This report must be filed by 15 FEB of each year. Complete both sheets. BALANCE SHEET for Fiscal year from 1 JAN ____ to 31 DEC ____ . ASSETS Beginning Year Ending Year 1. Cash $ $ 2. Accounts Receivable $ $ (money owed to you) 3. Equipment $ $ 4. Inventory $ $ 5. Other (attach schedule) $ $ 6. TOTAL ASSETS $ $ LIABILITIES Beginning Year Ending Year 7. Accounts Payable $ $ (money you owe) 8. Loans $ $ 9. Other (attach schedule) $ $ 10.TOTAL LIABILITIES $ $ 11.Assets minus Liabilities $ $ (subtract line 10 from line 6) 12.Prior year Net Worth $ (Transfer from line 11 Beginning Year) 13.Change in Net Worth $ (Subtract line 12 from line 11) ------------------------ INCOME STATEMENT for ___________________________________ (chapter name) Fiscal year from 1 JAN ____ to 31 DEC ____ . INCOME Amount 14. Contributions $ 15. Rebates from NSS HQ $ 16. Membership Dues $ 17. Interest $ 18. Special fundraising events (attach schedule) Gross Revenue $ minus direct expense $ Net Income (or Loss) $ 19. Merchandise sales (attach schedule) Gross Revenue $ minus direct expense $ Net Income (or Loss) $ 20. Other (attach schedule) $ 21. TOTAL REVENUES $ EXPENSES Amount 22. Supplies (administrative & bank), used $ 23. Telephone (administrative) $ 24. Postage and Shipping (administrative) $ 25. Occupancy (Rent and Utilities, mail box) $ 26. Other (attach schedule) $ 27. TOTAL EXPENSES $ 28. Income minus Expenses (subtract line 27 from line 21) $ Line 28 must be equal to line 13 or else there is an error.