Form 1024 - Application For Recognition Of Exemption Under Section 501(A) Page 5
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195
Form 1024 (Rev. 9-98)
Page
Part III. Financial Data (Must be completed by all applicants)
Complete the financial statements for the current year and for each of the 3 years immediately before it. If in existence less than 4 years, complete the
statements for each year in existence. If in existence less than 1 year, also provide proposed budgets for the 2 years following the current year.
A. Statement of Revenue and Expenses
(a) Current Tax Year
3 Prior Tax Years or Proposed Budget for Next 2 Years
Revenue
From
To
(b)
(c)
(d)
(e) Total
1
Gross dues and assessments of members
2
Gross contributions, gifts, etc.
3
Gross amounts derived from activities related to
the
organization’s
exempt
purpose
(attach
schedule) (Include related cost of sales on line 9.)
4
Gross amounts from unrelated business activities (attach schedule)
5
Gain from sale of assets, excluding inventory items
(attach schedule)
6
Investment income (see page 3 of the instructions)
7
Other revenue (attach schedule)
8
Total revenue (add lines 1 through 7)
Expenses
9
Expenses attributable to activities related to the
organization’s exempt purposes
10
Expenses attributable to unrelated business activities
11
Contributions, gifts, grants, and similar amounts
paid (attach schedule)
12
Disbursements to or for the benefit of members (attach schedule)
13
Compensation of officers, directors, and trustees (attach schedule)
14
Other salaries and wages
15
Interest
16
Occupancy
17
Depreciation and depletion
18
Other expenses (attach schedule)
19
Total expenses (add lines 9 through 18)
20
Excess of revenue over expenses (line 8 minus
line 19)
B. Balance Sheet (at the end of the period shown)
Current Tax Year
as of
Assets
1
1
Cash
2
2
Accounts receivable, net
3
3
Inventories
4
4
Bonds and notes receivable (attach schedule)
5
5
Corporate stocks (attach schedule)
6
6
Mortgage loans (attach schedule)
7
7
Other investments (attach schedule)
8
8
Depreciable and depletable assets (attach schedule)
9
9
Land
10
10
Other assets (attach schedule)
11
11
Total assets
Liabilities
12
12
Accounts payable
13
13
Contributions, gifts, grants, etc., payable
14
14
Mortgages and notes payable (attach schedule)
15
15
Other liabilities (attach schedule)
16
16
Total liabilities
Fund Balances or Net Assets
17
17
Total fund balances or net assets
18
Total liabilities and fund balances or net assets (add line 16 and line 17)
18
If there has been any substantial change in any aspect of the organization’s financial activities since the end of the period shown above,
check the box and attach a detailed explanation
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