Member completing this form:§
Name: __________________________________§
Address: __________________________________
§
Beneficiary organization:§
Name: __________________________________§
Address: __________________________________
§
1. Regular Gross Income§
Your salary (before any taxes are deducted) plus interest and dividend income from bank accounts and investments§
1. ____________§
2. Business Income§
a. The amount of funds drawn out of the business during this period
(line 2 of your Business Tithing Reconciliation) if applicable§
2a. ____________§
b. Cumulative net profit less drawings (line 4 of your Business Tithing
Reconciliation) if applicable§
2b. ____________§
3. Special Income§
Such as inheritance or cash gifts at birthdays or other times§
3. ____________§
4. Capital Gains 4.§
Gains on investments, the sale of a house, car or other possessions (For example, on a house sale the tithe is 10% of the difference between your sales price and the original price—this is referred to as the “capital gain.”)§
4. ____________§
5. Total Income§
Add together lines 1, 2(a), 2(b), 3 and 4 and enter the total here.§
5. ____________§
6. Tithe Due§
Divide the amount on line 5 by 10 and enter it here. This is the amount
of tithe due on your income for this period.§
6. ____________§
7. Previous Overpaid Tithing§
Enter the amount of any tithe overpaid from last year here.§
7. ____________§
8. Tithe Paid§
List the tithe you actually paid on the current period’s income here.§
8. ____________§
9. Total Underpaid (or Overpaid)§
Subtract lines 7 and 8 from line 6 and enter the amount here. Place the number in parentheses if it is a negative number and you have overpaid.§
Check one box below.§
☐ Line 9 is zero (0) and shows my tithe due and the tithe paid to the organization are equal.§
☐ Line 9 shows my tithe paid exceeds the tithe due by the amount shown. Please carry this forward to the next reconciliation.§
☐ Line 9 shows my tithe is underpaid. I am enclosing the underpaid tithing.§
Signature:___________
Date:_______________
§
I took my daśama bhāga vrata on (date): ________________________________§
Note: Please make one copy of your completed form for your records and send the original to the beneficiary organization.§