VETERANS ORGANIZATION SOLICITOR'S QUARTERLY REPORT A solicitor that raises more than $5000 for a veterans organization during a calendar quarter, must file the following report with the secretary of state at the end of that calendar quarter. A filing fee of $50.00 must accompany this report. (Please print or type. Use additional sheets if necessary.) _____________Quarter *** Please indicate which quarter you are reporting. 1st: January - March 3rd: July - September 2nd: April - June 4th: October - December 1. Solicitor's name: ___________________________________________________________________________________ Address: ___________________________________________________________________________ ___________________________________________________________________________________ Telephone number: (_________) ____________________________ 2. The name and address of the veteran's organization is as follows: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 3. The gross amount raised for the veterans organization was _______________________________ 4. The amount paid to the veterans organization was ______________________________________ Form #3506 American LegalNet, Inc. www.FormsWorkFlow.com 5. The name and address of the person representing the veterans organization to which the amount was paid is as follows: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Executed the ____________ day of ____________________________, __________. ____________________________________________ (Solicitor's Signature) ____________________________________________ (Printed Name & Title)