Form Bi-1 - Organization'S Monthly Bingo Report Page 2
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1
2Serial Number
Distributor’s Name
Distributor’s
Invoice
Invoice
Manufacturer’s
Total Retail Price
Registration
Number
Date
Name
of Game
of Tickets in Game
Total
Copy the total to Section B on the reverse side (Page 1)
INSTRUCTIONS
Section A - For each purchase of call bingo paper during the month, enter the data indicated by the column headings.
Purchases should be reported in the same month as the date on the distributor's invoice, not the date received or the date
paid. The data should be entered on a single line for each distributor's invoice. Be sure to total each column.
Section B - For each instant bingo (pull-tab) game purchased during the month, enter the data indicated by the column
headings above (page 2). The far right column, "Total Retail Price of Tickets in Game," is calculated by multiplying the
number of tickets in the game by the denomination of the tickets (25 cents, 50 cents, etc.). This is the gross revenue which
you will receive if you sell all of the tickets in the game to the players. Do not report the wholesale price that your
organization paid to the distributor for the game. Also write the total for Section B in the block on the reverse side (page 1).
Section C - Report the total gross receipts from the sale of all call bingo disposible paper faces to the players for all bingo
sessions conducted during the month. Do not include receipts from the sale of instant bingo tickets (pull-tabs) or daubers.
Section D - Report the total receipts from the sale of hard cards during the month on Lines 1 and 2 if applicable. If Line 1 is
$100 or less, then no tax is due. If Line 2 is $1,000 or less, then no tax is due. If tax is due, write the amount on Line 3 and
enclose a check for that amount made payable to the "Kansas Department of Revenue."
No. of times played this month: How many sessions did the organization host bingo during the month?
Average attendance per time: What was the average attendance for the month?
Total Net Proceeds: Add revenue from pull-tabs and faces. Subtract from that number, any purchases for pull-tabs or
faces purchased during the month, payouts on faces and pull-tabs. That number is the answer.
No. of drawings this month: Organizations are allowed 4 drawings pr. Yr. Only one drawing per session is allowed.
No. of times played off limits: Organization requested to play at another location other than address on their lic. Allowed
5 times per year and must be in the same county. EX: county fair. Notify this office 3 days in advance in writing.
PG. 2
(BI-1 Revised 04/10/11)
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Parent category: Financial