Charitable Solicitations Permit - Financial Statement

RECEIPTS*

	AMOUNT
1. CASH CONTRIBUTIONS / DONATION Include all direct contributions / donations received
2. MEMBERSHIP FEES Include all proceeds received from membership dues, etc.
3. PROCEEDS FROM SALES Include proceeds from sales / auctions / boutiques
4. SALES OF ADVERTISING SPACE Include sales for ad books, tribute books, etc.
5. TICKET / ADMINSSION SALES Total amount received from ticket / admission sales, meals, etc.
6. DONOR PACKAGES Include sales of combinations(s) of tables, tickets, advertising, etc.
7. IN-KIND DONATIONS Only include and describe in-kind donations that off set expenses, use a separate sheet if necessary & upload below
8. OUTSTANDING PLEDGES You must notify the Commission, in writing, upon the receipt of outstanding pledges
9. OTHER RECEIPT AMOUNT Describe and additional receipts below & add the value here.
TOTAL RECEIPTS

EXPENSES (do not estimate)*

	AMOUNT
1. ADVERTISING / PUBLICITY
2. DECORATIONS / TABLE FAVORS / GIFT BAGS
3. ENTERTAINMENT Do not include music or DJ expenses here
4. HOTEL OR CATERING EXPENSES Include tax and tips
5. MUSIC / DJ
6. PHOTOGRAPHY Include both still and video photography
7. POSTAGE, PRINTING, & STATIONARY SUPPLIES Include cost of invitations, labels, programs, etc.
8. RENTALS Include cost of tables, chairs, or other items rented for the event
9. SALARIES, WAGES, & COMMISSIONS List the name of the individual(s), company, or event planner who received salaries, wages, and / or commission payments as a result of this solicitation only ITEMIZE ADDITIONAL EXPENSES BELOW
10. SECURITY
11. FEES PAID TO THE CITY OF BEVERLY HILLS Include fees paid for street closures, City staff, etc.
12. MISCELLANEOUS Describe miscellaneous expenses below, and enter the total here:
TOTAL EXPENSES

Summary of Donations

DECLARATION
THIS REPORT MUST BE SIGNED BY EITHER AN OFFICER OF THE ORGANIZATION, EXECUTIVE DIRECTOR, OR A MEMBER OF THE BOARD OF DIRECTORS, AND FILED WITH THE CITY OF BEVERLY HILLS CHARITABLE SOLICITATION COMMISSION WITHIN 60 DAYS OF PERMIT EXPIRATION DATE.

I CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURTY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT.
Name of Officer of Organization
Title
Phone Number
Signature

Clear
Date Signed

MonthDayYear
Date

FINANCIAL STATEMENT OF CHARITABLE SOLICITATION ACTIVITY