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_P_QQ _1�9(?ESARA. FLE PRIZES AV%A,RDEQ_AjLHI�q <br /> SCHEDULE 2 SUM,11AARY OF PRIZES F Awo <br /> GASH DOOR PRIZES <br /> AT S DOOR <br /> 2 I Al S Description Value <br /> CASH RAFFLE PRIZES: v RAFFLE ------ <br /> Description Value <br /> 3 1 PT S <br /> .4 1 AT ell NOTE; INITIAL PURCHASING COSTS OF MERCHANDISE DOOR PRIZES/RAFf[ <br /> PRIZES SHOULD BE ENTERED UNDER PART B.SCHEDULE 1 <br /> 5 TOTAL CASH PRIZES $ D (EXPENDITURES) ONLY ONCE. <br /> SCHEDULE3 DISPOSITION 9F,-AND ACC-0-UNTING FOR9 NET PROFITS <br /> 1. BALANCE IN SPECIAL CASINO CHECKING ACCOUNT (Schedule 3. Line 6 of Last CFT-1 Report) .. . . . . $ <br /> 2. ADD NET PROFIT (OR LOSS) (Schedule 1, Part C, Line 1 of this Report) . . . . . . ... . . . .. . . .. . .... . . .... <br /> 3. ADD OTHER INCOME (interest, etc.) ..... .. .... .. . . . . ..... .. . .. . . .. .. . . .. . . . . . . . . . .. . ... .. . ... .. <br /> 4. TOTAL FUNDS AVAILABLE FOR DISBURSEMENT (Add Items 1 through 3) . .. .. . . . . . . . . .. . .. . . . .. . . . <br /> ALL DISBURSEMENTS SINCE LAST REPORT. DETAIL BELOW: <br /> DATE CHECK NO, PAYEE DESCRIPTION AMOUNT <br /> 5. TOTAL DISBURSEMENTS (from above schedule) .. ......... ...... ... . .. ...... ..... . . . . . ........ .. <br /> 6. BALANCE IN SPECIAL CASINO CHECKING ACCOUNT (line 4 less line 5) . . . . . . ... .. . .. . .. . ... ... .. . $ <br /> IMPORTANTM - PLEASE READ THE FOLLOWING PARAGRAPHS <br /> A. gross proceeds derived from a Casino Function are the total receipts from the sale of all tickets or other <br /> evidences of chance for the disposal (by means of chance) of awards permitted under Section 7A of Chapter 271 <br /> of the General Laws. <br /> B. Any organization conducting a Casino Function MUST FILE a return and PAY a tax of FIVE PER CENT of the <br /> GROSS PROCEEDS within TEN DAYS after each Casino Function. See Section 7A of the General Laws, <br /> Chapter 271. <br /> C. INTEREST AND PENALTY <br /> 1. Interest — Charged at 12% from date due to the date paid. <br /> 2. Penalty for Late Filing of Return — One percent of the tax due for each month or part thereof from date return <br /> due to the date filed up to a maximum of 25% the tax due. <br /> 3. Penalty for Late Payment of Ta — One-half of one percent of the tax due for each month or part thereof from <br /> the date tax due to the date paid up to a maximum of 25% of the tax due. <br /> D. Adequate books and records must be maintained and kept to substantiate compliance with the five per cent gross <br /> proceeds tax. For tax auditing purposes, such books and records should be preserved and available for a period <br /> of four years from the close of the calendar year to which the records apply. <br /> THIS DECLARATION MUST BE COMPLETED <br /> DECLARE, SUBJECT TO THE PENALTIES OF PERJURY, THAT If WAS THE MEMBER IN CHARGE OF THE CASINO <br /> FUN TION CONDUCTED BY THE LICENSEE HEREIN ON THE A-0 --- DAY OF I <br /> 19,iWTHAT I PERSONALLY SUPERVISED SAID FUNCTION, THAT I HAVE`READ THE FOREGOING STA EMENT,AND <br /> THAT THIS STATEMENT IS TRUE T THE-BT OF MY KNOWLEDGE AND BELIEF. <br /> T 'S TRUE T H <br /> SIGNAT R MEMBER I CHARGE OF CASINO FUNCTIONS DATE AREA BUSINESS TEL.NO. <br /> I? <br /> FORM PREPARED BY: FAREAI HOME PHONE <br />