Form G-6 - Application For Exemption From General Excise Taxes Page 4
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4FORM G-6
PAGE 4
(REV. 2012)
SCHEDULE D
COMPARATIVE STATEMENT OF RECEIPTS AND DISBURSEMENTS FOR HAWAII ACTIVITIES
Complete the comparative statement of receipts and disbursements for the organization’s Hawaii activities for the last two
completed tax years. If the organization recently started its activity in Hawaii or was recently formed (less than two com-
plete years of activity in Hawaii), prepare a projected budget of anticipated income and related expenses for the organiza-
tion’s Hawaii activities for 2 years.
(A)
(B)
From: ___ / ___ / ___
From: ___ / ___ / ___
To: ___ / ___ / ___
To: ___ / ___ / ___
ITEMS
(Year before the last
(Last completed tax
completed tax year)
year)
HAWAII RECEIPTS
Gifts/contributions received
Grants
Unusual grants
Membership dues/fees
Fundraising/special events (attach an itemized list)
Gross receipts from admissions
Gross receipts from the sale of merchandise
Gross receipts from services performed
Gross rental income
Other revenue (attach an itemized list)
TOTAL RECEIPTS
HAWAII DISBURSEMENTS
Fundraising expenses
Contributions/gifts/grants paid out (attach an itemized list)
Salaries and wages
Occupancy (rent, utilities, etc.)
Supplies
Insurance
Professional fees
Other disbursements (attach an itemized list)
TOTAL EXPENSES
RECEIPTS OVER DISBURSEMENTS
FORM G-6
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