MR/LD Report

ILLINOIS STATE COUNCIL

K of C Charities, Inc.

REPORT OF COUNCIL MENTAL RETARDATION/LEARNING DISABILITIES FUND DRIVE

DUE: NOVEMBER 1st

* Council Name:

* Council #:

* City:

* GK Name:

* IRS #:

* Date:

* 1. GROSS REVENUE FROM DRIVE:

2. STATE COUNCIL DEDUCTIONS

* 2a. 10% of Gross Revenue (line 1) for state Program:

2b. Liability and Accident Insurance: $30.00 [Do not include if participating in Suprme Council General Liability Insurance Program]

* 2c. Council Donation to MR/LD Home Loan Fund

* 2.d TOTAL STATE COUNCIL DEDUCTIONS (lines 2a + 2b +2C)

* 3. SUBTOTAL -Council monies: (line 1 minus 2d)

* 4A. Candy Costs

* 4B. Postage for business solicitations:

* 4C. Apron Costs

4D. Advertising (Attach copy of itemized bill and advertisement to be allowed)

4E. Miscellaneous (Attache receipts and written explanation)

* 4F. TOTAL allowable council expenses (lines 4A +4B + 4C + 4D + 4E)

* 5. Balance Available for Council Distribution (Line 3 minust 4F)

* 6. TOTAL Remittance to State Charities (Line 2d + 5):

* CHECK NUMBER

Total # of KC Volunteers:

# of Non-KC Volunteers

Total Drive Volunteers:

* GK Name

* FS Name

* Indicates Response Required