The statement must contain the following information for each charity casino:1° the number of admission tickets on sale;
2° the number of admission tickets sold;
3° the selling price of an admission ticket;
4° the gross revenues from the sale of admission tickets;
5° the gross revenues from the sale of additional phoney money;
6° the total value of prizes awarded;
7° the actual cost of each prize awarded, as well as supporting vouchers at the board’s request;
8° the total value of the prizes claimed;
9° the administration expenses;
10° the profit or loss;
11° the name and address of each winner of a prize valued at $2,000 or more, at the board’s request;
12° an attestation that all prizes offered were awarded or the reasons why they were not awarded.