INSTRUCTIONS
Report Type: Select the type of report you are ling; Original Report, Amended Report, or No Play No Purchase if there
were no games played or no purchases made during the reporting period.
Organization Information: Enter the organization name, mailing address, license number and reporting period.
Check box if this is a new mailing address: Check the box if the mailing address has changed.
Schedule 1, Schedule 2, Schedule 3 and Schedule 4: For each purchase or return of bingo faces and instant bingo tickets
during the month, enter the data indicated by the column headings. Purchases or returns should be reported in the same
month as the date on the distributor’s invoice, not the date received or the date paid.The information should be entered on
a single line for each distributor’s invoice. Check the box if there were no purchases or returns to report for this ling period.
Complete additional pages as needed. Remember to enter the total for each page at the bottom of each schedule and enter
the total number of faces and total retail price of instant bingo on the schedules and on Page 1 of the report.
Line 1. Number of times played this month: Enter the number of times for this reporting period that the organization held
bingo. Organizations are allowed to play at another location, but must be in the same or adjoining county. You are
required to notify the Department of Revenue three days in advance in writing if playing at another location.
Line 2. Call Bingo faces purchased from the Distributor: Enter the total of all schedule 1’s, column E.
Line 3. Call Bingo faces returned to the Distributor: Enter the total of all schedule 2’s, column E.
Line 4. Total of bingo faces: Subtract line 3 from line 2.
Line 5. Instant bingo tickets purchased from the Distributor: Enter the total of all schedule 3’s, column G.
Line 6. Instant bingo tickets returned to the Distributor: Enter the total of all schedule 4’s, column G.
Line 7. Total of instant bingo tickets: Subtract line 6 from line 5.
Line 8. Total number of instant bingo tickets sold by denomination: Enter the number of tickets sold for each
denomination.
Check here if you are selling instant bingo tickets from a vending machine. Check the box if a vending machine selling
instant bingo tickets is in use and provide the total number of vending machines your organization has.
Line 9. Gross Receipts from Reusable Cards and Admission Fees: Enter your total gross receipts from hard (re-usable)
cards and any admission fees collected.
Line 10. Tax amount due: Multiply line 9 by 3% and enter the result on line 10.
Line 11. Credit memo: Enter the amount of any credit memo that you may have recieved from the Kansas Department of
Revenue, otherwise enter zero.
Line 12. Subtotal: Subtract line 11 from line 10 and enter the result on line 12.
Line 13. Penalty: If you are ling this return after the due date, multiply line 12 by 25% and enter the result on line 13.
Line 14. Interest: If you are ling this return after the due date, multiply line 12 by the appropriate interest rate, which can
be found on our website at: https://www.ksrevenue.org/pandi.html.
Line 15. Total Due: Add lines 12, 13 and 14. Enter the result on line 15.
GENERAL INFORMATION
• If you have questions call 785-368-8222; email kdor_bingo@ks.gov; or visit our website at: https://www.ksrevenue.org/
bustaxtypes.html
• The due date is the 25th day of the month following the ending date of this report.
• Keep a copy of your report for your records.
• You must le a report even if there were no games played or purchases/returns made.
• File and pay electronically by going to: https://www.kdor.ks.gov/Apps/kcsc
• This form can be faxed to 785-296-4993 or emailed to kdor_bingo@ks.gov
• When sending a check or money order, include your license number and make payable to Charitable Gaming. Send
your return and payment to:
Kansas Department of Revenue
Charitable Gaming
120 SE 10th Ave
PO Box 750680
Topeka KS 66625-0680
Page 6
