Financial Statements for Non Profit Organization

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					TO: Governmental and Non-Profit Organizations Applying for
    City of Clarksville Funding in FY 2009

FROM: Wilbur Berry
     Commissioner of Finance and Revenue

DATE: April 22, 2008

SUBJECT: FY 2009 Budget Request

We are certain that your agency has already started to prepare your FY 2009 budget or
has completed preparing your FY 2009 budget .

If you anticipate requesting funding from the City of Clarksville for the Fiscal Year 2009,
we are requesting certain information about your organization to be submitted with your
funding request.

Please complete the attached application and submit the application together with your
FY 2009 budget to our office no later than May 9, 2008.

Unless you are another government organization, a 501-c-3 charitable organization,
or a 501-c-4 or 501-c-6 civic organization, you are not eligible for funding from the city.

If you are requesting funding as a 501-c-3, 501-c-4, or 501-c-6 organization, you must
provide proof from the IRS as to your non-profit charitable or civic organization status
at the time your request is submitted to the City of Clarksville for funding.

For non-profit organizations, It is essential that the basic requirements of the
State of Tennessee must be met for funding eligibility.

  1) Your organization provides year-round services benefiting the general welfare
  of the city's residents.
  2) Your organization files a copy of an annual audit of its business affairs and
  transactions and the proposed use of the contributed funds.
  3) Your organization is a 501-c-3, 501-c-4, or 501-c-6 organization with documented
   verification from the Internal Revenue Service provided to the City of Clarksville.

Completion of the application and providing the information requested will generally satisfy
the minimum requirements of the State to be eligible for funding as a "Non-Profit
Organization".

All applications and reports should be submitted to us no later than noon, Friday,
May 9, 2008. You may submit other information that you feel may be pertinent
to your request; however, if you do not meet the minimum requirements to be eligible
under the State of Tennessee minimum requirements your request for funding will not
be processed.

Wilbur M. Berry Jr.
Commissioner of Finance and Revenue
City of Clarksville, Tennessee
                         Municipal Donations to Nonprofit Organizations

http://www.comptroller.state.tn.us/ma/auditmanual06/Municipal%20Laws%20-%20PNP%20regs.pdf

Section 6-54-111, Tennessee Code Annotated, as amended, authorizes a municipality’s
governing body to appropriate funds for the financial aid of any nonprofit charitable
organization that provides year-round services benefiting the general welfare of the
residents of the municipality or any nonprofit civic organization working to maintain and
increase employment opportunities in the municipality. This section also provides for the
Comptroller of the Treasury to establish standard procedures to assist the municipal
governing body in the disposition of funds so appropriated. The auditor should consider
whether the municipality has complied with the following laws and rules:

    1      A municipality may appropriate funds for only those nonprofit charitable
           organizations that provide year-round services benefiting the general
           welfare of the residents of the municipality, or any nonprofit civic
           organization classified under Sections 501(c)(4) or (6) of the Internal
           Revenue Code working to maintain and increase employment
           opportunities in the municipality.

    2      The governing body of each municipality shall adopt a special resolution
           stating the purpose for which the funds are being appropriated, for each
           nonprofit organization that is to receive municipal funds.

    3      The budget document of the municipality shall include the name of each
           nonprofit organization and the specific amount appropriated for each
           organization.

    4      Municipal payments to nonprofit organizations shall be limited to the
           amounts appropriated for such purposes and in keeping with the
           municipality’s guidelines for how the appropriated funds may be spent.

    5      The municipality shall require that each nonprofit organization receiving
           financial assistance from the municipality file with the disbursing official
           of the municipality a copy of an annual audit of its business affairs and
           transactions and the proposed use of the contributed funds.

    6      For appropriations to nonprofit civic organizations, notices shall be
           published in a newspaper of general circulation in the municipality of the
           intent to make an appropriation, specifying the intended amount and
           purpose.
           Submitted By (signature): SIGNATURE ON FILE


Organization Requesting Funding:

                                                                                                                         REQUESTED FUNDING:
                                                        Section 1 - Documentation Provided and on File in Finance Department
Agency Name:
Name of Person Submitting Request:
Was Information Provided On or Before March 25                                        Yes                        No
If not submitted on or before March 25, when was it submitted
Agency Type (check one):              501-c-3, 501-c-4, 501-c-6                       State                     County             Other Government                 City/County

                                                            Section 2 - Proposed Use of City Funds or Purpose of Program




                                                       Section 3 - Documentation Provided and on File in Finance Department
                                           "x" as Applicable           Description of Documentation Provided                               Years on File or Other Information
Forms and Reports on File                                           1 IRS letter granting non-profit status
(place "x" by as many as                                            2 990's                                                       Latest being submitted with this document
applies):                                                           3 Audited Financial Statements                                Latest being submitted with this document
                                                                    4 Bank Statements
                                                                    5 Organization Prepared Financials
                                                                    6 Other (please describe)

                                                                              Section 4 - Funding in FY 2005
If not for profit, has non-profit status been verified on internet (check one)?                                                            Yes                          No
Did we contribute to agency in FY 2005 (check one)?                                                                                        Yes                          No
FY 2005 Appropriation ( if answer to preceding question was yes, how much):

                                                                      Section 5 - Summary Financial Statements

                                               Estimated                        % of Total                     Proposed                 % of Total
                                            Financial Status                     Revenue/                       Budget                   Revenue/
                                                FY 2005                        Expenditures                     FY 2006                Expenditures
           Revenues
City of Clarksville                                                                                                                      #DIV/0!
Montgomery County                                                                                                                        #DIV/0!
Other Governments                                                                                                                        #DIV/0!
Revenues from Other Sources                                                                                                              #DIV/0!
Total Revenues                                                 -                  #DIV/0!                                 -              #DIV/0!

        Expenditures
Salaries and Benefits                                                             #DIV/0!                                                #DIV/0!
Other Operating Expenditures                                                      #DIV/0!                                                #DIV/0!
Capital Outlay Expenditures                                                                       0%                                     #DIV/0!
Total Expenditures                                             -                  #DIV/0!                                 -              #DIV/0!
Estimated Net Surplus (Deficit)                                -                                                          -
Beginning Fund Equity
Ending Fund Equity                                             -                                                          -

Basis of Budgeting:                                                         Accrual                     Modified Accrual          Cash Basis
Basis of Accounting:                                                        Accrual                     Modified Accrual          Cash Basis

                                                                                 Section 6 - Major Salaries
Does Agency Pay Salaries:                                                                                        Yes                       No
If "Yes", Please Provide Salaries of Principal or Key Officers/Officials:
                                                    Name                          Salary               Percent of Total Expenditures
                                  1                                                                          #DIV/0!
                                  2                                                                          #DIV/0!
                                  3                                                                          #DIV/0!
                                  4                                                                          #DIV/0!
                                  5                                                                          #DIV/0!
                                  6                                                                          #DIV/0!
                                  7                                                                          #DIV/0!
                                  8                                                                          #DIV/0!
                                  9                                                                          #DIV/0!
                                 10                                                                          #DIV/0!
                                      Totals                                                  -              #DIV/0!




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           Submitted By (signature): SIGNATURE ON FILE


                                                                             Section 7 - Beneficiaries of Program
Estimated number of participants in program and area of coverage.

                                          Number of Participants                                                                Area of Coverage




If awarded the funding by the City of Clarksville, the organization agrees to allow access to the financial records and other records that the City of Clarksville may request
to review to ascertain that the funds provided for the city are used for the purposes now being requested. We agree that if awarded funds for the Fiscal Year 2009, the
organization will use the funds for the purposes now being proposed and we agree to not use the funds for other purposes without the prior approval of the City of Clarksville.
We certify that the information herein provided is accurate to the best of our knowledge.


Application completed by:



Signature of Person Completing Application                                                                 Date



Type Name of Person Completing Application                                                          Email Address of Peson Completing Application



Title of Person Completing Application




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