Tootsie Roll Order Form

Complete this form and mail checks to the Tootsie Roll Chairman, Kyle Christensen:

Kyle Christensen, Tootsie Roll Chairman

508 Kia Drive

Hartford, SD 57033

605-759-0698

[email protected]

Council Name: *

Council Number: *

Council Point of Contact Name *

First

Last

Phone

Email *

Council Point of Contact Address *

Address Line 1

Address Line 2

City

State

Zip Code

How many cases of Tootsie Rolls do you want to order for the coming year? *

PART 1: Calculation of Amount Available to Local Council from the Drive

Total amount collected during your local drive: *

(Draft a check for this amount to South Dakota State Council and mail it to Kyle Christensen 508 Kia Drive Hartford, SD 57033.)

Number of cases of Tootsie Rolls purchased by your council this year: *

Total cost to council for Tootsie Rolls

(one case is $23)

Net amount of local drive after deducting costs:

Local council's 80% share available to divide for local donations:

(The amount your council may distribute between recipients).

State council's 20% share:

PART 2: Local donation(s) made by dividing local council's 80% share amount the following recipients:

or of Amount

RECIPIENT #1: Name of person(s) or organization receiving donations:

RECIPIENT #1: Amount of donation:

(round to the nearest dollar)

RECIPIENT #2: Name of person(s) or organization receiving donations:

RECIPIENT #2: Amount of donation:

(round to the nearest dollar)

RECIPIENT #3: Name of person(s) or organization receiving donations:

RECIPIENT #3: Amount of donation:

(round to the nearest dollar)

RECIPIENT #4: Name of person(s) or organization receiving donations:

RECIPIENT #4: Amount of donation

(round to the nearest dollar)

RECIPIENT #5: Name of person(s) or organization receiving donations:

RECIPIENT #5: Amount of donation:

(round to the nearest dollar)

RECIPIENT #6: Name of person(s) or organization receiving donations:

RECIPIENT #6: Amount of donation:

(round to the nearest dollar)

RECIPIENT #7: Name of person(s) or organization receiving donations:

RECIPIENT #7: Amount of donation:

(round to the nearest dollar)

RECIPIENT #8: Name of person(s) or organization receiving donations:

RECIPIENT #8: Amount of donation:

(round to the nearest dollar)

RECIPIENT #9: Name of person(s) or organization receiving donations:

RECIPIENT #9: Amount of donation:

(round to the nearest dollar)

RECIPIENT #10: Name of person(s) or organization receiving donations:

RECIPIENT #10: Amount of donation:

(round to the nearest dollar)

PART 1: Calculation of Amount Available to Local Council from the Drive

PART 2: Local donation(s) made by dividing local council's 80% share amount the following recipients:

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