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Form preview Raffle tax form C. Any organizations conducting a raffle or bazaar MUST FILE a return and PAY a tax of FIVE PER CENT of the GROSS PROCEEDS within TEN DAYS after each raffle or bazaar. Print Form Massachusetts State Lottery Commission Charitable Gaming Division P. O. Box 859012 Braintree Massachusetts 02185-9012 TEL. 617 849-5555 FAX 617 849-5546 RAFFLE AND/OR BAZAAR TAX RETURN ATTENTION FILE RETURN AND PAYMENT WITHIN 10 DAYS AFTER OCCASION TO ABOVE ADDRESS SEE PENALTIES PAGE 2- PAR. A. THROUGH E. CHECK TYPE OF ACTIVITY RAFFLE BAZAAR OTHER SPECIFY PLEASE TYPE OR PRINT IN INK SCHEDULE 1 NAME OF ORGANIZATION STREET ADDRESS OR ORGANIZATION AREA CODE TELEPHONE NO. CITY OR TOWN F.ID. NO. OF ORGANIZATION COMPUTATION OF TAX 1. RECEIPTS FROM SALES ZIP CODE X No. of Tickets or Chances Sold DATE OF OCCASION Cost per Ticket or Chance 2. OTHER EXPENSES C. TAX PAID LINE 6 - SCHEDULE 1 D. TOTAL EXPENSES ADD ITEMS 2A-B-C 3. NET PROFIT OR LOSS SUBTRACT LINE 2D FROM LINE 1 IMPORTANT - PLEASE READ THE FOLLOWING PARAGRAPHS A. Gross proceeds derived from a raffle are the total receipts from the sale of all tickets certain among which entitle holders to prizes as determined by chance after the sale. THROUGH E* CHECK TYPE OF ACTIVITY RAFFLE BAZAAR OTHER SPECIFY PLEASE TYPE OR PRINT IN INK SCHEDULE 1 NAME OF ORGANIZATION STREET ADDRESS OR ORGANIZATION AREA CODE TELEPHONE NO. CITY OR TOWN F*ID. NO. OF ORGANIZATION COMPUTATION OF TAX 1. RECEIPTS FROM SALES ZIP CODE X No* of Tickets or Chances Sold DATE OF OCCASION Cost per Ticket or Chance 2. OTHER RECEIPTS 3. GROSS RECEIPTS ADD LINES 1 AND 2 4. TAX 5. PENALTY AND INTEREST SEE PAR D. - PAGE 2 6. TOTAL TAX DUE ADD LINES 4 AND 5 X. 05 Amount of Line 3 2. LESS EXPENSES A. TOTAL PRIZES AWARDED CASH OR VALUE B. OTHER EXPENSES C. TAX PAID LINE 6 - SCHEDULE 1 D. TOTAL EXPENSES ADD ITEMS 2A-B-C 3. NET PROFIT OR LOSS SUBTRACT LINE 2D FROM LINE 1 IMPORTANT - PLEASE READ THE FOLLOWING PARAGRAPHS A. Gross proceeds derived from a raffle are the total receipts from the sale of all tickets certain among which entitle holders to prizes as determined by chance after the sale. chance for the disposal by means of chance of awards permitted under Section 7A of Chapter 271 of the General Laws. See Section 7A of General Laws Chapter 271 as inserted by Chapter 810 of the Acts of 1968 and amended by Chapter 219 of the Acts of 1977. D. INTEREST AND PENALTY 1. Interest - Charged at 12 from date due to date paid* 2. Penalty for Late Filing of Return - One percent of the tax due for each month or part thereof from date return due to the date filed up to a maximum of 25 the tax due. date tax due to the date paid up to a maximum of 25 of the tax due. E* Adequate books and records must be maintained and kept to substantiate compliance with the five per cent gross proceeds tax. For tax auditing purposes such books and records should preserved and available for a period of three years after each return is filed* I DECLARE UNDER THE PENALTIES OF PERJURY THAT THIS RETURN HAS BEEN EXAMINED BY ME AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IS A TRUE CORRECT AND COMPLETE RETURN* SIGNATURE OF AUTHORIZED OFFICIAL TITLE AREA BUSINESS TELEPHONE NO.

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