DID YOU COLLECT MONEY
FOR NEWSPAPERS? OR SELL A BOOK?

Do you have money to turn in to SCLC?

Complete and “submit” the form below.
Mail a check for the amount your are turning in, made payable SOUTH COAST LITERACY COUNCIL, to
SOUTH COAST LITERACY COUNCIL
23615 EL TORO ROAD, STE X, # 422
LAKE FOREST CA 92630-4707

Your Name

First Name

Last Name

State your Center Name or your Board position

I have mailed or am mailing a check made payable to South Coast Literacy Council to 23615 EL TORO ROAD, STE X, # 422, LAKE FOREST CA 92630-4707

YES

NO [IF "NO", EXPLAIN IN THE "EXPLANATION" BOX BELOW.]

Explanation

Use this space to explain any special circumstances

The money I collected, which I am sending to SCLC, is for:

Check all that apply.

NEWSPAPER SALES

BOOK SALES

BOTH NEWSPAPER AND BOOK SALES

OTHER [IF "OTHER", EXPLAIN IN THE "OTHER FUNDS" BOX BELOW.]

Other Funds

Use this space to explain if any funds are other than newspaper or book sales.

Amount ( $ ) of newspaper sales

Put the dollar amount of newspaper sales here.

Amount ( $ ) of book sales

Put the dollar amount of book sales here.

Amount ( $ ) of "Other Funds"

Put any other money you are sending in here.

The total amount ( $ ) of money I am mailing to SCLC at 23615 EL TORO ROAD, STE X, # 422, LAKE FOREST CA 92630-4707 is:

Use the space below to include any other information SCLC's accountant will need to properly credit these funds.