Form 35b - Nebraska Lottery/raf E Annual Report - 2012-2013 Page 5
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7NEBRASKA SCHEDULE I — Lawful Purpose Disbursements
FORM 35B
and Bank Account Information
Schedule I
Attach this page to Form 35B (page 1).
Page 2
Organization's Name on Form 35B
Nebraska ID Number
35 —
Part A — Lawful Purpose Disbursements (Do not include lottery/raffle expenses.)
Attach additional sheets, if necessary.
$
1 Disbursements from lottery/raffle bank account for operating expenses of the organization . . . . . . . . 1
2 Transfers from lottery/raffle bank account to the general fund for operating expenses
of the organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Transfers from lottery/raffle bank account to special fund or trust (do not include savings or
C .D . ’ s listed below) . Indicate name of fund and its intended use
3
4 Outside donations (attach an itemized list or use the reverse side to list the name and address of
recipient, check number, date, amount, and description of intended use) . . . . . . . . . . . . . . . . . . . . . . . 4
$
5 Total lawful purpose disbursements (total of lines 1 through 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Part B — Bank Account Information
• Enter information from check register or bank statement for each account maintained for revenues from lottery/raffle.
• Attach additional sheets, if necessary.
SAVINGS OR C.D.’s
CHECKING
(List each account separately)
Name of financial institution . . . . . . . . . . . . . . . . . . . .
Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
City, state, zip code . . . . . . . . . . . . . . . . . . . . . . . . . . .
• Include account activity for the period covered by this report.
$
$
$
6 Beginning balance on July 1, 2012 or other
beginning date:
(include cash on-hand) 6
7 Deposits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
8 Interest earned . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9 Subtotal (total of lines 6 through 8) . . . . . . . . . . . .
9
10 Disbursements (checks paid and withdrawals made) 10
$
$
$
11 Ending balance on June 30, 2013 or other
ending date:
(line 9 minus line 10)
(include cash on-hand) . . . . . . . . . . . . . . . . . . . . . 11
$
12 Amount of lottery/raffle ticket sales that were not deposited between July 1, 2012 and
June 30, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
$
13 Amount of deposits that were derived from a lottery/raffle not required to be included
in this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
$
14 Amount of deposits that were not from lottery/raffle ticket sales . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
$
15 Amount of disbursements to pay prizes or expenses for a lottery/raffle not required to . . . . . . . . .
be included in this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
$
16 Amount of disbursements (on line 10 above) that were not prizes, expenses, or lawful purpose
disbursements (attach an itemized list) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Instructions
Part A
Lawful Purpose Disbursements
Complete Part A to report lawful purpose disbursements. Lawful purpose disbursements are uses of lottery/raffle profits which
are not expenses of conducting lottery/raffle activities. Transfers to special funds or trusts for building construction or renovation,
purchases of equipment, or similar dedicated uses are lawful purpose disbursements and must be reported on line 3. Certificates
of deposit purchased or transfers from the lottery/raffle bank account to a savings account are not lawful purpose disbursements
and must be reported in Part B, Bank Account Information.
Internal uses of lottery/raffle profits which qualify as lawful purpose disbursements include those made for any charitable,
benevolent, humane, religious, philanthropic, recreational, social, educational, civic, or fraternal activity conducted by the
organization for the benefit of its members.
LINE 4. Outside donations are amounts disbursed to recipients outside of the organization and must be for charitable or
community betterment purposes, as defined in the
Nebraska Lottery and Raffle Act Neb. Rev. Stat. §
9-408, and
Lottery and
Raffle Regulations
35-401. The itemized list of these types of donations must identify the recipient’s name and address, check
number, date, amount, and description of the intended use.
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