1. (a) authorized commercial lessor's name, name of hall and license number;
2. (b) location of premises;
3. (c) date and amounts of payments received;
4. (d) names, identification numbers, bingo license numbers of organizations that conducted bingo and each date each organization conducted bingo. Two copies of said report shall be mailed by the authorized commercial lessor to the commission.

On or before the 10th day of each month, every authorized commercial lessor shall file a statement of bingo rental receipts for the preceding month on form BC-204 as prescribed by the commission or facsimile of same with the licensing authority of the municipality where the premises are located disclosing: