Exemption From Real Estate Taxation Page 3

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Real Estate Tax Exemption Application for Nonprofit Organizations
Page 3
STATEMENT OF RECEIPTS AND EXPENDITURES,
continued
EXPENDITURES
9. Fund raising expenses ..................................................................................................................................
9.
10. Contributions, gifts, grants and similar amounts paid
.........................................................
(attach schedule)
10.
11. Disbursements to or for the benefit of members
.................................................................
(attach schedule)
11.
12. Compensation of officers, directors and trustees .........................................................................................
12.
13. Other salaries and wages..............................................................................................................................
13.
14. Interest .........................................................................................................................................................
14.
15. Rent..............................................................................................................................................................
15.
16. Depreciation and depletion ...........................................................................................................................
16.
17. Other expenditures
..............................................................................................................
(attach schedule)
17.
18. TOTAL EXPENDITURES (add lines 9 through 17).........................................................................................
18.
19. EXCESS OF RECEIPTS OVER EXPENDITURES (line 8 less line 18) ..............................................................
19.
SECTION 5 - ORGANIZATION STATEMENT OF ASSETS AND LIABILITIES FOR LAST FISCAL YEAR
3,
1
5
"
."
C O M P L E T E O N L Y I F S E C T I O N
Q U E S T I O N S
O R
W E R E A N S W E R E D
N O
Beginning date
Ending date
ASSETS
1. Cash
(a) interest bearing accounts .................................................................................................
1a.
(b) other.................................................................................................................................
1b.
2. Accounts receivable, net .........................................................................................................
2.
3. Inventories ..............................................................................................................................
3.
4. Bonds and notes
............................................................................................
(attach schedule)
4.
5. Corporate stocks
...............................................................................................
(attach schedule)
5.
6. Mortgage loans
..............................................................................................
(attach schedule)
6.
7. Other investments
.........................................................................................
(attach schedule)
7.
8. Depreciable and depletable assets
.................................................................
(attach schedule)
8.
9. Land........................................................................................................................................
9.
10. Other assets
..................................................................................................
(attach schedule)
10.
11. TOTAL ASSETS (add lines 1 through 10)................................................................................
11.
LIABILITIES
12. Accounts payable....................................................................................................................
12.
13. Contributions, grants, etc. payable ........................................................................................
13.
14. Mortgages and notes payable
........................................................................
(attach schedule)
14.
15. Other liabilities
..............................................................................................
(attach schedule)
15.
16. TOTAL LIABILITIES (Add lines 12 through 15)
16.
FUND BALANCE OR NET WORTH
17. Total fund balance or net worth .............................................................................................
17.
18. TOTAL LIABILITIES AND FUND BALANCE OR NET WORTH (line 16 plus line 17) .................
18.
19. Has there been any substantial change in any aspect of the organization's financial activities since the period
ended , as shown above?
yes
no
IF "YES," ATTACH A DETAILED EXPLANATION.

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