Form 35a - Nebraska Lottery By Pickle Card Annual Report

Important — Please Read

This booklet contains the annual reporting forms to be completed and filed with the Nebraska Department of Revenue

(Department) by any nonprofit organization which held a license to conduct a lottery by the sale of pickle cards during

the period July 1, 2012 through June 30, 2013. The

Nebraska Pickle Card Lottery Act

requires the organization to

make a complete, true, and accurate accounting to the Department on an annual basis of its gross proceeds from its

lottery by the sale of pickle cards. A copy of the report must also be submitted to the organization’s membership.

The report must be filed on the reporting forms provided in this report, and must include:

•

an accounting of the organization’s gross proceeds from its pickle card activity;

•

a breakdown of receipts and expenses;

•

lawful purpose usages of the pickle card profits; and

•

a detailed analysis of all commissions allowed to pickle card operators and commissions or salaries

paid to sales agents involved with the organization’s lottery by the sale of pickle cards.

All parts of the annual report must be completed and filed with the Department by August 15, 2013. If the

organization does not intend to renew its pickle card license, a final report must be filed within 45 days of the

expiration date of the license. In addition, a pickle card revenue status report is required to be filed each year

by August 15 until all profits from the conduct of a lottery by the sale of pickle cards have been disbursed.

Instructions for completing each section of this report are printed on each form. Failure to file a complete, true, and

accurate report or not filing the report by the due date are violations of the

Nebraska Pickle Card Lottery Act

and

may jeopardize an organization’s eligibility for license renewal and/or result in an administrative fine up to $1,000.

Helpful hint: Complete page 3 first. The amounts from line 1, page 3 carry to page 1.

Before filing the annual report, please perform these

procedures to ensure accuracy.

Pickle Card Inventory: Make sure that the July 1, 2013 beginning inventory is the same as the

June 30, 2012 ending inventory. If there is a discrepancy, please attach a written explanation.

1. Reconcile Gross Profit to Bank Deposits

A. On page 2, add line 7 and line 13, and subtract lines 12, 14, and 15 to determine bank deposits from pickle

card sales for the period.

B. Compare the amount found in step A above with the gross profit on line 5, page 1. If there is a significant

difference, the amount should be entered as an adjustment on line 6, page 1 as a deposit overage or

shortage. Attach a written explanation of the difference.

2. Reconcile Pickle Card Expenses and Lawful Purpose Disbursements to Bank Disbursements

A. Add line 18 of page 1 and lines 5, 15, and 16 of page 2 to determine the amount which was used for pickle

card expenses, lawful purpose disbursements, and other expenditures.

B. Compare the amount found in step A above to line 10, page 2. If there is a significant discrepancy, review

your records and correct the annual report.

3. Compare Bank Balances

Make sure that the July 1, 2012 beginning bank balance is the same as the June 30, 2012 ending bank balance

from the previous annual report. If there is a discrepancy, please attach a written explanation.

If you have any questions or need further assistance, please contact: Mike Haverman 402-471-6119, or 877-564-1315.

You may file online at https://charitablegaming.nebraska.gov.

Form 35a - Nebraska Lottery By Pickle Card Annual Report - 2012-2013 Page 2

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