Form LE-21 Schedule A "Distribution of Proceeds" - Colorado

What Is Form LE-21 Schedule A?

This is a legal form that was released by the Colorado Department of State - a government authority operating within Colorado. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 14, 2011;
  • The latest edition provided by the Colorado Department of State;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form LE-21 Schedule A by clicking the link below or browse more documents and templates provided by the Colorado Department of State.

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Download Form LE-21 Schedule A "Distribution of Proceeds" - Colorado

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State of Colorado
Quarter:
License No.:
Licensing & Enforcement Division
SCHEDULE A: LE-21 - Distribution of Proceeds
Organization:
a
b
c
Date
Purpose for which funds were spent. Be
(mm/dd/yyyy)
Check #
Amount
Payee individual or organization
specific.
Subtotal this
page
$
LE-21sa
page 1 of 3
Rev. 1/14/2011
State of Colorado
Quarter:
License No.:
Licensing & Enforcement Division
SCHEDULE A: LE-21 - Distribution of Proceeds
Organization:
a
b
c
Date
Purpose for which funds were spent. Be
(mm/dd/yyyy)
Check #
Amount
Payee individual or organization
specific.
Subtotal this
page
$
LE-21sa
page 1 of 3
Rev. 1/14/2011
State of Colorado
Quarter:
Licensing & Enforcement Division
License No.:
SCHEDULE A: LE-21 - Distribution of Proceeds
Organization:
Page 2
a
b
c
Date
Purpose for which funds were spent. Be
(mm/dd/yyyy)
Check #
Amount
Payee individual or organization
specific.
Subtotal this
page
$
LE-21sa
page 2 of 3
Rev. 1/14/2011
State of Colorado
Quarter:
Licensing & Enforcement Division
License No.:
SCHEDULE A: LE-21 - Distribution of Proceeds
Organization:
Page 3
a
b
c
Date
Purpose for which funds were spent. Be
(mm/dd/yyyy)
Check #
Amount
Payee individual or organization
specific.
Subtotal this
page
$
Total Sched A
$
LE-21sa
page 3 of 3
Rev. 1/14/2011
Instructions for LE-21 Schedule A Distribution of Proceeds
This schedule records all expenditures made by the licensee in the quarter.
For each expenditure:
Column a: Enter the date that the expenditure was made.
Column b: Enter the number of the withdrawal slip or the check number (must be in consecutive order) of the
expenditure or by electronic transactions referenced by transaction number or date.
Column c: Enter the amount of the expenditure.
Column d: Give the name of the organization or individual receiving the funds.
Column e: List the purpose for which the funds were spent. Expenditures must comply with the authorized
use of the funds in both the statute and the licensee's organizational documents.
Note: Net proceeds must be used within one year of receipt. If the licensee wishes to hold the proceeds for
more than one year, it may apply to the Secretary of State for permission. If good cause is shown, the Secretary
of State may grant the request.
Example:
During the current quarter, your organization wrote six checks. The checks were:
$ 250 to Joe's Place for bingo rent on January 1;
$ 100 to Red Cross as a contribution for flood relief on January 2;
$ 300 to Printing Co. for raffle tickets on January 8;
$ 150 to T's Inc for Little League jerseys on January 9;
$ 40 to 1234 Accounting on January 11; and
$ 45 to XYZ Guards for bingo security on January 15.
On the Schedule A of the LE-21, you need to give the date, amount, the withdrawal slip or check number, the
name of the person or organization receiving the funds, and the purpose of the expense. Therefore, your
Schedule A would have the following lines:
1/1/06
#1001
$250
Joe's Place
Bingo Hall Rent
1/2/06
#1002
$100
Red Cross
Contribution-Flood Relief
1/8/06
#1003
$300
Printing Co.
Raffle Ticket Printing
1/9/06
#1004
$150
T's Inc.
Little League jerseys
1/11/06 #1005
$40
1234 Accounting
Bingo Bookkeeping
1/15/06 #1006
$45
XYZ Guards
Bingo Security
LE-21sa_HELP
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Rev. 11/3/2014
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