Form IFC

REPORT OF INDIVIDUAL

JIM RYAN

FUNDRAISING CAMPAIGN

ATTORNEY GENERAL

CHARITY:

Name

Campaign Beginning

and Ending

Mailing Address

CO# 01-

City, State, Zip Code

Phone #

Contact Person

Title

Phone #

PROFESSIONAL FUND RAISER (PFR):

Name

PFR #02-

NATURE OF FUNDRAISING ACTIVTY:

A.

Amount received by the charitable organization .......................................................... A.

$

PAID BY:

B.

Expenses:

PFR

Charity

1.

Professional Fundraiser Fee................. 1.

2.

Solicitor Compensation....................... 2.

3.

Salaries.............................................. 3.

4.

Printing.............................................. 4.

5.

Postage.............................................. 5.

6.

Telephone.......................................... 6.

7.

Rent & Utilities.................................. 7.

8.

Supplies............................................. 8.

9.

Travel................................................ 9.

10.

10.

11.

11.

12.

12.

13.

TOTAL EXPENSES (PFR + Charity)............. 13.

         B.

$

C.

Total Amount Raised.................................................................................................. C.

$

D.

Percentage of funds received by charity (Line A divided by Line C)................................ D.

%

E.

Bank and account number where funds are deposited?

F.

Who (charity or PFR) has signature control of the account(s) listed above?

F.

Attach a schedule explaining, in detail, how expenses are allocated between fundraising campaigns.

We, the undersigned, declare and certify under perjury that we have examined this report, including all the schedules, and statements, and the facts therein stated are true and complete and filed with the Illinois Attorney General for the purpose of having the people of the State of Illinois rely thereupon.

PFR CAMPGAIN

MANAGER (Print Name)

TITLE

SIGNATURE

DATE

OFFICER, DIRECTOR

OF CHARITY (Print Name)

TITLE

SIGNATURE

DATE