Joint Financial Report For Solicitation Campaign

SOUTH CAROLINA SECRETARY OF STATE PUBLIC CHARITIES DIVISION JOINT FINANCIAL REPORT FOR A SOLICITATION CAMPAIGN PROFESSIONAL FUNDRAISING COMPANY Filing Instructions This form must be filed within 90 days after a solicitation campaign has been completed or within 90 days after the anniversary of a solicitation campaign lasting more than one year. Please contact our office with any questions regarding this form at 803-734-1790 or charities@sos.sc.gov. Mail to South Carolina Secretary of State, Attn: Division of Public Charities, 1205 Pendleton St., Suite 525, Columbia, SC 29201. Professional Fundraising Company Registered Charitable Organization Registered with the Secretary of State's Office with the Secretary of State's Office ____________ Registration No. ____________ Phone ____________ Registration No. ____________ Phone _________________________________ Full Legal Name ________________________________ Full Charity Name _________________________________ DBA ________________________________ DBA _________________________________ Address ________________________________ Address _________________________________ City, State, Zip ________________________________ City, State, Zip 1. 2. Solicitation in South Carolina: Start Date ______________ Method of solicitation: ___ Phone ___ Mail End Date ______________ or ____ is continuous. ___ Bingo ___ Door to Door ___ Print Media ___ Electronic Media 3. Period covered by this report: ______________ to ______________ ___ This contract has ended early Enter revenue and expenses from all states, not just from South Carolina, if the campaign is multi-state. 4. Gross Revenue ..............................................................................................$ ____________________ 5. Total Expenses (Attach itemized list of all expenses) ...................................$ ____________________ This form will be returned for correction and considered not received if an itemization of expenses is not attached. 6. Amount paid to (or retained by) charitable organization...............................$ ____________________ I do heareby declare that the information contained herein is true and correct to the best of my knowledge, information and belief. Professional Fundraising Company _________________________________________ Name Date _________________________________________ Title _________________________________________ Signature Joint Financial Return, revised March 2012 Charitable Organization _________________________________________ Name Date _________________________________________ Title _________________________________________ Signature American LegalNet, Inc. www.FormsWorkFlow.com