Form Fs - Charitable Solicitation Financial Statement - Kansas Secretary Of State
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1Secretary of State/Corporation Division
Form
Charitable Solicitation Financial Statement
FS
Period Covering _________________________ to _________________________.
GROSS RECEIPTS:
____________________
(Attach a listing of total receipts and income for each
separate solicitation project/source)
SOLICITATION
EXPENSES:
(___________________)
NET PROFIT:
____________________
ADMINISTRATIVE
(___________________)
EXPENSES:
OPERATING INCOME:
____________________
EDUCATIONAL/
INFORMATION
PROGRAM
EXPENSES:
(___________________)
OTHER EXPENSES:
(___________________)
NET INCOME:
____________________
CHARITABLE
DISTRIBUTIONS
IN KANSAS:
(___________________)
CHARITABLE
DISTRIBUTIONS
OUTSIDE OF KANSAS: (___________________)
(Attach a listing of non-Kansas recipients of
distributions and such recipients’ purposes)
OTHER
DISTRIBUTIONS:
(___________________)
BALANCE THIS
PERIOD:
____________________
BEGINNING
BALANCE:
____________________
ENDING BALANCE:
____________________
I declare under penalty of perjury under the laws of the State of Kansas that the foregoing is true and correct.
Executed by me on _________________, ______.
Month
Year
Authorized Officer
I declare under penalty of perjury under the laws of the State of Kansas that the foregoing is true and correct.
Executed by me on _________________, ______.
Month
Year
Chief Fiscal Officer
Rev. 12/99 kp
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