G1
Lawful Gambling Monthly Tax Return
Organization Name
Federal ID Number (FEIN)
Minnesota Tax ID Number
License Number
Address
Check if Address Changed
Email Address
Month/Year Reported
City
State
Zip Code
Number of Sites
Number of barcoded games reported
Check all
Amended Return
Filing under Extension (see instructions)
on Schedule B2s for the month:
that apply:
Final Return (see instructions)
No Gambling Activity this Month
This return includes (check all that apply):
Schedule B2
Schedule NRL
Schedule ER
A
B
C
Gross Receipts
Prizes Paid
Net Receipts
1 Non-linked bingo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Raffles (if tax-exempt raffles were
conducted, complete Schedule ER) . . . . . . . . . . . . . . . . . . 2
3 Paddletickets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Add lines 1 through 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Interest and other income (including advertising or
sponsorship income; see instructions) . . . . . . . . . . . . . . . . 5
6 Linked bingo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Tipboards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Paper pull-tabs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Electronic pull-tabs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Add lines 4 through 9 . Line 10c is your
gross profits for the month . . . . . . . . . . . . . . . . . . . . . . . 10
11 Net receipts tax (multiply line 4C by 8.5% [0.085]; if negative, enter zero) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Combined net receipts tax (from Worksheet E, line 11; if negative, enter the amount on line 18). . . . . . . . . 12
13 Total tax before credits (add lines 11 and 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Net receipts tax credit used (from Schedule NRL, column E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Exempt raffle tax credit (from Schedule ER, line 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Total nonrefundable credits (add lines 14 and 15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
17 Total tax before refundable credit (subtract line 16 from line 13; if negative, enter zero) . . . . . . . . . . . . . . . .17
18 Combined net receipts tax credit (from Worksheet E, line 11; if negative) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
19 Monthly regulatory fee (multiply line 10a by 0.125% [.00125]) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
20 TOTAL TAX DUE OR REFUND (add lines 17, 18 and 19) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Continued
(Rev . 12/15)