Form Bi-1 - Organization'S Monthly Bingo Report
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2KANSAS DEPARTMENT OF REVENUE
Charitable Gaming
Phone: (785) 296-6127 email: bingo@kdor.ks.gov
FOR OFFICE USE ONLY
ORGANIZATION’S MONTHLY BINGO REPORT
Name of organization / License number
Monthly reporting period
Make a blank copy for each month and send to KDOR on due date.
Check the month being recorded.
July ___
Nov. ___
Mar. ___
Aug.___
Dec. ___
Apr. ___
Sept. __
Jan. ___
May ___
Oct. ___
Feb. ___
June ___
TH
DUE BY THE 25
OF THE FOLLOWING MONTH
SECTION A - CALL BINGO PAPER PURCHASED OR RETURNED DURING THE MONTH
(List each invoice separately. If you had no purchases or returns, then write "None.")
Distributor’s
Invoice
Number of Faces Purchased For
Distributor’s Name
Invoice
Registration
Number
Date
Regular & Special
Progressive
Mini Games
Number
Games
Games
Totals
SECTION B - TOTAL RETAIL PRICE OF ALL INSTANT BINGO TICKETS (PULL-TABS)
$
PURCHASED OR RETURNED DURING THE MONTH
(total from reverse side)
SECTION C - TOTAL MONTHLY RECEIPTS FROM ALL CALL BINGO GAMES, INCLUDING
$
HARD CARD SALES FROM SECTION D BELOW. If you had no games, then write "0" or "None."
Number of times played this month______ Average attendance per time _________ Total Net profit _____________
Number of drawings this month______ Number of times played off limits _____
See Page 2 for instructions
SECTION D - SALE OF HARD CARDS AND ENFORCEMENT TAX DUE PER BINGO REGULATION 92-23-31
Line 1
Gross receipts from hard card sales to persons with physical or mental infirmities
$
Line 2
Gross receipts from hard card sales if licensee conducts no more than two sessions per
$
year pursuant to subsection (b) of Regulation 92-23-31.
Line 3
Tax Due. If Line 1 exceeds $100, multiply Line 1 by 3% and write the answer here, or
$
if Line 2 exceeds $1,000 per session, multiply Line 2 by 3% and write the answer here:
I certify that this is a true correct and complete report.
Signature
Title
Date
____
Mail this report to: Sales & Excise Tax, Kansas Dept. of Revenue, 915 SW Harrison St., Topeka, KS 66625-5000.
Page 1
SECTION B - INSTANT BINGO TICKETS (PULL-TABS) PURCHASED OR RETURNED DURING THE MONTH
(List each game separately based on invoices dated during the month being reported.)
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