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Get GA GBI B04 2010

GEORGIA BINGO ANNUAL REPORT GBI Form B04 01/2010 FOR YEAR 20 Under Official Code of Georgia Annotated Section 16-12-59 Rules of the Georgia Bureau of Investigation 92-2-. NAME OF ORGANIZATION POST/CHAPTER/LODGE NO. BINGO LICENSE NO. SALES TAX REGISTRATION NO. ADDRESS CITY STATE ZIP CODE METHOD OF ACCOUNTING CHECK ONE CASH 1 TOTAL RECEIPTS FROM BINGO OPERATIONS Do not include food/alcohol 2 TOTAL PRIZES PAID OUT Include value of non-cash prizes 3 GROSS PROCEEDS Subtract line 2 from line 1 ACCRUAL 4 BINGO EXPENSES Do not include food/alcohol 4a SALES TAX PERCENTAGE FOR COUNTY 4a 4b 4c OTHER PAID EMPLOYEES EXCEPT 30/DAY FOR BINGO WORKERS 4d STATE FEDERAL TAXES FICA WITHHELD BINGO WORKERS ONLY 4d 4e TOTAL SALARIES ADD LINE 4C 4D 4e 4f BINGO LICENSE FEE 4g RENT/MORTGAGE PAYMENT 4g 4h UTILITIES 4h 4i INSURANCE FEES 4i 4j LEGAL FEES 4j 4k ACCOUNTING FEES 4k 4l BINGO SUPPLIES CARDS DAUBERS ETC. 4l 4m OFFICE SUPPLIES PRINTING POSTAGE 4m 4n JANATORIAL SERVICES 4n 4o SECURITY GUARD SERVICES 4o 4p OTHER ITEMIZE 4p 4q 4r 4s TOTAL EXPENSES ADD LINES 4b 4e 4f THRU 4r 4b SALES TAX COLLECTED ON BINGO RECEIPTS 4c SALARIES PAID TO WORKERS DO NOT INCLUDE SNACK BAR OR 5 TOTAL DONATIONS LIST ON NEXT PAGE/B04-1 NOTE Do not include funds transferred to general funds 4s 6 TOTAL ADD LINE 4S LINE 5 7 NET PROCEEDS Subtract Line 6 from Line 3 Note Total should not be less than -0-. Itemize on next page GBI Form B04-1 how net proceeds will be spent. Under penalties of making a false statement I declare that I have examined this report including any attachments and by providing my signature below I certify the accuracy of this record to the best of prepared this report including any attachments and to the best of my knowledge and belief it is true correct and complete. 4l 4m OFFICE SUPPLIES PRINTING POSTAGE 4m 4n JANATORIAL SERVICES 4n 4o SECURITY GUARD SERVICES 4o 4p OTHER ITEMIZE 4p 4q 4r 4s TOTAL EXPENSES ADD LINES 4b 4e 4f THRU 4r 4b SALES TAX COLLECTED ON BINGO RECEIPTS 4c SALARIES PAID TO WORKERS DO NOT INCLUDE SNACK BAR OR 5 TOTAL DONATIONS LIST ON NEXT PAGE/B04-1 NOTE Do not include funds transferred to general funds 4s 6 TOTAL ADD LINE 4S LINE 5 7 NET PROCEEDS Subtract Line 6 from Line 3 Note Total should not be less than -0-. Itemize on next page GBI Form B04-1 how net proceeds will be spent. Under penalties of making a false statement I declare that I have examined this report including any attachments and by providing my signature below I certify the accuracy of this record to the best of prepared this report including any attachments and to the best of my knowledge and belief it is true correct and complete. my knowledge. Signature of Organization Officer Name of Officer Type or Print Title Daytime Telephone Number Date Signature of CPA or RPA and Title Firm Name Mailing Address City Zip Code Business Telephone Number GBI FORM B04 Page 2 NAME OF CHARITY OR NAME OF PERSON RECEIVING DONATION 5 ITEMIZED DONATIONS ADDRESS OF CHARITY OR PERSON AMOUNT NAME OF PERSON/COMPANY TOTAL And enter on line 5 7 NET PROCEEDS EXPENSED TRANSFERRED TO GENERAL FUNDS Attach Additional Pages If Necessary Revision 01/2010. .

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