INSTRUCTIONS: ARIZONA VERIFICATION RECORD (Form 71-1009)
Arizona bingo game operators document each occasion using a form 71-1009. This verification record must be maintained for three years. This document can be obtained from the website of the Arizona Department of Revenue.
Arizona Verification Record 71-1009 Step 1: Section A requires you to document the occasion. Enter the date, license number, number of players, and the supervisor for the occasion.
Arizona Verification Record 71-1009 Step 2: Section B requires you to document card sales. Enter the item number in the first column, the price in the second column, the number sold in the third column, the total income in the fourth column, and the wastage cards in the fifth column.
Arizona Verification Record 71-1009 Step 3: Enter the total card sales in dollars at the bottom of Section B.
Arizona Verification Record 71-1009 Step 4: Section C requires you to document supply sales. For each listed category, enter the number sold in the second column, the price in the third column, and the income in the fourth column.
Arizona Verification Record 71-1009 Step 5: Enter the total supply sales in dollars at the bottom of Section C.
Arizona Verification Record 71-1009 Step 6: Section D requires you to document inducements. Enter the giveaway on line 1.
Arizona Verification Record 71-1009 Step 7: On line 2, enter the amount of fair market discounts, subtract the sale price from this value, and enter the resulting difference to determine your inducement value.
Arizona Verification Record 71-1009 Step 8: Section E requires you to document your cash records. Enter your admission fee on line 1, the card sales on line 2, and the total of the two on line 3.
Arizona Verification Record 71-1009 Step 9: Enter your gross receipts on line 4 and subtract this from line 3. Enter the resulting difference on line 5.
Arizona Verification Record 71-1009 Step 10: Complete the remainder of Section E as instructed to calculate your ending cash.
Arizona Verification Record 71-1009 Step 11: Calculate your adjusted gross receipts as instructed in section F.
Arizona Verification Record 71-1009 Step 12: Complete the legend and game work sheet sections as directed on the second page.
Arizona Verification Record 71-1009 Step 13: A supervisor and a witness should sign the first page, as well as giving the date the form was completed.
