Form 11a - Professional Solicitor'S Annual Financial Report
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4Form 11A
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OMMONWEALTH OF
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FFICE OF THE
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ROFIT
RGANIZATIONS
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HARITIES
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SHBURTON
LACE
B
, M
02108
OSTON
ASSACHUSETTS
Form 11A
Professional Solicitor’s Annual Financial Report
Please TYPE or CLEARLY PRINT all entries in black ink.
1.
Professional Solicitor (use legal principal place of business):
Name:
Address:
City:
State:
Zip Code:
Phone:
Fax:
Email address:
Website (URL):
2.
Charitable organization for whom the solicitation was conducted:
Name:
AGO Account #:
Address:
Phone:
3.
Campaign dates (MM/DD/YYYY). In the first row, list the start and end dates for the campaign
as listed on the corresponding Form 10A. In the second row, list the dates for the portion of the
campaign reported on this Form.*
Campaign duration:
/
/
to
/
/
Period reported here:
/
/
to
/
/
*If you are reporting on a campaign that began and ended in the same calendar year, both rows should
match. If you are reporting on a campaign that was conducted/will be conducted in more than one calendar
year (e.g. 7/1/2006 – 6/30/2007), indicate the calendar year period reported here in row two (e.g. 7/1/2006-
12/31/2006
4.
Individual to contact, if more information is needed about this form:
Name:
Address:
City:
State:
Zip Code:
Phone:
Email:
Form 11A
Page 1 of 4
Rev. 07/2007
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