Form Ss-6022 - Summary Of Financial Activities Of A Professional Solicitor For A Solicitation Campaign - Departament Of State, State Of Tennessee Page 2

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SIGNATURE SECTION
This report must be signed by an authorized official of the professional solicitor and two (2) authorized officials of
the charitable organization.
I / we certify that the information furnished in this financial report and all continuation sheets is true and correct to the best of
my / our knowledge. This form must be signed in the presence of a Notary.
Notary Seal
Sworn to and Subscribed before me at:
_____________________________________________
___________________________________
Signature of Authorized Officer of Professional Solicitor
City / State
_____________________________________________
This ______ day of ___________, 200____.
Print Name
_____________________________________________
___________________________________
Title
Notary Signature
_____________________________________
My commission expires: _______________
Date
_______________________________________________________________________________________________
Notary Seal
Sworn to and Subscribed before me at:
_____________________________________________
___________________________________
Signature of Authorized Officer of Charitable Organization
City / State
_____________________________________________
This ______ day of _________, 200_____.
Print Name
_____________________________________________
___________________________________
Title
Notary Signature
_____________________________________
My commission expires: _______________
Date
_____________________________________________________________________________________________
Notary Seal
Sworn to and Subscribed before me at:
_____________________________________________
___________________________________
Signature of Authorized Officer of Charitable Organization
City / State
_____________________________________________
This ______ day of _________, 200_____.
Print Name
_____________________________________________
___________________________________
Title
Notary Signature
_____________________________________
My commission expires: _______________
Date
SS-6022 (Rev. 11/03/06)
RDA 1742

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