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    Philaco DACS Financial Form

    Uploaded by

    mmlemieux4

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Philaco DACS Financial Form

    Uploaded by

    mmlemieux4
    4 views1 page

    Original Title

    Philaco DACS financial form

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    © © All Rights Reserved

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    Copyright:

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    4 views1 page

    Philaco DACS Financial Form

    Uploaded by

    mmlemieux4

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Florida Department of Agriculture and Consumer Services

    Remit completed form to:


    Division of Consumer Services
    [email protected]
    SOLICITATION OF CONTRIBUTIONS or
    ANNUAL FINANCIAL REPORTING FORM FDACS
    Chapter 496, Florida Statutes Solicitation of Contributions
    COMMISSIONER Rule 5J-7.004, Florida Administrative Code 2005 Apalachee Pkwy.
    Tallahassee, FL 32399-6500
    1-800-HELP-FLA (435- (850) 410-3800

    CH# DTN
    Organization Name (Registration
    ( #) (as listed on the preprinted
    renewal application)

    ___________________________________________________________________________________________________________________________
    Organization Physical Address City State Zip

    FISCAL YEAR ENDING ____/____/_______

    Yes x No Is this a proposed budget? (newly formed organizations only)

    Yes x No Is this a consolidated financial statement for chapters, branches and affiliates?

    REVENUE
    1. Federated campaigns: 1. ______________

    2. All Fundraising events: 269.30


    2. ______________

    3. Related Organizations: 3. ______________

    4. Government Grants: 4. ______________

    5. All other contributions, gifts, grants & similar amounts: 910.00


    5. ______________

    6. In-kind contributions (non- cash contributions): 6. ______________

    7. Program service revenue: 400.00


    7. ______________

    8. Income from gaming activities: 8. ______________


    9. Sales of inventory revenue: 15,715.02
    9. ______________

    10. Misc./Other revenue 998.55


    10. ______________
    11. Membership Dues and assessments 11. ______________

    12. TOTAL REVENUE 19,192.87


    12. __
    _ _____________
    ______________

    EXPENSES
    1. Program services (including payments to affiliates)
    3,750.00
    1. _______________

    2. Management and general 3,696.64


    2. _______________
    3. Fundraising 3. _______________

    4. TOTAL EXPENSES (add lines 1 through 3) 7,446.64


    4. _______________

    FDACS-10122 11/21
    Page 1 of 3

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