Form Ss-6082 - Disaster Relief Fundraising Quarterly Financial Report
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Division of Charitable Solicitations and Gaming
For Office Use Only
Tre Hargett, Secretary of State
DISASTER RELIEF
FUNDRAISING
QUARTERLY FINANCIAL
State of Tennessee
REPORT
312 Rosa L. Parks Avenue, 8th Floor
Nashville, Tennessee 37243
615-741-2555
INSTRUCTIONS: Any charitable organization other than a bona fide religious institution, which solicited and received
contributions exceeding twenty-five thousand dollars ($25,000) for a charitable purpose related to a disaster between May
1, 2010, and May 20, 2011, shall file a financial report with the secretary of state on June 30, 2011. The report shall detail
all funds received and expended by the organization as a result of the solicitation. After June 30, 2011, the organization
shall file quarterly financial reports with the secretary of state detailing the money raised and expended by the organization
as a result of the solicitation, until the funds are expended. The quarterly reports shall be filed within thirty (30) days of the
close of the quarter.
1. Organization Name:
2. Address:
3. Phone Number:
4. Registration Number
(if applicable)
5. Disaster for which contributions were solicited:
6. Financial Period:
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
,
,
to
Month
Day
Year
Month
Day
Year
I. Revenue
Gross Contributions received as a result of solicitations
$
Total Revenue
$
II. Expenses
Program Services:
$
Gifts/Grants
$
Fundraising
$
Administrative
$
Other (attach schedule)
$
Total Expenses
$
III. Program/Recipent Description
Describe the program services provided by the organization which were funded by contributions detailed in this
report. (If the organization provided grants to other organizations, list the grant recipients and amounts distributed
to such recipients) (attach additional pages if necessary)
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