Form 1024 - Application For Recognition Of Exemption Under Section 501(A) Page 5
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Form 1024 (Rev. 1-2018)
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
From
Revenue
(b)
(c)
(d)
(e) Total
To
1 Gross dues and assessments of members .
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2 Gross contributions, gifts, etc. .
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3 Gross amounts derived from activities related to the
organization’s exempt purpose (attach schedule)
(Include related cost of sales on line 9.) .
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4 Gross amounts from unrelated business activities (attach schedule)
5 Gain from sale of assets, excluding inventory items
(attach schedule)
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6 Investment income (see instructions) .
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7 Other revenue (attach schedule)
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8 Total revenue (add lines 1 through 7) .
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Expenses
9 Expenses attributable to activities related to the
organization’s exempt purposes .
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10 Expenses attributable to unrelated business activities
11 Contributions, gifts, grants, and similar amounts paid
(attach schedule)
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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 .
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15 Interest
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16 Occupancy
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17 Depreciation and depletion
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18 Other expenses (attach schedule) .
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19 Total expenses (add lines 9 through 18) .
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20 Excess of revenue over expenses (line 8 minus
line 19)
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B. Balance Sheet (at the end of the period shown)
Current Tax Year
Assets
as of
1 Cash .
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2 Accounts receivable, net
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2
3 Inventories
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4 Bonds and notes receivable (attach schedule) .
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5 Corporate stocks (attach schedule)
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6 Mortgage loans (attach schedule) .
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7 Other investments (attach schedule) .
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8 Depreciable and depletable assets (attach schedule) .
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9 Land
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9
10 Other assets (attach schedule)
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11 Total assets .
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Liabilities
12 Accounts payable
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13 Contributions, gifts, grants, etc., payable
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14 Mortgages and notes payable (attach schedule)
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15 Other liabilities (attach schedule) .
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16 Total liabilities .
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16
Fund Balances or Net Assets
17 Total fund balances or net assets .
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18 Total liabilities and fund balances or net assets (add line 16 and line 17)
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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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▶
1024
Form
(Rev. 1-2018)
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