Form 35 - Nebraska Class I Bingo Annual Report - 2012-2013 (Page 4 of 8) in pdf

Instructions

When and Where to File. The annual report for the period July 1, 2012 to June 30, 2013 must be filed

with the Nebraska Department of Revenue by August 15, 2013. If the organization’s current license expires

September 30, 2013 and it does not intend to renew its license, it must file a final report for the period July 1, 2013

to September 30, 2013 within 45 days of the expiration date of the license. That final report should reflect three

months of bingo activity and the final distribution of all bingo profits or a plan for the disbursement of any

remaining funds. The organization must continue to submit bingo revenue status reports each year by August 15

until all bingo profits have been disbursed for lawful purposes.

If the organization does not intend to renew its license, has completed all bingo activity by June 30 of

any year, and has disbursed all of its bingo profits for lawful purposes, write “Final Report” at the top of

the report.

Reporting Period. The annual report is to cover the organization’s bingo activities from July 1 through June 30.

If the organization is filing a short period report, the beginning and ending dates of the reporting period must be

entered in the space provided at the top of the report. If all profits from the conduct of bingo have been disbursed

during this reporting period and no further bingo activity is anticipated, write “Final Report” at the top of page 1.

Accounting Method. The annual report is to be prepared based upon the organization’s accounting basis: cash;

accrual; or other.

Specific Instructions

Line 1a. Enter the gross receipts derived from the conduct of bingo (e.g., receipts from the sale or rental of bingo

paper, hard cards, bingo card monitoring devices, admissions and the value of bingo paper or hard cards purchased

with coupons awarded as bingo prizes or promotional prizes).

Line 1b. Enter all receipts from the sale of bingo supplies (e.g,. daubers, glue sticks, tape).

Line 1c. Enter the value (selling price) of bingo paper or hard cards purchased with coupons awarded as bingo

prizes or promotional prizes.

Line 2. Enter the actual cost of all prizes paid. Do not include the value (selling price) of coupons redeemable

for bingo paper or hard cards awarded as bingo prizes (which are shown on line 3b).

Line 3a. Enter the value (selling price) of donated prizes awarded at the bingo occasions.

Line 3b. Enter the value (selling price) of coupons redeemable for bingo paper or hard cards awarded as

bingo prizes.

Line 4. Enter the gross compensation paid to the chairpersons for services performed related to the conduct

of bingo.

Line 5. Enter the gross compensation paid to bingo workers and pickle card sellers working at the bingo occasions.

Payroll taxes withheld must also be included (i.e., state and federal income tax withholding and social security).

Line 6. Enter the gross compensation paid to all individuals for services performed related to the conduct of bingo

which are not provided for in any lease agreement.

Line 7. Enter the cost of security services for the conduct of bingo. Generally, security services are services

provided by a licensed detective agency or by off-duty law enforcement officers during the conduct of the

bingo occasions.

Line 8. Enter the amount paid for rental of the bingo premises. Include maintenance, repairs, and janitorial

expenses included in the lease agreement.

Line 9. Enter the amount paid for the rental of bingo equipment utilized in the conduct of bingo. Bingo

equipment includes, but is not limited to: blower machines; flash boards; bingo card monitoring devices; and other

similar equipment.

Form 35 - Nebraska Class I Bingo Annual Report - 2012-2013 Page 4