From:   
Council #: Council Name:
Council Address:
Council City: , Mo.     Zip Code:

Date: ex. 5/12/2007

Cases of Tootsie Rolls Purchased:    Cases Used:
                                                                                                 Include cents ex. 25.00
1. Total revenue received before deductions:                        $
2. Cost of Tootsie Rolls:                                    $ 
3. Promotional Expense:                                   $ 
4. Miscellaneous Expense:                                $ 
5. Total Cost (add lines 2,3,4):                                                   $
                                                                                                        ==========
6. Net Proceeds (deduct line 5 from line 1):                           $

Grand Knight:
MR Program Chairman:

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