133
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