GC-7R
I
GC-7R
NYS RACING & WAGERING BOARD
1 Watervliet Ave. Ex-t., Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax. (518) 453-8492
www.racing.state.ny.us
FINANCIAL STA TEMENT OF
RAFFLE OPERATIONS
TO REPORT NET PROFITS GREATER THAN
$30,000 FOR THE CALENDAR YEAR:
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Instructions: Prepare report in triplicate. Due Januarv 30th of the year following the conduct of a raffle occasion. Send
original to clerk of your municipality, one copy to N.Y.S. Racing and Wagering Board and retain one copy for your files.
Organizati on:
N.Y.S. Identification Number: GC - [=cJ- CLLI- CLLI-o==r=ITILicense Number:CITIJ
Street address:
City: Zip Code: County:
Date(s) of Raffle Drawing(s):
A. RECEIPTS (lfthere is more than one drawing. attach records detailing origin offiguresfor Sections A and B)
1. ;ick~~mber of tickets printed.... .................................................... ....... ....................... ................ ......... ~
b. Number of tickets sold... ........ .................... ...................................... .............. ......... ......... ............... o==r=ITI
c. Number of tickets unsold.................:... ........ ..... ......... ....................... ....... ............... .......... .......... .... ITTI==c=J
d. Price of each ticket............................................................................. $ ~. CD
e. Ticket receipts (item 1 b times item 1d)........................................................ $
2. Other Receipts......................... ............. ................................ ................................ $
3. Total Receipts (Add items Ale and A2)............................................................. $
B. EXPENDITURES - (Only payments directly related to the conduct of the raffle. Attach additional sheets if necessary.)
Describe Expenditure Payee Check No.
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8. Total Expenditures (Add items B 1 through B7).................................................. $
C. NET PROFIT OR (LOSS)
1. Profit or (Loss) Before Additional License Fee (item A3 less item B8)............ $
2. Less: Profit not subject to Additional License Fee............................................
3. Profit or (Loss) Subject to Additional License Fee (item C1less item C2)....... $
4. Additional License Fee (2% of Line C3) (List Check Number: )... $
5. Net Profit or (Loss) (item C3 less item C4)....................................................... $
D. DISPOSITION OF AND ACCOUNTING FOR NET PROCEEDS $
1. Unexpended balance of net proceeds shown on last report..................................
2. Net Profit or (Loss) from this raffle (item C5)..................................................... $
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7. Other Expenses
$
$
$
$
$
$
$
$
$
1. Total Value of Prizes (Part E).......
2.
3.
4.
5.
6.
Tickets.......................................... .
License Fee...................................
Raffle Equipment & Supplies........
Services................................. ..........
Rent............................................... ..
-$30,000.00
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L BJ-GC-7R (Rev. 4/03)
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