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STATE OF KANSAS

DEPARTMENT OF REVENUE

Charitable Gaming

Phone (785) 296-6127

Kansas Department of Revenue

FAX (785)296-7185

Docking State Office Bldg, Room 214

915 SW Harrison Street

Hearing Impaired TTY (785) 296-3909

E-mail Address: phil_wilkes@kdor.state.ks.us

Topeka, Kansas 66625-3512

STATUTORY REQUIREMENT TO MAINTAIN A BINGO TRUST BANK ACCOUNT

K.S.A. 79-4706(u) states:

"Every licensee who has gross receipts of $1,000 or more received from participation in games,

admission fees or charges and from other sources directly related to the operation or conduct of

any games of bingo in any calendar month shall maintain a bingo trust bank account into which

all such receipts are deposited daily and from which all payments are made relating to the

management, operation or conduct of any games of bingo, except payments of prizes of less

than $200. Having once established such bingo trust bank account, the licensee shall continue

to make deposits of all receipts therein. Every licensee shall notify the administrator of the

name of the bank in which the bingo trust bank account is maintained, together with the number

and name of the account. Every licensee who maintains a bingo trust bank account shall

maintain a complete record of all deposits and withdrawals from such bank account and the

same shall be available to the administrator to audit at any reasonable time."

If your organization is required by the above statute to maintain a bingo trust bank account, then complete the

following form and send it to the Administrator of Charitable Gaming at the address above:

REPORT OF BINGO TRUST BANK ACCOUNT

AND

CONSENT TO EXAMINE AND AUDIT ACCOUNT

In compliance with K.S.A. 79-4706(t), __________________________________________________,

(Name of Organization)

Bingo License No. ________________, hereby notifies the Administrator of Charitable Gaming of the

bingo trust bank account established by this organization on ________________________, 20______:

Account Name

Account Number

Name of Bank or Savings and Loan

Address of Bank or Savings and Loan

On behalf of the above-named organization, I hereby authorize the above-named bank or savings and

loan association to allow at any reasonable time any agent or investigator of the Kansas Secretary of

Revenue to examine and audit the records of the aforementioned trust account.

Signature of Person Authorized to Make Withdrawals

Position or Office Held in the Organization

BI-56 (Rev. 10/01)

Form Bi-56 - Report Of Bingo Trust Bank Account And Consent To Examine And Audit Account