Form of Statement for A Street Collection
Please complete (using Block Capitals) and return this form to :Director of Community and Cultural Services Licensing Section City Of Sunderland Civic Centre Sunderland SR2 7DN
Full Name of Person responsible for Collection or Sale_______________________ ___________________________________________________________________ Full Name of Society that the Collection is in aid of
Name and Address of Hon. Secretary
Object of Collection or Sale Date of Collection or Sale
Certificate of Hon. Treasurer I certify that to the best of my knowledge that this is a true account of the expenses, proceeds and application of the proceeds of the collecting to which it relates Signed Approved at a meeting of on the day of 20 Hon. Treasurer
Certificate of Auditor I certify that I have obtained all the information and explanations required by me as auditor and that the account is in my opinion a true account of the expenses, proceeds and application of the proceeds of the collection to which it relates. Date Signed Qualifications
Statement of Income and Expenditure Proceeds of Collection £ From Collectors or sale, as per list of collectors and Vendors and amounts attached hereto
From other sources Bank Interest Other Items (If any) :Badges or other adornments Other Items (If any): -
p
Expenses and Application of Proceeds £ p
Printing and Stationery Postage Advertising Street Collection Boxes and Carriage
Disposal Of Balance (Insert Particulars): -
Total
Total