Form BC-102 (BC-102A) Schedule A "Bingo Rental Statement" - New York

What Is Form BC-102 (BC-102A) Schedule A?

This is a legal form that was released by the New York State Gaming Commission - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2014;
  • The latest edition provided by the New York State Gaming Commission;
  • 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 printable version of Form BC-102 (BC-102A) Schedule A by clicking the link below or browse more documents and templates provided by the New York State Gaming Commission.

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Download Form BC-102 (BC-102A) Schedule A "Bingo Rental Statement" - New York

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Division of Charitable Gaming
Form BC-102/102A Schedule A
Bingo Rental Statement
(To be filed with Form BC-101
“Application for Commercial Lessor’s License”)
Name of Applicant __________________________________________________________________________________
Location of Premises ________________________________________________________________________________
Description: Building Size _______ x _______ Number of Floors _________ Date of Construction _______________
Areas to be Rented
Floor
Wide
Long
Lawful Capacity for Public
Floor
Wide
Long
Lawful Capacity for Public
No.
Assembly Purposes
No.
Assembly Purposes
______ ______ x ______ _______________________
______ ______ x ______ __________________________
______ ______ x ______ _______________________
______ ______ x ______ __________________________
HAVE PREMISES EVER BEEN USED FOR BINGO RENTAL? ____ Yes ____ No
If yes, for how long? _____//_____//______ to _____//______//_______
SKETCH THE PREMISES SHOWING THE DIMENSIONS AND AREAS TO BE RENTED. (New applicants only)
1.Total number of times premises are leased out during a calendar year ________________________________________
2.Total number of times premises are leased out for bingo during a calendar year ________________________________
3. Percentage of total times premises are leased out for bingo during a calendar year ______________________________
4. If premises are owned by lessor, list the following:
a) Date premises purchased ____________________________________________________________________
b) Original cost ______________________________________________________________________________
c) Total capital improvements made ______________________________________________________________
d) Current assessed value of premises ___________________________________________________________
e) Current book value of premises _______________________________________________________________
5. If premises are leased by lessor, list the following:
a) Name and address of owner __________________________________________________________________
_________________________________________________________________________________________
b) Term of lease: _______//________//________ to _______//_______//_______
c) Annual rent _______________________________________________________________________________
www.gaming.ny.gov
Page 1 of 6
BC-102/102A (Rev. 10/2014)
Division of Charitable Gaming
Form BC-102/102A Schedule A
Bingo Rental Statement
(To be filed with Form BC-101
“Application for Commercial Lessor’s License”)
Name of Applicant __________________________________________________________________________________
Location of Premises ________________________________________________________________________________
Description: Building Size _______ x _______ Number of Floors _________ Date of Construction _______________
Areas to be Rented
Floor
Wide
Long
Lawful Capacity for Public
Floor
Wide
Long
Lawful Capacity for Public
No.
Assembly Purposes
No.
Assembly Purposes
______ ______ x ______ _______________________
______ ______ x ______ __________________________
______ ______ x ______ _______________________
______ ______ x ______ __________________________
HAVE PREMISES EVER BEEN USED FOR BINGO RENTAL? ____ Yes ____ No
If yes, for how long? _____//_____//______ to _____//______//_______
SKETCH THE PREMISES SHOWING THE DIMENSIONS AND AREAS TO BE RENTED. (New applicants only)
1.Total number of times premises are leased out during a calendar year ________________________________________
2.Total number of times premises are leased out for bingo during a calendar year ________________________________
3. Percentage of total times premises are leased out for bingo during a calendar year ______________________________
4. If premises are owned by lessor, list the following:
a) Date premises purchased ____________________________________________________________________
b) Original cost ______________________________________________________________________________
c) Total capital improvements made ______________________________________________________________
d) Current assessed value of premises ___________________________________________________________
e) Current book value of premises _______________________________________________________________
5. If premises are leased by lessor, list the following:
a) Name and address of owner __________________________________________________________________
_________________________________________________________________________________________
b) Term of lease: _______//________//________ to _______//_______//_______
c) Annual rent _______________________________________________________________________________
www.gaming.ny.gov
Page 1 of 6
BC-102/102A (Rev. 10/2014)
6. Income and expenses: (From ______//_______//_______ to _______//_______//_______) Must be a 12 month period
Gross Income:
Bingo rentals: _________________________
Concession income: ____________________
All other income from subject premises (attach schedule) _____________________
Total: ______________
Estimated Expenses for New
Expenses Directly
License Period. Attach Schedule
Actual
Attributable to Bingo
Explaining all differences over
Operating Expenses:
Expenses
(if applicable)
$1,000 from actual
Compensation (Schedule 1)
$____________
$___________________
$_____________________
Salaries (Schedule 2)
$____________
$___________________
$_____________________
Payroll Taxes
$____________
$___________________
$_____________________
Maintenance
$____________
$___________________
$_____________________
Utilities
$____________
$___________________
$_____________________
Repairs
$____________
$___________________
$_____________________
Rents
$____________
$___________________
$_____________________
Taxes (Schedule 3)
$____________
$___________________
$_____________________
Interest (Schedule 3)
$____________
$___________________
$_____________________
Depreciation (Schedule 4)
$____________
$___________________
$_____________________
Accounting fees
$____________
$___________________
$_____________________
Insurance (Schedule 5)
$____________
$___________________
$_____________________
Legal fees
$____________
$___________________
$_____________________
Rubbish removal
$____________
$___________________
$_____________________
Telephone
$____________
$___________________
$_____________________
Supplies
$____________
$___________________
$_____________________
Commercial Lessor License fee
$____________
$___________________
$_____________________
Other expenses
$____________
$___________________
$_____________________
_________________
$____________
$___________________
$_____________________
_________________
$____________
$___________________
$_____________________
_________________
$____________
$___________________
$_____________________
Subtotal
$____________
$___________________
$_____________________
6) $____________
$___________________
$_____________________
Amortization allowance (Schedule
Total
$____________
$___________________
$_____________________
7. List organizations renting premises:
www.gaming.ny.gov
BC 102/102A (Rev. 10/2014)
Page 2 of 6
Organization
Occasions
Rent Charged
Rent Requested
_______________________
Sunday Evening
_________________
____________________
_______________________
Saturday Evening
_________________
____________________
_______________________
Friday Evening
_________________
____________________
_______________________
Thursday Evening
_________________
____________________
_______________________
Wednesday Evening
_________________
____________________
_______________________
Tuesday Evening
_________________
____________________
_______________________
Monday Evening
_________________
____________________
_______________________
Sunday Afternoon
_________________
____________________
_______________________
Saturday Afternoon
_________________
____________________
_______________________
Friday Afternoon
_________________
____________________
_______________________
Thursday Afternoon
_________________
____________________
_______________________
Wednesday Afternoon
_________________
____________________
_______________________
Tuesday Afternoon
_________________
____________________
_______________________
Monday Afternoon
_________________
____________________
Schedule 1 – Compensation Management
Name
Title
Description of Duties
Weekly Hours
Annual
Worked
Compensation
_____________________ _____________________ ____________________________ ___________ _____________
_____________________ _____________________ ____________________________ ___________ _____________
_____________________ _____________________ ____________________________ ___________ _____________
_____________________ _____________________ ____________________________ ___________ _____________
_____________________ _____________________ ____________________________ ___________ _____________
_____________________ _____________________ ____________________________ ___________ _____________
Total Compensation $ ___________________
Schedule 2 – Other Salaries
Name of Employee
Position
Description of Work
Weekly Hours
Weekly
Annual
Worked
Salary
Salary
____________________ ___________________ _______________________ ___________ __________ ___________
____________________ ___________________ _______________________ ___________ __________ ___________
____________________ ___________________ _______________________ ___________ __________ ___________
____________________ ___________________ _______________________ ___________ __________ ___________
____________________ ___________________ _______________________ ___________ __________ ___________
____________________ ___________________ _______________________ ___________ __________ ___________
____________________ ___________________ _______________________ ___________ __________ ___________
____________________ ___________________ _______________________ ___________ __________ ___________
Total Salaries $ ______________________
www.gaming.ny.gov
BC 102/102A (Rev. 10/2014)
Page 3 of 6
Schedule 3 – Interest and Taxes
Explanation
Amount
Explanation
Amount
_____________________________ _________________ ____________________________ _________________
_____________________________ _________________ ____________________________ _________________
_____________________________ _________________ ____________________________ _________________
_____________________________ _________________ ____________________________ _________________
_____________________________ _________________ ____________________________ _________________
Schedule 4 – Depreciation
1. Description of Property
2. Date Acquired 3.Cost or
4. Depreciation
5. Method of
6. Life
7. Depreciation
other basis allowed or allowable computing
or rate
for this year
in prior years
depreciation
_______________ _________ _________________ ____________ ___________ ______________
Buildings
_______________ _________ ________________ ___________ __________ _____________
Furniture and fixtures
_______________ _________ ________________ ___________ __________ _____________
Machinery and other equipment
_______________ _________ ________________ ___________ __________ _____________
Other (specify) ____________
______________________ _______________ _________ ________________ ___________ __________ _____________
______________________ _______________ _________ ________________ ___________ __________ _____________
______________________ _______________ _________ ________________ ___________ __________ _____________
______________________ _______________ _________ ________________ ___________ __________ _____________
Total cost or other basis $ _____________________
Total depreciation for this year $ _____________________
Schedule 5 – Insurance
Insurance Company
Coverage
Term of Policy
Premium
_________________________ __________________________ __________________________ __________________________
_________________________ __________________________ __________________________ __________________________
_________________________ __________________________ __________________________ __________________________
_________________________ __________________________ __________________________ __________________________
_________________________ __________________________ __________________________ __________________________
_________________________ __________________________ __________________________ __________________________
Total Premium $ ______________
www.gaming.ny.gov
BC 102/102A (Rev. 10/2014)
Page 4 of 6
Schedule 6 – Amortization
1. Description
2. Date completed
3.Cost or
4. Amortization 5. Method of
6. Life
7. Amortization
or acquired
other basis
allowed or allowable
computing
or rate
for this year
in prior years
amortization
_____________ ______________ ________________ ___________ _____________ ________________
Initial Conversion Expense
_____________ ______________ ________________ ___________ _____________ ______________
Leasehold Acquisition Expense
______________ ______________ ________________ __________ _____________ ______________
_________________________
______________ ______________ ________________ __________ _____________ ______________
_________________________
Total cost or other basis $ ___________________
Total amortization for this year $ ___________________
Schedule 7 – Officers and Stockholders of Owner of Premises
Name of Officer and Stockholder
Address
Percent of Stock Owned
_______________________________
______________________________ ________________________________
_______________________________
______________________________ ________________________________
_______________________________
______________________________ ________________________________
_______________________________
______________________________ ________________________________
_______________________________
______________________________ ________________________________
_______________________________
______________________________ ________________________________
_______________________________
______________________________ ________________________________
_______________________________
______________________________ ________________________________
Schedule 8 – Name and Address of Operator of Concession;
if a, corporation list name and address of all officers and stockholders
www.gaming.ny.gov
BC 102/102A (Rev. 10/2014)
Page 5 of 6