NA-RAFFLES AND BAZAARS - A-F - BROWN

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i L J Massachusetts State Lotte7y Commission CHARITABLE GAM &G DIVISION P.O_ BOX 3723 TIMOTHY P..CAHILL BOSTON, MA 02241-3723 JOSEPH C. SULLIVAN 7V44== a td;P,, oc TEL. 781-849-5555 y FAX 781-849-5554* RAFFLE AND/OR BAZAAR TAX RETURN RLE RETURN AND PAYMENT WITHIN 10 DAYS AFTER OCCASION TO ABOVE ADDRESS (SEE PENALTIES PAGE 2 - PAR. A THROUGH E.) CHECK (J) ^s TYPE OFACTIVITY: RAFFLE Ind • •u' a 1vL • FOR MASSACHUSETTSsTATE LOTTERY COMMISSION USE ONLY IDENTIFICATION NUMBER Received BAZAAR El OTHER (SPECIFY) ❑ .. rr MINE== 1. RECEIPTS FROM SALES - ,y /-12 G X7/< e -Q 4 .......................... $ No. o/ nckem o cost per Tkket Chances Sola- a Char WR j AESACHUSETTS STATE LOTTERY COMY7.SK)*USEONLY DATECHECK RECEIVED DATE cHEcK OEPOSf7E0 m CHEM NUMBER m m m m MO DAY YR - MO DAY YR RBT (OVER) 2. OTHER RECEIPTS ................................................ $ O :0':5) 3. GROS$ RECEIPTS (ADD LINES I AND 2) ................................................... S 4. TAX X.05 ....................................................... $ IQ (o Anwlmtol Line 3 U 5. PENALTY AND INTEREST(SEEPAR.D - PAGE 2) ......................................... $ ' �6. TOTAL TAX DUE (ADD LINES 4AND 5) ............................................:.......5 w r GCHEDULE2 fe COMPUTATION OF NET PROFIT OR !LOSS): i 2 1. GROSS RECEIPTS (FROM LINE 3 -SCHEDULE I),,,_,,,,t,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, EW 2- LESS EXPENSES: ATOTAL PRIZES AWARDED (CASH ORVALUE) S ' �� Wr ..................... B. OTHER EXPENSES ............................ $ �G' 'da C. TAX PAID (LINE 6 -SCHEDULE 1) .............................. S /12 41 ©Q u EXPENSES ITEMS 2A -B -C) $ w �u (ADD ................................$ D. TOTAL .................... . ...................... .. $ 3. NET PROFIT OR(LOSS)(SUBTRACTUNE2D FAOWUNE1) ............................... m x> WR j AESACHUSETTS STATE LOTTERY COMY7.SK)*USEONLY DATECHECK RECEIVED DATE cHEcK OEPOSf7E0 m CHEM NUMBER m m m m MO DAY YR - MO DAY YR RBT (OVER)