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Schedule C <br />Site license number <br />n Fayoa <br />1 Date approved <br />by mamharshin <br />L <br />I <br />• nyn • <br />Brief description <br />of expenditure: <br />E <br />To <br />m <br />Q <br />S <br />m <br />0 m <br />m <br />?• <br />C <br />c <br />M <br />Federal unrelated business tax (federal form 9901) <br />and /or federal wagering tax stamp (federal form 11C) <br />Minnesota unrelated business tax (form M -4) <br />x <br />E <br />° <br />U <br />s <br />a <br />c7 <br />m <br />c <br />. <br />S <br />T <br />o_. <br />N <br />E <br />-cot: <br />= <br />L. <br />tl1.V <br />N', <br />m <br />2> <br />m- <br />N <br />m <br />m <br />CC <br />9- <br />.,, C., <br />V <br />e� ^ <br />W o <br />R. <br />1J <br />C= <br />cl <br />2 ` n: <br />n, C Q. n <br />0 -1- , ILA- <br />N Vl <br />J <br />UVI <br />r)� <br />,t'� <br />C <br />G, <br />O <br />1�n <br />V I <br />.' <br />C. <br />`` <br />c <br />`? <br />C <br />j <br />4 C <br />O <br />.. C <br />r <br />\J <br />L. <br />��'ac <br />- <br />`J m: <br />^,r:i <br />-_. <br />>q <br />` <br />C <br />\ <br />r <br />h <br />L, <br />1 <br />U .. <br />jt <br />J - <br />4VVV1 <br />0 <br />-- I'^ <br />c <br />•v <br />�0 <br />, <br />�' <br />r•3 <br />� -,. <br />� <br />P <br />i. <br />0 , <br />�� <br />a <br />` V <br />t• <br />— <br />0 <br />> <br />Vl <br />Q u <br />C U <br />.z -, <br />0 C. <br />Lawful <br />purpose code <br />0 <br />0 <br />0 <br />0 <br />349.213 <br />= <br />m <br />1 <br />m m <br />m <br />(1) <br />or" <br />Amount <br />of check <br />a 8 <br />f/- n <br />` In <br />c <br />n <br />N <br />8 0 <br />0 <br />J <br />, J <br />6 <br />m <br />i I <br />0 g 9 <br />. r <br />o Li. Ce <br />m <br />c; <br />C <br />.- <br />r_ <br />Check made out to: <br />Internal Revenue Service <br />Internal Revenue Service <br />Commissioner of Revenue <br />0 <br />U <br />U <br />IR b a <br />,— <br />F,i) .•:} <br />>a. <br />ID <br />r <br />�. <br />CJuro ; + G( <br />UQU=792 r7a2) , o <br />s <br />vO <br />Uti <br />VI <br />VI <br />lJ <br />q vl Q. <br />°3 <br />Vi 0 <br />17 Add lines 1 through 16. Fill in total here and also <br />on line 40 of your monthly summary and tax return . . . $ <br />Check <br />number <br />9 <br />N <br />Co 00 <br />N N <br />Tr <br />cn <br />00 <br />N <br />iP 0' <br />f i en <br />tb N <br />N N <br />0 <br />00 <br />M <br />— N) rn <br />? z3" -I- <br />00 C0 Vv <br />r ) N <br />Date <br />of check <br />N <br />M <br />Q <br />to <br />tot <br />7 I %Z <br />8 I°I, <br />' <br />Oo <br />cp <br />O <br />cq <br />v tit <br />E <br />O N <br />O z <br />?' <br />0 <br />_5 <br />m m <br />a 0 0 <br />m c <br />Q <br />C <br />0 <br />m v <br />• o <br />cc).. <br />= <br />U <br />0m <br />•a 3 <br />E ^ <br />m <br />Mall thls schedule to: <br />Do not mail to Department of Revenue <br />49 <br />= <br />m <br />— <br />a. <br />'o <br />m <br />3), <br />• E <br />= E <br />aH <br />c <br />O <br />D <br />E <br />+/-1 <br />O m <br />g <br />m <br />c <br />=• B <br />E <br />c <br />0 <br />LL N <br />tt- <br />m o <br />2 <br />a <br />0 <br />