Southwest Alternatives Institute, Inc.Restricted Gifts Reporting FormThis form must be completed and mailed back to SAI no later than May 15, or as agreed. This a report of all funds spent with money donated through SAI and dispersed to your group for the fiscal year (April 1-March 31). Even if there is no activity with SAI, this form must be completed by all active groups to retain status each year. Attach receipts, as requested. Keep original receipts on file. Report Period Covered: April 1, _______ through March 31, ______ Group: __________________________________ Address: __________________________________ City: ________________________ State: _________ Zip: __________ Contact Person: _____________________ Contact Person Phone: ____________________ RESTRICTED USEThe funds were used for tax-exempt purpose(s) were (check one): EDUCATIONAL CHARITABLE MEDICAL OTHER: ___________________ EXPENSE BUDGETPlease detail expenses totaled for the reporting period: 1. PERSONNEL $ ________ 2. FRINGE $ ________ 3. TRAVEL $ ________ 4. SPACE/RENTALS $ ________ 5. CONSUMABLE SUPPLIES $ ________ 6. PRINTING/REPRODUCTION $ ________ 7. EQUIPMENT PURCHASE $ ________ 8. POSTAGE $ ________ 9. UTILITIES $ ________ 10. RENT/OVERHEAD $ ________ 11. ENTERTAINMENT $ ________ 12. ADMINISTRATION $ ________ 13. MEDICAL $ ________ 14. OTHER (specify) $ ________ TOTAL AMOUNT SPENT $ ________ TOTAL AMOUNT UNSPENT (balance) $ ________ Please write a brief narrative (on back) of how these expenses were used for tax-exempt purpose(s) as indicated above. Attach a copy of all receipts. Mail to SAI, P.O. Box 3355, Tucson, AZ. 85722. If you need help filling out this form, please call 520-623-3733. Thank you _________________________________ ________________________ Signed by Group Representative Date _________________________________ _________________________ Received by SAI Date |