Form C1 - Charitable Organization Initial Registration Form Page 3

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C1
CHARITABLE ORGANIZATION INITIAL REGISTRATION FORM
(Continued)
SECTION B: Financial Information
An organization may submit a copy of its IRS Form 990, 990-EZ, or 990-PF in lieu of completing Section B.
If an organization has not yet filed an IRS return, it must provide preliminary financials for its most recent
fiscal year-end.
• Is an IRS Form 990, 990-EZ, or 990-PF attached?
Yes
No If no, provide the following information:
INCOME
1. Contributions Received
$______________________1
2. Government Grants
$______________________2
3. Program Service Revenue
$______________________3
4. Other Revenue
$______________________4
0.00
5. TOTAL INCOME
$______________________5
EXPENSES
6. Program Expenses
$______________________6
7. Management & General Expenses
$______________________7
8. Fund-raising Expenses
$______________________8
0.00
9. TOTAL EXPENSES
$______________________9
0.00
10. EXCESS or DEFICIT
$______________________10
(Line 5 minus Line 9)
ASSETS
11. Cash
$______________________11
12. Land, Buildings & Equipment
$______________________12
13. Other Assets
$______________________13
0.00
14. TOTAL ASSETS
$______________________14
LIABILITIES
15. Accounts Payable
$______________________15
16. Grants Payable
$______________________16
17. Other Liabilities
$______________________17
0.00
18. TOTAL LIABILITIES
$______________________18
0.00
FUND BALANCE/NET WORTH
$______________________
(Line 14 minus Line 18)
5

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