SOUTH CAROLINA SECRETARY OF STATE PUBLIC CHARITIES DIVISION JOINT FINANCIAL REPORT FOR A SOLICITATION CAMPAIGN COMMERCIAL CO-VENTURER Filing Instructions This form must be filed within 90 days after a solicitation campaign has been completed or within 90 days after the anniversary of a solicitation campaign lasting more than one year. Please contact our office with any questions regarding this form at 803-734-1790 or charities@sos.sc.gov. Mail to South Carolina Secretary of State, Attn: Division of Public Charities, 1205 Pendleton St., Suite 525, Columbia, SC 29201. Commercial Co-venturer Registered Charitable Organization Registered with the Secretary of State's Office with the Secretary of State's Office ____________ Registration No. ____________ Phone ____________ Registration No. ____________ Phone _________________________________ Full Legal Name ________________________________ Full Charity Name _________________________________ DBA ________________________________ DBA _________________________________ Address ________________________________ Address _________________________________ City, State, Zip ________________________________ City, State, Zip 1. 2. Solicitation in South Carolina: Start Date ______________ End Date ______________ or ____ is continuous. Brief description of method of solicitation: ______________________________________________ 3. Period covered by this report: ______________ to ______________ If the contract on file with the Charities Division ended early, please check here: _______ 4. Gross Revenue .............................................................................................. $ ____________________ Gross revenue is for this specific solicitation from all states, not just South Carolina, if the campaign is multi-state. 5. Amount paid to (or retained by) charitable organization ............................... $ ____________________ I do heareby declare that the information contained herein is true and correct to the best of my knowledge, information and belief. Commercial Co-venturer _________________________________________ Name Date _________________________________________ Title _________________________________________ Signature Joint Financial Return for CCV, revised June 2015 Charitable Organization _________________________________________ Name Date _________________________________________ Title _________________________________________ Signature American LegalNet, Inc. www.FormsWorkFlow.com