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INSTRUCTIONS: ARIZONA VERIFICATION RECORD (Form 71-1009)
As part of the bingo licensing process in Arizona, a form 71-1009 is used to document each game. This form can be obtained from the website of the Arizona Department of Revenue.
Arizona Verification Record 71-1009 Step 1: Section A concerns the occasion. Enter the date, the license number, the number of players and the supervisor for the occasion.
Arizona Verification Record 71-1009 Step 2: Section B concerns card sales. For each such transaction, enter the item number, price, number sold, total income and wastage cards. Enter the total card sales at the bottom of the table provided.
Arizona Verification Record 71-1009 Step 3: Section C concerns supply sales. For each dauber, glue stick or other sold, enter the number sold, price and income. Enter the total supply sales at the bottom of the table provided.
Arizona Verification Record 71-1009 Step 4: Section D concerns inducements. Document your giveaways, discounts, admission fees, card sales, supply sales, gross receipts, cash payouts, remaining receipts, beginning cash, cash on hand, cash short or cash over, bank deposit and ending cash as instructed.
Arizona Verification Record 71-1009 Step 5: Section E concerns adjusted gross receipts. Enter your total income on the first blank line and the total prize money on the second blank line.
Arizona Verification Record 71-1009 Step 6: Subtract the second blank line from the first blank line and enter the resulting difference on the third blank line. This is your adjusted income.
Arizona Verification Record 71-1009 Step 7: The supervisor should enter their signature on the first blank line.
Arizona Verification Record 71-1009 Step 8: A witness should enter their signature on the second blank line.
Arizona Verification Record 71-1009 Step 9: The date the form was completed should be entered on the third blank line.
Arizona Verification Record 71-1009 Step 10: Enter any miscellaneous information at the bottom of the first page.
Arizona Verification Record 71-1009 Step 11: The two tables provided at the top of the second page require you to document legend items.
Arizona Verification Record 71-1009 Step 12: The two tables provided at the bottom of the second page are game worksheets. For each game, enter its number, the item number, the cost of each, the number sold, the total income and the prize.