Free FS.P65 - Kansas

Contact Information
Kansas Secretary of State Ron Thornburgh Memorial Hall, 1st Floor 120 S.W. 10th Avenue Topeka, KS 66612-1594
(785) 296-4564
[email protected]
www.kssos.org


KANSAS SECRETARY OF STATE


Charitable Solicitation Financial Statement
All information must be completed or this document will not be accepted for filing.

FS

53-10

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Tax year beginning _______________ and ending _______________ . Total contributions, gifts, grants and other
amounts given:
(Attach a listing of total receipts and income
for each separate solicitation project/source)
Cost of fundraising: Net amount to charity: Administrative expenses: Operating income: Educational/informational program expenses: ( Other expenses: Net income: Charitable distributions in Kansas: Charitable distributions outside of Kansas: (Attach a listing of non-Kansas recipients of distributions and such recipients' purposes) Other distributions: Balance this period: Beginning balance: Ending balance: ( ) ( ) ) ( ) ( )

Please complete the form, print, sign and mail to the Kansas Secretary of State with the filing fee. Selecting 'Print' will print the form and 'Reset' will clear the entire form.
Do not write in this space

( (

) )

I declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct. Executed on ____________ ________ , _________ .
Month Day Year

Authorized officer

Chief fiscal officer

Rev. 8/11/03 jb Rev. 2/09/05 jls

K.S.A. 17-1763