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Monthly Gross Revenue Statistical Report - Gaming Salon NGC-30 - Nevada
| Monthly Gross Revenue Statistical Report - Gaming Salon Form. This is a Nevada form and can be used in Tax And License Division Nevada Gaming Commission And State Gaming Contol Board Statewide . |
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NEVADA GAMING COMMISSION MONTHL Y GROSS REVENUE STATISTICAL REPORT GAMING SALON NGC-30 (07-29-02) FILING DEADLINE: Account No., Name, Address, Zip Code Please correct if in error For Gaming operations during the month of: (For Commission Use Only) SECTION A NO. OF COINS IN DROP GROSS REVENUE UNITS ($) ($) ($) CODE SLOT MACHINES 020 $100.00 021 $500.00 022 Multi Denomination 024 Other Denominations 053 Adjustments TOTALS NO. OF PIT CREDIT DROP WIN GROSS REVENUE SECTION B PIT CREDIT PIT CREDIT UNITS ISSUES ($) PAYMENT (CHIPS)($) PAYMENT (CASH)($) ($) ($) ($) CODE TABLE GAMES 002 Craps 003 Roulette 001 Twenty-One 005 Wheel of Fortune 006 Baccarat 007 Mini-Bacc 037 Pai Gow 039 Sic-Bo 043 Pai Gow Poker 059 3-Card Poker 009 Other Games (Describe Below): 050 Adjustments TOTALS SECTION C NO. OF WRITE GROSS REVENUE NOTE: THIS FORM IS FOR INFORMATIONAL PURPOSES UNITS ($) ($) CODE COUNTER GAMES ONLY. ALL REVENUE ON THIS FORM MUST BE INCLUDED IN THE REVENUE TOTALS RECORDED ON 035 Race Book THE NGC-31 (MONTHLY GROSS REVENUE STATISTICAL 048 Race Parlay Cards REPORT). 052 Race Pari-Mutuel 034 Sports Parlay Cards The HASH TOTAL is a number comprised of the following subtotals added together. 036 Sports Pool 004 Football SECTION A: (NO. OF UNITS TOTAL CONVERTED TO DOLLARS ) 008 Basketball (COINS IN TOTAL) 033 Baseball (DROP TOTAL) Sports Pari-mutuel 058 SECTION B: (NO. OF UNITS TOTAL CONVERTED TO DOLLARS ) (PIT CREDIT ISSUES TOTAL) 051 Adjustments (PIT CREDIT PAYMENTS (CHIPS) TOTAL) Totals (PIT CREDIT PAYMENTS (CASH) TOTAL) (DROP TOTAL) PERSON TO CONTACT SECTION D NO. OF GROSS REVENUE (WIN TOTAL) UNITS ($) REGARDING THIS REPORT CODE CARD GAMES 030 Poker SECTION C: (NO. OF UNITS TOTAL CONVERTED TO DOLLARS ) (WRITE TOTAL) 032 Other Card Games NAME 054 Adjustments SECTION D: (NO. OF UNITS TOTAL CONVERTED TO DOLLARS ) PHONE NUMBER TOTALS TOTAL GROSS REVENUE HASH TOTAL (Add Sections A, B, C, D) I, , certify and declare under the penalties of perjury that I am the (Owner, Partner, President, Treasurer, Other) of the business named above; that this is a true, correct and complete report to the best of my knowledge, information, and belief; and that this report is made with the knowledge and consent of all other individuals licensed. Dated Signed Please return to State Gaming Control Board, Tax and License Division P.O. Box 8004, Carson City, NV 89702-8004
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