Form Bco-165 - Solicitation Campaign/event Financial Report, Professional Solicitor (Ps) 1994
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1SOLICITATION CAMPAIGN/EVENT FINANCIAL REPORT - FORM BCO-165
(Rev. 6-94)
PROFESSIONAL SOLICITOR (PS)
REPORT MUST BE FILED WITH THE DEPARTMENT WITHIN 90 DAYS AFTER A SOLICITATION CAMPAIGN OR EVENT HAS BEEN
COMPLETED OR ON THE ANNIVERSARY OF THE COMMENCEMENT OF A SOLICITATION CAMPAIGN LASTING MORE THAN ONE
YEAR.
Full business name and address of Professional Solicitor
PS Certificate Number: __________________________
as registered with the Department:
___________________________________________________________
Contract Number:_______________________________
(FULL BUSINESS NAME)
___________________________________________________________
(ADDRESS)
___________________________________________________________
(CITY
(STATE)
(ZIP CODE)
CONTRACT INFORMATION
1.
Name and address of charitable
organization:__________________________________________________________________________________________________
________________________________________________________________________________________________________________
2.
Effective and termination date of contract (must be the same dates as stated in the
contract)___________________________________
3.
Brief description and dates of campaign (must be the same dates as stated on the solicitation
notice)____________________________
_______________________________________________________________________________________________________________
FINANCIAL REPORT
1.
Total contributions (cash basis, only report contributions received)…………….
2.
Compensation received by PS for services rendered…………………………….
3.
All expenses paid by PS
(attach itemized list of all expenses incurred)…………………………………………….
4.
All other expenses paid by the charity…………………………………………….
.
5
Total expenses (add lines 2,3 & 4)………………………………………………….
6.
Net proceeds received by the charity (line 1 minus line 5)……………………….
7.
If #6 is negative, report the guaranteed dollar amount received by the charity
or if less than the guaranteed percentage amount, report the balance owed..………..
do hereby declare that the information contained herein is true and correct to the best of my knowledge, information and
I
belief.
________________________________________________
_______________________________________________________
AUTHORIZED CONTRACTING AGENT
TYPE OR PRINT NAME AND TITLE OF AUTHORIZED
FOR THE PROFESSIONAL SOLICITOR
CONTRACTING AGENT FOR THE PS
________________________________________________
_______________________________________________________
AUTHORIZED OFFICIAL OF THE
TYPE OR PRINT NAME AND TITLE OF AUTHORIZED
CHARITABLE ORGANIZATION
OFFICIAL OF THE CHARITABLE ORGANIZATION
________________________________________________
_______________________________________________________
AUTHORIZED OFFICIAL OF THE
TYPE OR PRINT NAME AND TITLE OF AUTHORIZED
CHARITABLE ORGANIZATION
OFFICIAL OF THE CHARITABLE ORGANIZATION
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