Form IL-406-0647 "Premium Grand Summary Report" - Illinois

What Is Form IL-406-0647?

This is a legal form that was released by the Illinois Department of Agriculture - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 1984;
  • The latest edition provided by the Illinois Department of Agriculture;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form IL-406-0647 by clicking the link below or browse more documents and templates provided by the Illinois Department of Agriculture.

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Download Form IL-406-0647 "Premium Grand Summary Report" - Illinois

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This form can be filled in
on-line, saved, printed and
mailed to the: Illinois
ILLINOIS DEPARTMENT OF AGRICULTURE
Department of Agriculture
County Fair Office P.O. Box
PREMIUM GRAND SUMMARY REPORT
19281 Springfield, IL
62794-9281
YEAR
NAME OF FAIR ASSOCIATION
City/Town
County
Please list President, Secretary, Treasurer and a complete list of your Directors. Use additional page if necessary.
Officers and Directors for 20____
NAME
TITLE
FULL ADDRESS WITH ZIP CODE
Date fair was organized:_______________
Is fair incorporated:___________________
If so, date of incorporation:_________________
# of acres on fairgrounds:______________
Owned or Leased:_________________________
(If leased, is there a 20-year lease and does fair board have continuous possession of land during every day of
lease period? __________
NOTE:
Expiration Date of Lease:_________________________
Make sure that your dates are correct and that they
match the dates on your Declaration of Intention.
DATES OF NEXT YEAR'S FAIR: ____________________
DATES OF CURRENT FAIR:__________________
Estimated Attendance:_________________
Admission Fee:
Adults: $_________
Children: $
Carnival Name:_________________________________________________
Does your fair plan to participate in the Rehabilitation Program next fiscal year? ________________________
Report due date is October 15. Penalties will be assessed if report is late.
Mail to: Illinois Department of Agriculture
Bureau of County Fairs & Horse Racing
P.O. Box 19281
Springfield, Illinois 62794-9281
PH: 217/782-4231 FAX: 217/524-6194
IMPORTANT NOTICE: This state agency is requesting disclosure of information that is necessary to accomplish the statutory
purpose as outlined under Illinois Revised Statutes, Chapter 85, Paragraph 651 through 672. Failure to provide information
shall prevent this form from being processed. This form has been approved by the State Forms Management Center. IL406-0647 (3-84)
77
This form can be filled in
on-line, saved, printed and
mailed to the: Illinois
ILLINOIS DEPARTMENT OF AGRICULTURE
Department of Agriculture
County Fair Office P.O. Box
PREMIUM GRAND SUMMARY REPORT
19281 Springfield, IL
62794-9281
YEAR
NAME OF FAIR ASSOCIATION
City/Town
County
Please list President, Secretary, Treasurer and a complete list of your Directors. Use additional page if necessary.
Officers and Directors for 20____
NAME
TITLE
FULL ADDRESS WITH ZIP CODE
Date fair was organized:_______________
Is fair incorporated:___________________
If so, date of incorporation:_________________
# of acres on fairgrounds:______________
Owned or Leased:_________________________
(If leased, is there a 20-year lease and does fair board have continuous possession of land during every day of
lease period? __________
NOTE:
Expiration Date of Lease:_________________________
Make sure that your dates are correct and that they
match the dates on your Declaration of Intention.
DATES OF NEXT YEAR'S FAIR: ____________________
DATES OF CURRENT FAIR:__________________
Estimated Attendance:_________________
Admission Fee:
Adults: $_________
Children: $
Carnival Name:_________________________________________________
Does your fair plan to participate in the Rehabilitation Program next fiscal year? ________________________
Report due date is October 15. Penalties will be assessed if report is late.
Mail to: Illinois Department of Agriculture
Bureau of County Fairs & Horse Racing
P.O. Box 19281
Springfield, Illinois 62794-9281
PH: 217/782-4231 FAX: 217/524-6194
IMPORTANT NOTICE: This state agency is requesting disclosure of information that is necessary to accomplish the statutory
purpose as outlined under Illinois Revised Statutes, Chapter 85, Paragraph 651 through 672. Failure to provide information
shall prevent this form from being processed. This form has been approved by the State Forms Management Center. IL406-0647 (3-84)
77
-2-
GRAND SUMMARY
(Report of animals/articles entered, premiums offered, entry fees collected, and premiums awarded)
20_____
Please complete all required information.
Total
# of Animals # of Articles Premiums Entry Fees Premiums
DEPARTMENTS
Entered
Offered
Entered
Collected
Paid
Beef Cattle
A
Dairy Cattle
B
Heavy Horses
C
Equine Pulling Contest
D
Jacks, Jennets and Mules
E
Sheep
F
Swine
G
JR. Dept. Livestock (30%--N/A)
H
Poultry, Rabbits and Ratites
I
Agricultural Products
J
Horticulture
K
Floriculture
L
Textiles and Fine Arts
M
Education and Natural History
N
Dairy, Apiary and Culinary
O
JR. Dept. Non-Livestock (30%--N/A)
P
Tractor Pull
Q-1
Truck Pull
Q-2
Light Horse & Western Dept.-
R
Equine Events
Harness Races
S
(S & T considered one Dept. for 30% rule)
Running Races
T
(S & T considered one Dept. for 30% rule)
Goats and Llamas
U
Misc.
V-1
(Please Label)
V2:
V-2
V3:
V-3
Rodeo
Z
Ribbons & Trophies
$ 0.00 $ 0.00 $ 0.00
GRAND TOTAL PREMIUMS PAID:
0
0
Be sure to list all #'s of animals/articles entered above.
No one department can exceed 30% of total Premiums paid (except H & P)
TOTAL ANIMALS + ARTICLES ENTERED:
0
0
GRAND TOTAL ENTERED:
0
78
-3-
FINANCIAL STATEMENT
RECEIPTS
1 - Gate Admissions
2 - Grandstand Admissions (include federal tax, if any)
3 - Auto Parking
4 - Stalls and Pens
5 - Concessions, Commercial Exhibits, Carnival
6 - Total Entry Fees
7 - Estimated State Aid (Current Fair)
8 - Estimated Rehabilitation Aid (Current Fair)
9 - Aid From County (if any)
10 - Rental From Grounds, Buildings, Promotions (except During Fair)
11 - Other Income Not Included Above (Do Not Include Borrowed Money)
$ 0.00
TOTAL INCOME (Add Items on Lines 1 through 11):
EXPENDITURES
12 - TOTAL PREMIUMS
13 - Grounds Improvements
(include money spent for bldgs. And other permanent.-type improvements which qualify under Line 11)
14 - Music and Attractions
15 - Judges and Assistants
16 - Administrative and Office Payrolls
17 - Gate, Grandstand, Police and Parker Payrolls
18 - General and Common Labor Payrolls
19 - Advertising (Including Premium Book)
20 - Federal Admission Tax
21 - Other Operating Expenses
(Including Interest on Indebtedness)
TOTAL EXPENDITURES -- (Add Items 12 through 21):
$ 0.00
$ 0.00
OPERATING PROFIT ____ OR LOSS ____
$
Money Spent for Real Estate and Capital or Permanent-Type Improvements This Year:
79
-4-
State of Illinois
}
___________________ County
We, President and Secretary of the _________________________________________________________
Name of Fair Association
of ________________ County, do hereby swear that during the calendar year 2 0 ____,
the sum of ___________________________________________ ($____________________)
dollars in eligible premiums was actually paid out to exhibitors for shown exhibits as evidence of which the
above listed receipts are enclosed herewith (ACTUAL PREMIUMS EARNED EXCLUDING CHARGED
FOR ENTRY FEES, STALL RENT, ETC.) We also certify that all reporting documents required by the
Illinois Department of Agriculture are included with this PREMIUM GRAND SUMMARY REPORT (due
October 15). We further state that all gambling and gambling devices which are declared unlawful by the
laws of Illinois and the sale of alcoholic liquors other than beer have been prohibited and excluded from the
grounds of the fair and from adjacent grounds under the fair's authority, during the fair and at all other
times when the fairgrounds or adjacent grounds are in the possession of and under the immediate control
and supervision of the fair officials; and that all
receipts from any source other than admissions to the grandstand and entry fees for races, not
necessary for the payment of labor and advertising, have been prorated among all other claims and
expenses or that all other claims and expenses have been paid in full.
President
Signature:
Secretary
Signature:
Date:
, 2 0 ____.
Contact Person regarding this and other reports/necessary documentation.
(Please supply two (2) email addresses if possible.)
NAME:
____________________________________________
ADDRESS: ____________________________________________
PHONE:
____________________________________________
EMAILS:
____________________________________________
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