Deadline is March 31, 2022

Note:  Items in bold print are required to be answered. Your submission will not go through if one of these questions is not answered.

Type the numbers you see to the right but DO NOT hit enter. If you cannot read the number, refresh your browser.:

Enter security code:

Chapter Number:

Chapter City:

Chapter State (Please Abbreviate):

Name of Chapter Banker/Treasurer:

ASSETS - Please record balance/value at 12/31/2021 for assets listed below. Enter 0 for any item that you have nothing to report.:

Cash-Checking Account:

Cash-Savings Account:

Cash-Savings & Loan Account:

Bonds:

Common or Preferred Stock:

Real Estate:

US Savings Bonds:

Other Assets:

Total Assets:

Total Assets should equal the sum of all assets reported above.:

LIABILITIES-Please record liability amounts at 12/31/2021 for the liabilities listed below. Enter 0 for any line you have nothing to report.:

Notes Payable:

Installment Accounts Payable:

Mortgage Payable on Real Estate:

Chattel/Secured Mortgages:

Unpaid Taxes:

Other Liabilities:

Total Liabilities:

Total Liabilities should equal the sum of all liabilities reported above.:

INCOME - Please record income received in 2021 for the following income categories.:

Income from Chapter Member Dues:

Income from Fund-Raising:

Member Donations to Charity Thru Local Chapter in support of Chapter Community Service Activity:

All Other Income:

Total Income:

Total Income should equal the sum of all income categories reported above.:

EXPENSES - Please record expenses paid in 2021 for the follow expense categories.:

Total Donations to Non-Profit Organizations (Include Member Donations received as income):

Total Chapter Operating Expenses:

Total Amount of Scholarships Awarded:

How many scholarships did you award?:

All Other Expenses:

Total Expenses:

Total expenses should equal the sum of all expense categories reported above.:

Name, Address, City, State & Zip of Bank:

Name, Address, City, State & Zip of Savings & Loan:

Does your Chapter Managers/Trustees or other officers audit the Chapter's books?:

Yes No

If not, please arrange such an audit or review with the appropriate Chapter officers.: