Form Sc- Registration Statement For Solicitations Page 3
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319. Complete this statement of the cost of fund raising incurred or anticipated to be incurred by the organization, including a statement
of such costs as a percentage of contributions received.
List all costs - describe below:
Total costs:
Total costs as a percent of contributions received:
%
20. Attach a financial statement (form provided) covering complete disclosure of the fiscal activities of the organization during the
preceding year. The Secretary of State will accept executed copies of federal IRS returns and reports in lieu of a financial
statement. Also, if the organization received contributions exceeding $100,000, an audited financial statement prepared in
accordance with generally accepted accounting principles and an opinion of an independent CPA on the financial statement must
be filed.
I declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct.
Executed on this _________ of ___________________________ , ________
.
Day
Month
Year
Name (printed or typed)
Authorized officer
Name (printed or typed)
Chief fiscal officer
Instructions
1. Submit this registration statement and financial statement, with a $35 registration.
2. Solicitation registration expires on the last day of the sixth month following the month in which fiscal
year of charitable organization ends.
3. Solicitation registration must be renewed each year.
Notice: There is a $25 service fee for all returned checks.
Rev. 8/11/03 jb
K.S.A. 17-1763
Page 3 of 3
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