Washington State Unified Registration Statement Addendum Form (Page 2 of 3) in pdf

1. The total gross dollar value of all contributions received

from solicitations:

Solicitations include, but are not limited to, special events, sale of

inventory, and amounts collected on behalf of the charitable organization

by a commercial fundraiser or commercial coventurer.

2. The total gross dollar value of revenue from all other

+ $

sources (not the result of a solicitation):

3. The total dollar value of gross receipts:

= $

"Gross receipts" include, but are not limited to, contributions, gross

revenue from special events, sales of inventory, goods or services

(including tickets to events), and all other revenue from solicitations,

regardless of custody of funds.

Amounts collected on behalf of the charitable organization by a

(line 1 + line 2 = line 3)

commercial fundraiser or commercial coventurer must be included on line

4. The total gross dollar value of expenditures used directly

for charitable program services:

Payments to affiliates may be included if costs involved are not connected

with the administrative or fundraising functions of the reporting

organization.

5. The total gross dollar value of expenditures used for

+ $

administrative and fundraising:

"Administrative and fund-raising costs" include, but are not limited to, the

following expenses if not directly related to program services: salaries,

wages, compensation, legal, accounting, occupancy, equipment costs,

printing and publications, telephone, postage, supplies, travel, meetings,

fees for services, and cost of goods or inventory sold that are not directly

related to program services.

Amounts paid to or retained by a commercial fundraiser or fundraising

counsel must be included on line 5.

6. The total dollar value of program service, administrative

= $

and fundraising expenditures:

Enter on line 6 the sum of the expenditures reported on lines 4 and 5. This

includes, but is not limited to, amounts paid to or retained by a

commercial fundraiser or fundraising counsel, amounts expended for

charitable program services, administrative expenses, fees for services,

(line 4 + line 5 = line 6)

and fundraising costs incurred by the charitable organization.

7. Beginning assets (gross):

8. Ending assets (gross):

CHARITY S COMMENTS REGARDING SOLICITATION REPORT (OPTIONAL)

Attach additional information or provide an explanation, if any, which the organization believes would be of assistance in understanding

the financial information provided in Solicitation Report or IRS tax return, or to provide context for reported information. Be sure to

clearly label attachment as Solicitation Comments .

THREE HIGHEST PAID OFFICERS OR EMPLOYEES OF THE ORGANIZATION

Officer or Employee Name

Title

NOTE: If no one is compensated, write None . If less than three persons are compensated, write n/a on the appropriate row(s).

REQUIRED ATTACHMENTS FOR FIREFIGHTER, POLICE, SHERIFF OR VETERANS SERVICE ORGANIZATIONS

Attach written authorization, signed by two officials from a bona fide police, sheriff, or fire fighter department, if your organization uses

police,

sheriff,

fire fighter,

firemen or a similar name during the conduct of solicitations.

Attach written authorization, signed by the highest ranking official in WA State of a Federally chartered or nationally recognized

military veterans service organization (as determined by the United States Veterans Administration), if your organization uses the

name of said military veterans service organization during the conduct of solicitations.

URS Addendum/Rev 10/07

Washington State Unified Registration Statement Addendum Form Page 2

Related Articles

Related forms

Related Categories