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CITY OF REDMOND City Cashier, MS: 2SPL PO Box 97010 Redmond, WA 98073-9710 (425) 556-2144 GAMBLING TAX RETURN Within the Corporate Limits of the City Business Name Address Business License # RED Telephone email address Tax is due to the City by by 5 pm on or before the last day of each April, July, October and January, after which penalties apply. Submit original return with payment made payable to the City of Redmond. This report is for the quarter ending Classification Gross Receipts Deduct Cost of Prizes Net Receipts Tax Rate Total Tax Due Bingo Game or Raffle 5% Amusement Games 2% Pulltabs (non-profit organizations) 10% Pulltabs (as commercial stimulant) 5% Social Card Games (as commercial stimulant) 12% Social Card Games (non- profit organizations) $1.00 per year per member I declare under the penalties of perjury that this return (including any accompanying schedules and statements) has been examined by me and to the best of my knowledge and belief is a true, correct and complete return. Signature of Applicant Title Printed Name Date Washington State Gambling Commission License No. Date Expires