Managing and reporting the financial outcomes of raffle operations is a crucial responsibility for organizations engaging in such activities, particularly in the state of New York. The GCVS-2 form serves as an essential document for those who have conducted a raffle and reported net profits of less than $30,000 for the calendar year. Structured by the New York State Racing & Wagering Board, this form not only facilitates compliance with state regulations but also ensures a transparent account of the raffle's financial transactions. It covers a broad spectrum of details, requiring the organization to report on numbers of tickets printed, sold, and unsold, the net profit or loss, and the disposition of net proceeds. Additionally, the form mandates a detailed account of every expenditure directly related to the conduct of the raffle, from the cost of tickets to renting venues or purchasing supplies. Finally, it includes sections for declaring the value of prizes offered and received, including those donated, with a comprehensive statement attested by the head of the organization, the member in charge, and the preparer, if applicable. The diligence in filing this form, adhering to the guidelines provided, and meeting the submission deadline—January 30th of the year following the conduct of a raffle occasion—ensures that organizations remain in good legal standing while fostering an environment of accountability and trust.
| Question | Answer |
|---|---|
| Form Name | Gcvs 2 Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | form gcvs 2, GC-5, B1, Payee |
NYS RACING & WAGERING BOARD 1 Broadway Center, Suite 600 Schenectady, NY
Telephone (518)
VERIFIED STATEMENT RAFFLE OPERATIONS
TO REPORT NET PROFITS
LESS THAN $30,000
FOR THE CALENDAR YEAR:
Instructions: Prepare report in triplicate. Due January 30th of the year following the conduct of a raffle occasion(s). Send original to clerk of your municipality, one copy to N.Y.S. Racing and Wagering Board and retain one copy for your files.
Organization:
N.Y.S. Identification Number: |
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Street address: |
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City: |
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County: |
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Date(s) of Raffle Drawing(s): |
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A.RECEIPTS (If there is more than one drawing, attach records detailing origin of figures for Sections A and B) 1. Tickets
a. Number of tickets printed...............................................................................................................
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b. |
Number of tickets sold |
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c. Number of tickets unsold |
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d. |
Price of each ticket |
$ |
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e. |
Ticket receipts (item 1b times item 1d) |
$ |
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2. |
Other Receipts |
$ |
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3. |
Total Receipts (Add items A1e and A2) |
$ |
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B.EXPENDITURES - (Only payments directly related to the conduct of the raffle. Attach additional sheets if necessary.)
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Describe Expenditure |
Payee |
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Check No. |
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1. |
Total Value of Prizes (Part E) |
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$ |
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2. |
Tickets |
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$ |
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3. |
Raffle Equipment & Supplies |
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$ |
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4. |
Services |
$ |
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5. |
Rent |
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$ |
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6. |
Other Expenses |
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$ |
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7. |
Total Expenditures (Add items B1 through B6) |
$ |
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C. NET PROFIT OR (LOSS) |
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$ |
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1. |
Net Profit or (Loss) (item A3 less item B7) |
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STOP: If the figure on line C1 is greater than $30,000.00 then you must obtain a raffle license
D. DISPOSITION OF AND ACCOUNTING FOR NET PROCEEDS |
$ |
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1. |
Unexpended balance of net proceeds shown on last report |
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2. |
Net Profit or (Loss) from this occasion (item C1) |
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3. |
Interest earned on net proceeds on deposit in interest bearing account(s) |
$ |
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4. |
Other deposits into or adjustments in Special Games of Chance Account |
$ |
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Explanation:
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Page 1 of 2 |
5. Total Net proceeds (Add items D1 through D4) |
$ |
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Disbursements of Net Proceeds since last report: (Attach additional sheets if necessary) |
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Date |
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Check No. |
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Description of Disbursements |
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Name & Address of Payee |
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Amount
6.Total Disbursements.............................................................................................
7.Unexpended balance of net proceeds (item D5 less item D6).............................
E. SCHEDULE OF PRIZES (Cash or Fair Market Value of Merchandise Prize(s))
DESCRIPTION OF PRIZES
$
$
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VALUE
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$ |
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$ |
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Total Value of Prizes (Report on Line 1 Part B) |
$ |
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F. SCHEDULE OF DONATED PRIZES (Cash or Fair Market Value of Merchandise Prize(s)) |
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DESCRIPTION OF PRIZES DONATED ONLY |
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VALUE |
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$
$
$
$
Total Value of Donated Prizes |
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G. Grand Total Value of Prizes (Total from Section E plus Section F) |
$ |
Note that this amount may not exceed $100,000.00 for the calendar year |
Instructions: This section must be fully completed by all parties.
I swear, or affirm that the information and statements contained herein have been examined by me and to the best of my knowledge and belief are true, correct and complete.
.
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Head of Organization:
First Name
Street Address
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Phone Number |
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Member in Charge: |
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First Name |
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Street Address |
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Phone Number |
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Preparer (if different): |
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First Name |
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Street Address |
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Phone Number |
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Last Name
City |
Zip |
Signature
Last Name
City |
Zip |
Signature
Last Name
City |
Zip |
Signature
Page 2 of 2
County
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Date
County
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County
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Date