Free Form AU-212.4 - New York

New York State Department of Taxation and Finance

New York State Pari-Mutuel Betting Tax Return - Schedule IV
Outstanding Pari-Mutuel Tickets Balance
Page to Inter-track wagering at Date (mm/dd/yy) Organization name

AU-212.4
(8/04)

Reporting period: from

On-track including ITW of

(See instructions on back)

Previous balance

Current period

Total outstanding

Paid in current period

Balance

Remarks

AU-212.4 (8/04) (back)

Instructions
Current period -- Enter the amount of outstanding tickets added this date. Total outstanding -- Add the two preceding lines and enter the total. Paid in current period -- Enter the total of outstanding tickets cashed this date. Balance -- Subtract the Paid in current period line from the Total outstanding line and enter the remaining balance. This balance must also be entered as the Previous balance on the next reconciliation date. Remarks -- Enter any explanation required.

General information
This schedule will provide a daily reconciliation of outstanding ticket balances. Track operators will prepare separate schedules for on-track races and inter-track wagering if segregated. List the name of the organization and type of racing applicable to outstanding ticket schedule. If on-track outstanding tickets include the uncashed tickets of an inter-track wagering participant, enter the name of participant on the line provided. If this schedule is prepared by an inter-track wagering participant maintaining their own segregated outstanding ticket balances, enter the name of the host track.

Line instructions
Date -- Enter the date of reconciliation. Previous balance -- Enter the balance from the last reconciliation.