Affidavit and Revenue CerUfication. Parish M^ixJDrWAA^LA City, State

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Gwenda Skinner
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1 / Affidvit nd Revene erufit TsrYi V./J i r\f-fvas Prish MixJDrWAALA ity, Stte NTITY NAM ANNUAL SWRN FINANIAL STATMNTS AND RTIFIATIN F RVNUS $5, R LSS (if pplible) The nnl sw fnil stteents re reqired by Lisin Revised Stte 4:54 t be filed with the Legisltive Aditr with 9 dys fter the lse f the fisl yer The ertifit f revenes $5, r less, if pplible, is reqired by Lisin Revised Stte 4:5(l)()()(i). Persnlly e nd ppered befre the ndersigned thrity, feeuil (ffier's ne), wh, dly swrn rn, depses nd sjrs tht the fni) stteents herewith given present firiy the \f\e f: fipnil psit ftsuikyx.(entity ne) s f iji l I \Q (enter entity's yer end dte), nd the reslts f perts fr the yer then ended, rdne with the bsis f ntg desribed with the pnyg fnil stteents. (plete if pplible): In ddit. \lf \\, (ffier's ne), wh, dly sw, depses nd sys tht ij/vw.\jsk\j \n (entity ne) reeived $5, r less revenes nd ther sres fr the yer ended \'\ \\ (enter entity's yer end dte), nd nlgly, is nt reqired t hve n dit fr the previsly ented yer. ( ffier Signre Sw t nd sbsribed befre e this,u. Jill M. Grieshber, sq. Lisin Br #745 My iss expires pn y deth. imssksd' ************************************************************ Ne Title Underprvlss f stte lw, this reprt Is pbli dent, Apy f the reprt hs bbjii sbitted t the entity nd ther pprprite pbli ffiils. The reprt is vilble fr pbli spet t the Btn Rge ffie fthe Legisltive Aditr nd, where pprpnte, t the ffie f te pqrish lerk f rt. Relese Dte '

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3 Stteent A \Sy('rr\i PJP \\\\l Blne Sheet, n (entity's yer end dte) (Ageny Ne) ASSTS (blnes t end f yer) -Give brief desript: Generl ther Fnd Fnd Ttl lg.$ $h.. sh nd sh eqivlents n hnd. Investents (fir vle) n hnd. ffie frnishgs (st f desks, et) _ 4. qipent (st f fx he, et) '" 5. ther (desribe) --' - 6. Ttl Assets (dd les 5) $ g "Kdi $ $. WynT- UABILITIS AND FUND BALAN (blnes t end f yer): Libilities (give brief desript): 7: $ g i G i.. Ttl Libilities (dd les 7-) Q. Fnd blne (nt fr Le 6 n Stteent B) \/yi*j. I iq/.ql. ther.5?.. Q 4. Ttl Libilities nd Fnd Blne (dd les -) $_[fl'a $ -tp $\'?(. Nte: Le 6 (Ttl Assets) shld el Le 4 (Ttl Libiiitfes nd Fnd Bine)

4 stteent B \S)U\rtrViv iixt/n \ A(\ (AgenyNe) Stteent f sh Reeipts nd Disbrseents Fr the Yer nded \b\ \\ (entity's yer end dte) Generl ther Fnd Fnd Ttl RIPTS (Prvide Brief Desript f ll nies reeived): 5, 6. Ttl reeipts (dd les - 5) $ M''. $ H %il% DISBURSMNTS (Prvide Brief Desript f expendires de): 7.MntrAxnf.Wf-Vs\(V.;pA.f,V) $lqi/.5r$ $,9-. Ttl Disbrseents (dd les 7 -) $\l U?r.Db $ & $ K.ZS.Q 4. Inrese (r derese) fnd blne, - (Le6 s le ) S-Q.iW $ %-i \\, 5. Fnd Blne t begng f yer * -id / 5 s-i,' / (ndg Fnd blne fr lst yer's reprt) TQ'J riq 6. Fnd blne (r defiit) t end f yer (Add les 4-5). - -This nt ls ges n le. Stteent A $ \ " '. $ IJ %\%?i'g

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6 J N.' - i f - /» & i n i n M T - * - T - T - I A, rtk M, LA, LA / rfj JJ* J A f S, A, A, JJ* A, JJ\ J J A WT WT WT *ry WT WT WT WT WT trt WT WT WT WT *9 VT "T JZ I i-«-md»jrf'(-i» T-T--*-T-! SI s-g S PV ) k. z ( b. z D Z t "5.. t; - t i g i= l- t i d). - ) J P Si i: 5 er ve er/hr. er/hr i er ve er ve er ve il dire - ( - - " - S i H «fhr. ve ve TJ - v= ) is - w ) ffl Mst n Fr n Fr Vltz! ( t, : i: (U ) _ -Q - - *-» * j J (U (U ) ) I I is B i 4 U lit: -9 S sl _ ID Mr - t U. t k. T - ) M M h - M M D t-f-

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Affidavit and Revenue Certification Chimp Haven, Inc. Caddo Parish Keithville, LA

Affidavit and Revenue Certification Chimp Haven, Inc. Caddo Parish Keithville, LA / / / / Affivit Revee Certifiti Chi Hve, I. C Prih Keithville, LA ANNAL WRN FINANCL TATNT AND CRTIFICATIN F RN $0,0 R L (if lible) The l wr fiil tteet re reqire by Lii Revie ttte 24:14 t be file with the