Fillable DAILY RECORD TOTAL RECEIPTS OF ALL GAMES OTHER (Kansas Department of Revenue)

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DAILY RECORD TOTAL RECEIPTS OF ALL GAMES OTHER (Kansas Department of Revenue)

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DAILY RECORD
Organization ________________________________ Manager ___________________________ Number of Players __________ Date__________________
Location ___________________________________________ Callers_________________________________________________________________________
MINI or EARLY BIRD GAMES
OTHER CALL BINGO
TOTAL RECEIPTS OF ALL GAMES
1. Funds on hand at end of session
$ _____________
1. Funds on hand at end of session
$ _____________
1. Gross receipts from Mini Games
$ _____________
2. Start up money
$ _____________
2. Start up money
$ _____________
2. Gross receipts from Other Call Games
$ _____________
3. Difference (line 1- line 2)
$ _____________
3. Difference (line 1- line 2)
$ _____________
3. Gross receipts from Instant Bingo
$ _____________
4. Total cash prizes paid out
$ _____________
4. Total cash prizes paid out
$ _____________
4. Gross receipts from Hard Cards
$ _____________
5. Gross receipts (line 3 + line 4)
$ _____________
5. Gross receipts (line 3 + line 4)
$ _____________
5. Total receipts (Lines 1+2+3+4)
$ _____________
Receipts
Prize Amount
TYPES OF GAME
Prize Amount
6. Total deposits
$
Winners of $100 or more
_____________
$ _____________
$ _____________
$ _____________
$ _____________
$ _____________
$ _____________
$ _____________
$ _____________
$ _____________
$ _____________
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Name:
Address:
Name:
Address:
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Address
Name
Address:
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Address
Name:
Address:
Name:
Address:
______________________________________________________
____________________________________________________
______________________________________________________
____________________________________________________
______________________________________________________
____________________________________________________
______________________________________________________
: ____________________________________________________
: ______________________________________________________
____________________________________________________
______________________________________________________
: ____________________________________________________
______________________________________________________
____________________________________________________
Total Prizes Awarded
$ _____________
______________________________________________________
INSTANT BINGO
____________________________________________________
1. Funds on hand at end of session
$
2. Start-up money
$
3. Difference (line 1 – line 2) $
4. Total prizes paid out **
$
5. Gross receipts (line 3 + line 4)
$
** (include cash and value of tickets awarded)
_____________
_____________
Total Prizes Awarded
$ _____________
DRAWINGS
_____________
_____________
PROGRESSIVE BINGO GAMES
Drawing #_____out of a maximum of 4 per calendar year
Value of Prize $__________________
_____________
1. ____________ #’s or less for prize $
2. s or less for prize $
___________
____________ #’ ___________
BI-5 Rev. 2-16
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DAILY RECORD TOTAL RECEIPTS OF ALL GAMES OTHER (Kansas Department of Revenue)

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Completed 24 August 2020

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