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					                                                                                                                                                                                                                                                                         G1
Lawful Gambling Monthly Summary and Tax Return
                 Organization name                                                                                                       Federal ID number                           Minnesota tax ID number                                       License number


                 Address                                                                                                                 Email address                                                                                             Month/year reported
  please print




                 City                                                                                                                    State                                       Zip code                                                      Number of sites


                 Number of pulltab, tipboard and paddleticket games                                                            Check all:                     Amended return                                                   Filing extension (attach letter)
                 reported on Schedule B2s for the month:                                                                       that apply                     No gambling activity this month
                 This return includes:
                        Schedule A (# of pgs                                       )                  Schedule B2 (# of pgs                                     )                Schedule F                          Barcode label sheet (# of pgs                       )

                                                                                                                                                                  A                                               B                                            C
                                                                                                                                                            Gross receipts                                   Prizes paid                                  Net receipts

                   1 Bingo  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 1
                   2	 Raffles	(if tax-exempt raffles were conducted,
                      check here        and complete Schedule ER)  .  .  .  .  .  .  .  . 2
                   3 Paddletickets  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 3
                   4 Add lines 1 through 3  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 4
  Gross profit




                   5 If line 6C of last month’s G1 is negative, enter the
                     amount without parentheses in columns A and C  .  .  .  . 5
                                 To stop reporting loss on line 5, see inst., pg. 6.
                   6 Subtract line 5 from line 4  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 6
                   7 Interest and other income (enter the same
                     amount in columns A and C)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 7
                   8 Tipboards  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 8
                   9 Pulltabs  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 9
                  10 Add lines 6 through 9 . Line 10C is your
                 	 	 gross	profits	for	the	month	  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 10
                 11 a Net receipts tax (multiply line 6C by 8.5% [.085];
                      if line 6C is a negative number, enter zero)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 11a
                          b Combined-receipts tax, if any (from Worksheet E, line 9)  .  .  .  .  .  .  .  .  .  .  .  .  . 11b
  Tax and fees




                          Add lines 11a and 11b  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 11
                 12 Monthly regulatory fee (multiply line 10A by 0.1% [.001])  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 12
                 13 Add lines 11 and 12 and pAy ThiS AMounT  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 13
                    (If exempt raffles were reported, pay amount on Schedule ER, line 6, instead)
                          Check payment method:                                            Electronic (see inst., pg. 4)                                       Check (Make check payable to Minnesota Revenue )
                 14 Total 1 .7 percent tax paid during the month, if any
Gross profit




                    (listed on distributors’ invoices for pulltabs and tipboards)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 14
after taxes




                 15 Add lines 13 and 14  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 15
                 16	 Gross	profits	after	state	taxes	and	fees	(subtract line 15 from line 10C)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 16
                     Enter the result here and on line 17 on the back of this form .
                 I declare that all information on this summary and tax return is true, correct and complete.
  Sign here




                 Signature	of	chief	executive	officer	                                                                  Date	                          Signature	of	gambling	manager	                                	            Date	                 Daytime	phone


                 Preparer’s	signature	                                                                                  Name	of	firm	                  	                                                             	            Date	                 Daytime	phone



                 Mail Form G1, schedules and any required attachments to:
                 Minnesota Revenue, Mail Station 3350, St . Paul, MN 55146-3350
(Rev . 10/09)
G1 page 2
                      17 Amount from line 16 on the front of this form  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 17

                      inventory
                       18 Beginning inventory (from last month’s Form G1, line 21)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 18
                      19 Cost of gambling products obtained during the month (include state and local sales
 inventory




                         tax and freight charges, but don’t include the 1.7 percent tax listed on distributors’ invoices)  .  .  .  .  . 19
                      20 Add lines 18 and 19  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 20
                      21 Ending inventory (dollar value on the last day of the month; do not include any
                         sales tax, freight charges or the 1.7 percent tax on distributors’ invoices)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 21

                      22 Total value of gambling products sold (subtract line 21 from line 20)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 22

                      Expenses paid during the month
                      23 Compensation and payroll taxes  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 23
                      24 Penalty and interest paid on taxes (including payroll taxes) on any
                         Form G1 or LG1010, Schedule C/D since beginning gambling activities  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 24
                      25 Advertising expenses  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 25
                      26	 Accounting	services	for	lawful	gambling	tax	forms,	annual	financial	audit,	annual	certified
                          inventories, cash counts and qualifying legal work  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 26
                      27	 Bank	service	charges;	office	supplies;	costs	for	authorized	lawful	gambling	classes;	storage,	
 Allowable expenses




                          trash removal and cleaning expenses; linked bingo provider fee; and miscellaneous expenses  .  .  .  . 27
                      28	 Purchase	and/or	repair	expenses	for	office	furnishings,	office	equipment
                          and devices used for lawful gambling  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 28
                      29 Rent for conducting lawful gambling  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 29
                      30 Utilities  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 30
                      31 Theft insurance and the amount permitted for liability insurance  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 31
                      32 Local government investigation fee and costs for new or renewed gambling
                         manager’s bond  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 32
                      33 Cash long or cash short (if cash long, put parentheses around the amount)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 33
                      34 Reimbursement for excess cash short (this is a negative amount)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 34 (                                                                                           )
                      35 Reimbursement for negative expense calculation (this is a negative amount)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 35 (                                                                                                           )

                      36 Total allowable expenses (add lines 22 through 35)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 36

                      Profit carryover for the month
                      37	 Net	profit	after	state	taxes	and	fees	(subtract line 36 from line 17)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 37
                      38	 Profit	carryover	from	last	month	(from last month’s Form G1, line 44)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 38
                      39 Approved adjustments (attach state agency letter of approval). If an amount
 Profit carryover




                         was listed on line 5C, include it as a positive number in the amount listed here  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 39
                      40 Add lines 37 through 39  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 40
                      41 Lawful purpose expenditures (from Form LG 1010, Schedule C/D)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 41
                      42 Board-approved expenditures (from Form LG 1010, Schedule C/D)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 42
                      43 Add lines 41 and 42  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 43


                      44	 Profit	carryover	for	this	month	(subtract line 43 from line 40)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 44

                      (Line 45 has been eliminated)

                      46	 Difference	between	gambling	fund	balance	and	profit	carryover	
 Balance




                          (amount from Schedule F, line 24; include parentheses, if any)  .  .  .  .  .  .  .  . 46
                      47 Total dollar value of unsold tickets from pulltab and tipboard games
                          reported on Schedules B2, line 16, Column I, for the month  .  .  .  .  .  .  .  .  .  .  . 47

				
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