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MINNESOTA• REVENUE <br />Tax Credit for Exempt Raffles <br />Schedule ER <br />You may conduct tax- exempt raffles if the net proceeds are used exclusively to help relieve the effects of poverty, <br />homelessness, or physical or mental disability for an individual or family (effective August 2000), <br />The credit is nonrefundable and cannot be greater than your tax liability on line 11 of Form 01. <br />License number <br />a- 0°8164 <br />Organization name <br />L t (ALE CFtin1AVA I Re. 'DEPT <br />Mont ear reported <br />Sept/ Wo3 <br />I. 121 39 l . 00 <br />1 Gross receipts for exempt raffles 'J.00 <br />2 Prizes awarded for exempt raffles 2 ?r. <br />3 12, 21(0.00 <br />3 Net receipts (subtract line 2 from line 1; cannot be more than line 2C of Form 01) <br />4 Amount from line 13 of this month's Form 01 <br />5 Tax credit (multiply line 3 by 8.5% (.085); cannot be more than line 11 of Form 01) <br />Enter this amount as a negative number on this month's Form LG1010, Schedule C /D <br />6 Tax liability and fees (subtract line 5 from line 4). PAY THIS AMOUNT instead of the <br />amount on line 13 of Form 01. Make check payable to Minnesota Revenue <br />Also enter this amount on line 14 of this month's Schedule F (do not use the amount <br />from Form 01, line 13). <br />(acv. 7/03) <br />Note: <br />Do not change the amount on Ilne 11 or 13 of Form 61. <br />Attach this schedule to the front of Form 01. <br />4 1 36% 55 <br />5 Ito-3s. 3(0 <br />6 <br />898.23 <br />L� TS <br />Cornell Ka'nler Kosbab <br />& Shideli, PLLP <br />