"Annual Supplier Report of Gross Sales for Bingo" - New York

Annual Supplier Report of Gross Sales for Bingo is a legal document that was released by the New York State Gaming Commission - a government authority operating within New York.

Form Details:

  • Released on October 10, 2019;
  • The latest edition currently provided by the New York State Gaming Commission;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New York State Gaming Commission.

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ANNUAL SUPPLIER REPORT OF GROSS SALES
FOR BINGO
_______________________________________________________________________________________________________________________
Current License Year
: ____________
Pursuant to Executive Law 435, this form is a summation of the amount of gross receipts realized from the sale and rental of Bingo
supplies and equipment to licensed authorized organizations in the preceeding calendar year. Submit this form (original signature)
along with a check for the amount owed to the NYS Gaming Commission attention: Bureau of Licensing. Make check payable to the
“NYS Gaming Commission”. This completed form and check must be submitted no later than January 15
th
to the Bureau of Licensing.
Company Name: ___________________________________________________________ License No.: ________
_______________________________________________________________________________________________________________________
Bingo Supplies and Equipment
Total Sales/Rentals of Bingo Carton/Boxes And Blowers To Distributors
$____,____,____.___
Total Sales/Rentals of Bingo Carton/Boxes And Blowers To Organizations
$____,____,____.___
Total Sales/Rentals of Bingo Carton/Boxes And Blowers To Commercial Halls
$____,____,____.___
Total Sales/Rentals of Electronic Bingo Aides To Distributors
$____,____,____.___
Total Sales/Rentals of Electronic Bingo Aides To Organizations
$____,____,____.___
Total Sales/Rentals of Electronic Bingo Aides To Commercial Halls
$____,____,____.___
TOTAL AMOUNT OF ALL SALES & LEASES:
$_____,____,____.___
Total Bingo Gross Sales/Rentals:
$_____,____,____.___
Additional License Fee*:
$_____,____,____.___
Application Fee:
$_____,____,__25.00_
Total Bingo Fee Owed:
$_____,____,____.___
* $1,000 to $4,999
= $10.00
$5,000 to $19,999
= $50.00
$20,000 to $49,999
= $200.00
$50,000 to $100,000
= $500.00
$100,000.01 and above = $1,000.00
___________________________________________________________________________________________________________
.
I swear or affirm that the information and statements contained herein have been examined by me and are true, accurate and complete
Print Name & Title: _______________________________________________________________________________
Signature & Title: ________________________________________________________________________________
Bureau of Licensing
1 Broadway Center, P.O. Box 7500 Schenectady, NY 12301
www.gaming.ny.gov
rev. 10/10/2019
ANNUAL SUPPLIER REPORT OF GROSS SALES
FOR BINGO
_______________________________________________________________________________________________________________________
Current License Year
: ____________
Pursuant to Executive Law 435, this form is a summation of the amount of gross receipts realized from the sale and rental of Bingo
supplies and equipment to licensed authorized organizations in the preceeding calendar year. Submit this form (original signature)
along with a check for the amount owed to the NYS Gaming Commission attention: Bureau of Licensing. Make check payable to the
“NYS Gaming Commission”. This completed form and check must be submitted no later than January 15
th
to the Bureau of Licensing.
Company Name: ___________________________________________________________ License No.: ________
_______________________________________________________________________________________________________________________
Bingo Supplies and Equipment
Total Sales/Rentals of Bingo Carton/Boxes And Blowers To Distributors
$____,____,____.___
Total Sales/Rentals of Bingo Carton/Boxes And Blowers To Organizations
$____,____,____.___
Total Sales/Rentals of Bingo Carton/Boxes And Blowers To Commercial Halls
$____,____,____.___
Total Sales/Rentals of Electronic Bingo Aides To Distributors
$____,____,____.___
Total Sales/Rentals of Electronic Bingo Aides To Organizations
$____,____,____.___
Total Sales/Rentals of Electronic Bingo Aides To Commercial Halls
$____,____,____.___
TOTAL AMOUNT OF ALL SALES & LEASES:
$_____,____,____.___
Total Bingo Gross Sales/Rentals:
$_____,____,____.___
Additional License Fee*:
$_____,____,____.___
Application Fee:
$_____,____,__25.00_
Total Bingo Fee Owed:
$_____,____,____.___
* $1,000 to $4,999
= $10.00
$5,000 to $19,999
= $50.00
$20,000 to $49,999
= $200.00
$50,000 to $100,000
= $500.00
$100,000.01 and above = $1,000.00
___________________________________________________________________________________________________________
.
I swear or affirm that the information and statements contained herein have been examined by me and are true, accurate and complete
Print Name & Title: _______________________________________________________________________________
Signature & Title: ________________________________________________________________________________
Bureau of Licensing
1 Broadway Center, P.O. Box 7500 Schenectady, NY 12301
www.gaming.ny.gov
rev. 10/10/2019