Charitable Organization Annual Report Template

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CHARITABLE ORGANIZATION ANNUAL REPORT
For charitable organizations not required to file information or a tax return with the Internal Revenue Service
1.
LEGAL NAME OF CHARITABLE ORGANIZATION:_____________________________________________________
____________________________________________________________________________________________________
STREET ADDRESS
________________________________________________________________(____)___________________________
CITY
STATE
ZIP CODE
TELEPHONE NUMBER
2.
Individual and/or officer having custody of contributions and/or responsibility for distribution of contributions:
___________________________________________________________________________________________________
NAME
___________________________________________________________________________________________________
BUSINESS ADDRESS
________________________________________________________________(____)___________________________
CITY
STATE
ZIP CODE
TELEPHONE NUMBER
3.
FISCAL YEAR DATE
From _______/______/______
To ________/_______/_______
4.
Total amount of revenue collected:
$_______________________
5.
Amount allocated for Program Services:
$________________________
6.
Amount allocated for Management and general expenses:
$________________________
7.
Fund-raising expenses:
$_________________________
I swear and/or affirm, under penalty of law, that the foregoing representations are true and accurate.
__________________________________ ________________________________________
____________________
Printed Name
Signature
(Title)
_____/_______/_______
Date Signed
NOTARY
STATE OF_______________
)
) SS.
COUNTY OF _____________
)
Subscribed and sworn to, before me, a Notary Public in, and for, said County and State, this _______ day of ________________,
200____.
My Commission Expires:
_______________________________________________________
______/______/_____
Signature of Notary Public
County of Residence
_______________________________________________________
__________________
Printed Name
Stamp or Seal

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