Note: The Tax Division is offering users an interactive option to some of the forms provided on this page. This means that you may either print a blank form to fill out manually, or you may enter your data directly onto the form and then print the completed form to sign and send to the Tax Division. As interactive forms become available, they will be posted to this page.

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Form Number		Title	Revision Date	Document Type
Permittee Forms
Applications
Permittee Application
	826a	Permittee Application Amended Fill In	(Rev 4/13)
	826ai	2013 Permittee Application Amended Instructions	(Rev 9/12)
	826rc	2013 Permittee Application Check List	(Rev 10/12)
	826rc	2013 Permittee Application Check List Renewal	(Rev 10/12)
	826	Permittee Application Fill In	(Rev 4/13)
	826l	2013 Permittee Application Cover Letter	(Rev 9/12)
	826i	2013 Permittee Application Instructions	(Rev 9/12)
Pull-Tab Vendor Registration
	854	2013 Pull-Tab Vendor Registration	(Rev 9/12)
Permittee Test Available Online
	862	2013 Permittee Test	(Rev 7/12)
Reports
Permittee Quarterly Report
	828	2013 Permittee Quarterly Report Fill In	(Rev 11/12)
	828i	2013 Permittee Quarterly Report Instructions	(Rev 12/12)
Calcutta Pool Report
	810	2012 Calcutta Pool Report	(Rev 7/11)
	810	2013 Calcutta Pool Report	(Rev 9/12)
Permittee Annual Financial Statement
	833EZ	2012 Permittee Annual Financial Statement -EZ Fill In	(Rev 10/12)
	833EZi	2012 Permittee Annual Financial Statement -EZ Instructions	(Rev 12/12)
	833	2012 Permittee Annual Financial Statement Fill In	(Rev 11/12)
	833i	2012 Permittee Annual Financial Statement Instructions	(Rev 12/12)
Permittee Quarterly Report
	828	2012 Permittee Quarterly Report	(Rev 3/12)
	828i	2012 Permittee Quarterly Report Instructions	(Rev 9/12)
Operator Forms
Applications
Operator Application
	847a	Operator Application Amended Fill In	(Rev 4/13)
	847ai	2013 Operator Application Amended Instructions	(Rev 9/12)
	847l	2013 Operator Application Cover Letter	(Rev 9/12)
	847	Operator Application  Fill In	(Rev 4/13)
	847i	2013 Operator Application Instructions	(Rev 8/12)
Operator Surety
	847c	2013 Operator Surety Bond	(Rev 9/12)
Assignment of Cash
	847d	Assignment of Cash Deposit Fill In	(Rev 4/13)
Operating Contract
	856	Operating Contract  Fill In	(Rev 4/13)
Reports
Operator Quarterly Report
	843	2013 Operator Quarterly Report Fill In	(Rev 9/12)
	843	2013 Operator Quarterly Report	(Rev 11/12)
Operator Quarterly Report
	843	2012 Operator Quarterly Report	(Rev 3/12)
	843i	2012 Operator Quarterly Report Instructions	(Rev 3/12)
Operator Annual Report
	844	2012 Operator Annual Report Fill In	(Rev 11/12)
	844i	2012 Operator Annual Report Instructions	(Rev 9/12)
MBP (Multiple-Beneficiary Permittee) Forms
Applications
Multiple-Beneficiary Permittee Application
	859a	2013 Multiple-Beneficiary Permittee Application Amended	(Rev 9/12)
	859ai	2013 Multiple-Beneficiary Permittee Application Amended Instructions	(Rev 9/12)
	859l	2013 Multiple-Beneficiary Permittee Application Cover Letter	(Rev 9/12)
	859	2013 Multiple-Beneficiary Permittee Application	(Rev 9/12)
	859i	2013 Multiple-Beneficiary Permittee Application Instructions	(Rev 9/12)
Reports
Multiple-Beneficiary Permittee Quarterly Report
	867	2013 Multiple-Beneficiary Permittee Quarterly Report Fill In	(Rev 11/12)
	867i	2013 Multiple-Beneficiary Permittee Quarterly Report Instructions	(Rev 9/12)
Multiple-Beneficiary Permittee Quarterly Report
	867	2012 Multiple-Beneficiary Permittee Quarterly Report Fill In	(Rev 4/12)
	867i	2012 Multiple-Beneficiary Permittee Quarterly Report Instructions	(Rev 4/12)
Multiple-Beneficiary Permittee Annual Report
	866	2012 Multiple-Beneficiary Permittee Annual Report Fill In	(Rev 11/12)
	866i	2012 Multiple-Beneficiary Permittee Annual Report Instructions	(Rev 9/12)
Distributor Forms
Distributor Application
	837l	2013 Distributor Application Cover Letter	(Rev 9/12)
	837	Distributor Application Fill In	(Rev 4/13)
Manufacturer Forms
Manufacturer Application
	853l	2013 Manufacturer Application Cover Letter	(Rev 9/12)
	853	Manufacturer Application Fill In	(Rev 4/13)
Sworn Statement
	95	Sworn Statement  Fill In	(Rev 8/11)
Other Forms
Gaming Request for Appeal
	851	Gaming Request for Appeal	(Rev 10/12)
	851i	Gaming Request for Appeal Instructions	(Rev 10/12)
Bingo Prize Receipt
	877	Bingo Prize Receipt	(Rev 10/12)
Pull-Tab Prize
	858a	Pull-Tab Prize Receipt	(Rev 4/13)
	858	Pull-Tab Prize	(Rev 4/13)
Prize Receipt - Other than Pull-Tab
	874	Prize Receipt - Other than Pull-Tab	(Rev 4/13)
Permittee/Licensee Authorization of Handling Electronic Bingo Devices
	702	Permittee/Licensee Authorization of Handling Electronic Bingo Devices	(Rev 9/12)
Power of Attorney for Appeal
	852	Power of Attorney for Appeal	(Rev 10/12)
Request for Gaming Information
	876	Request for Gaming Information	(Rev 8/11)

Previous Years' Forms