Chapter Name:

Chapter No.:

Chapter Chairman:

Phone No.:

Address:

City, State Zip:

Email Address:

1.

OPENING BALANCE (including cash on hand) as of June 1, 20___

2.

Income:

A.

Member’s Contributions (including Dues):

B.

Grants Received (Donations for Specific Purpose)

C.

Gifts Received (Donations with No Strings Attached)

D.

Other Income (Interest, etc.).  Please specify)

3.

TOTAL INCOME [Add lines A through D]:

4.

TOTAL ASSETS [Add lines 1 and 3]:

5.

Expenses:

E.

Dues Submitted to AGTS-DV

F.

Money Submitted to AGTS-DV for Meetings & Events

G.

Chapter Meeting & Event Costs (includes Food, Rental Fees & Event Admission Fees)

H.

Operating Expenses (includes Office Supplies, Photocopying, Postage, Tape for Portfolios, etc.)

I.

Educational Materials (includes Art Posters, Books & Magazines kept by the Chapter)

J.

Donations (to Schools, etc.). Please specify:

K.

Other Expenses (Bank Fees, etc.). Please specify.

6.

TOTAL EXPENSES [Add lines E through K]:

7.

ENDING BALANCE (including cash on hand) as of May 31, 20___.
[Subtract Line 6 from Line 4]:

Preparer’s name (print):

Phone No.:

Preparer’s Signature:

Date Signed: