Final Report Form

From Council # (*)

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Council Name

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Address (*)

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City, State, and Zip (*)

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Date

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Cases of Tootsie Rolls Purchased (*)

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Cases of Tootsie Rolls Used (*)

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Please use dollars and cents format for these entries, for example $34.50

1. Total revenues received (before deductions) (*)

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2. Cost of Tootsie Rolls (*)

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3. Promotional Expenses

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4. Miscellaneous Expenses

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5. Total Cost (add lines 2, 3, & 4) (*)

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6. Net Proceeds (deduct line 5 from line 1) (*)

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7. Amount remitted (line 6 or larger amount) (*)

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Within 30 days after completion of drive, this final report must be completed. Mail the funds to: Ralph Cupelli, Columbian Charities Treasurer, 6 Circle Lane, Cirksville, MO. 63501. Include a copy of this form with your check for the net (or more) payable to: COLUMBIAN CHARITIES OF MISSOURI, INC. 50% of the net proceeds will be credited to the council to use for council supported Developmental Disabilities projects by filing a Disbursement Request Form. Remember funds can only be disbursed to Developmental Disabilities programs which have a tax exempt status. Council disbursement funds may be requested once the net proceeds have been mailed to the Treasurer. These funds should be requested as soon as possible after the fund raising drive and no later than June 30th of the fraternal year in which they were raised.

Grand Knight (*)

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Developmental Disabilities Program Chairman Name (*)

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Please double check all the information above. Prior to submitting this form, you will want to print a paper copy for your records. If everything is correct, fill in the code below, and click on "Submit". Your information will be sent to the Columbian Charities Treasurer and the Community Activities Program Director.

Please fill in the code and click Submit

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