Fillable 637177093526130000 BINGO Monthly Report For Large (City of Carson, California)

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637177093526130000 BINGO Monthly Report For Large (City of Carson, California)

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MONTHLY BINGO REPORT Month _________ Year ________
Exhibit A
Organization name
Total monthly attendance Number of sessions conducted
Bingo location
Street City Zip
GROSS RECEIPTS
1 Total bingo sales $
2 Other sales derived from bingo games
3 Total gross receipts (line 1 + line 2) $
PRIZES AWARDED / COMPUTATION OF CITY FEE
4 Total prize payouts $
5 Less exemption $1,500.00
6 Net amount subject to fee (line 4 - line 5)
7 City fee: 0.30% (line 6 x .003) - attach check $
DISBURSEMENT OF FUNDS FOR CHARITABLE PURPOSES
To whom distributed Date Amount
8 $
9 $
10 $
11 $
Officer's name printed Officer's phone number
Signature of Officer
Date
Name of contact (for questions regarding this report) Contact's phone number
City of Vacaville
The report and payment are due no later than 30 days Finance Division
after the end of each month. Attn: Bingo Reporting
Attach check and mail or deliver complete reports to: 650 Merchant Street
Vacaville, CA 95688
3/99 (rev.)
City of Vacaville Bingo Reporting
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637177093526130000 BINGO Monthly Report For Large (City of Carson, California)

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Completed 28 July 2021

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