INSTRUCTIONS
Return Type: Select the type of return you are ling: Original or Amended.
Distributor Information: Enter the distributor name, mailing address, license number and ling period.
No Sales/Returns to Report This Period: Check this box only if you have mp sales or returns to report.
Schedule 1, Schedule 2, Schedule 3 and Schedule 4: For each sale or return of bingo paper and instant bingo tickets during
the month, enter the data indicated by the column headings. Sales or returns should be reported in the same month as the
date on the invoice.The information should be entered on a single line for each invoice. Check the box if there were no sales
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 faces and total retail price on the schedules and on page 1 of the report.
Line 1. Bingo faces sold: Enter the total of all Schedule 1’s, column E.
Line 2. Bingo faces returned: Enter the total of all Schedule 2’s, column E.
Line 3. Total taxable bingo faces: Subtract line 2 from line 1 and enter the result on line 3.
Line 4. Tax due on bingo faces: Multiply line 3 by $.002 and enter the result on line 4.
Line 5. Total tax due on bingo faces: Multiply line 4 by 98% and enter result on line 5.
Line 6. Instant bingo tickets sold: Enter the total of all Schedule 3’s, column G.
Line 7. Instant bingo tickets returned: Enter the total of all Schedule 4’s, column G.
Line 8. Total taxable instant bingo tickets: Subtract line 7 from line 6 and enter the result on line 8.
Line 9. Total tax due on instant bingo tickets: Multiply line 8 by 1% and enter result on line 9.
Line 10. Total tax amount due: Add lines 5 and 9 and enter the result on line 10.
Line 11. Credit memo: Enter the amount of any credit memo that you may have received 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 tax, penalty and interest due: Add lines 12, 13 and 14 and enter the result on line 15.
General Information
• The due date is the 25th day of the month following the ending date of this return.
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Keep a copy of your return for your records.
You must le a return even if there were no games played. Mark the “No Sales No Reports” box on page 1.
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.
If you have questions call 785-368-8222; email us at kdor_bingo@ks.gov; or visit our website at: https://www.ksrevenue.
org/bustaxtypesbingo.html.
When sending a check or money order, write your registration number on your check or money order and make payable to
Charitable Gaming. Send your return and payment to:
Kansas Department of Revenue
Charitable Gaming
PO Box
750680
Topeka KS 666
25-0680
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