U.S. DOD Form dod-af-af-2046 NAFI BINGO ACTIVITY REPORT SHEET NUMBER DATE LOCATION NAFI/ACTIVITY (This form is subject to the Privacy Act of 1974-See reverse) GAME PRIZE DESCRIPTION ITEM NO WINNER COST COST PRINT NAME AND SSAN SIGNATURE & MBR CARD NO. ADDRESS (Include ZIP Code) TOTAL TICKETS A B ENDING NUMBER BEGINNING NUMBER NUMBER SOLD PRICE C D . E INCOME/COSTS RECEIPTS COST OF PRIZE(S) CASH PRlZE(S) TOTAL COST OF PRlZE(S) RECEIPTS GROSS PROFIT CERTIFIED BY LABOR NET INCOME FORM AF JUL 76 2046 PREVIOUS EDITION IS OBSOLETE PRIVACY ACT STATEMENT AUTHORITY: 10 USC 8012; 44 USC 3101; and EO 9397. PRINCIPAL PURPOSE(S): To record all social recreation and open mess bingo prize disbursements, to establish ticket accountability, and to record receipts. ROUTINE USES: To account for all bingo prize disbursements for each bingo event, to reflect ticket sales by price of ticket, and to record receipts. Informa­ tion fournished may be disclosed to any DOD component or part thereof, and upon request, to other federal, state, and local governmental agencies in the pursuit of their official duties; disclosed to news media announcing winners; and used for other lawful purposes including law enforcement and litigation. The SSAN is used for identification of the individual and records. DISCLOSURE IS VOLUNTARY :Failure to provide the infomation and SSAN may preclude the individual from receiving the bingo prize.