Form Cht-1 - Application For Registration As A Charitable Trust Page 3
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4FINANCIAL REPORT
Please supply fiscal/accounting beginning/ending dates and complete line items 1 - 6:
Fiscal/accounting year begin date: (Mo/Day/Year)
Fiscal/accounting year end date: (Mo/Day/Year)
1. Beginning assets:
$
2. Total revenue:
$
3. Grants, contributions, and program services:
+ $
4. Compensation of officers, directors, trustees, etc.:
+ $
5. Total expenses (add lines 3, 4 and all other expenses):
= $
6. Ending assets:
$
SECTION 5 – SIGNATURE (Required)
By signing this application for registration, the applicant certifies: ( a ) he/she is authorized to represent the above-named charitable
trust; and (b) the information contained in the application and in the attachments are accurate and true to the best of the applicant’s
knowledge.
_________________________________
_____________________________ _____________________ _________________
Signature of trustee, officer, or director
Printed name
Title
Date
Contact telephone number (_____)__________________________
NOTE: Expedited Service is available for registration documents requiring priority processing. To utilize Expedited Service, please
enclose $50 per registration document (in addition to regular fees), check (√) the box on page one of this document, and write the
word “EXPEDITE” in bold letters on the outside of the envelope. Your request will be processed by the Charities Program within
two working days of submission or as soon thereafter as possible.
↓
↓
Please proceed to page 4, Section 6 if the organization wishes to be included in the Charitable Trust Directory.
CHT-1/Rev 08/10
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Parent category: Legal