Form Po - Professional Fund Raiser Operating Statement printable pdf download

Form Po - Professional Fund Raiser Operating Statement

Secretary of State/Corporation Division

Form

Professional Fund Raiser Operating Statement

__________________________________________________________

Name of Professional Fund Raiser

________________________________________________________________

Address, City, State, Zip

__________________________________________________________

Name of Charitable Organization

________________________________________________________________

Address, City, State, Zip

Fund raising activity (actual or expected):

Beginning date

_________________________________________________________

Month

Day

Year

Ending date

_________________________________________________________

Month

Day

Year

_________________________________

Date of this report

Authorized signature(s) of professional fund raiser (proprietor, or all partners, or corporate officer and title):

_____________________________________

I declare (or verify, certify or state) under penalty of perjury under the laws of the State of Kansas that the foregoing

is true and correct. Executed on this________ day of ____________________________, _______.

Year

____________________________________________

Name (printed or typed)

Authorized Signature

____________________________________________

Title/Position

This form must be filed for each charitable organization before acting as a professional fund raiser for the charitable organization.

(K.S.A. 17-1764)

Rev.12/99 kp

Form Po - Professional Fund Raiser Operating Statement