CARBOOT SALE – RETURNS FORM

1	Name of the Applicant: ………………………………………………………………………………….
2	Address of the Applicant: ………………………………………………………………………………..
………………………………………………………………………………………………………………
Post Code: ……………………………………… Tel No: ……………...………………………………
3	Name of charity or fund which is to benefit: …………………………………………………………..
4	Date of Event: . …………………………………………………………………………………………..

SHOW NIL ENTRIES

Proceeds of 
Collection	
Amount	
Total	Expenses & Application of Proceeds	
Amount	
Total	

From Event:

Interest on proceeds

Other items:-	£	£	

Printing & Stationery
Postage
Advertising

Staff
Hiring Facilities
Other items:-

	£	£	
TOTAL
			TOTAL			

Certificate of the person to whom the permit was granted  
I certify that to the best of my knowledge and belief the above is a true account of the proceeds, expenses and application of the proceeds of the collection.

Certificate of the Accountant or Independent Responsible Person  
I certify that I have obtained all the information and explanations required by me and that the above is in my opinion a true account of the proceeds, expenses and application of the proceeds of the collection.

Signed: ……………………………………………………………………………… Date: ………………….

Qualifications: …………………………………………………………………………………………………….

This application should be returned to: Kirklees Council, Licensing Department, Flint Street Depot, Flint Street, Fartown, Huddersfield, HD1 6LG. Tel: 01484 456868

Personal Data

We have recently updated our Privacy Notice about how we use personal data provided to the Council. Further information can be found at:
http://www.kirklees.gov.uk/beta/information-and-data/pdf/privacy-notice-other-licenses.pdf