Spreadsheet: 36e538ac-746b-4c30-951e-f70d6c7d4c19
Sheet: Sheet1

 |  |  |  |  |  |  |  |  |  |  | Please select from Drop Down List:
 |  |  |  |  |  |  |  |  |  |  | 101 Arlington
 |  |  |  | Outstanding Cookie Balance Form |  |  |  |  |  |  | 102 East Fishkill
 |  |  |  |  |  |  |  |  |  |  | 103 Fishkill
 |  |  |  |  |  |  |  |  |  |  | 104 Harlem Valley
1. Submit a separate form for each girl/guardian who has any amount unpaid by May 30th. |  |  |  |  |  |  |  |  |  |  | 105 Hyde Park
2. Complete all information, including the amount that was originally owed and any amount paid. |  |  |  |  |  |  |  |  |  |  | 106 Millbrook
3. Attach signed parent permission form |  |  |  |  |  |  |  |  |  |  | 107 New Oaks
4. Submit to Council Finance (email: [EMAIL] or fax: [PHONE]) by June 13th to qualify for  payment adjustment |  |  |  |  |  |  |  |  |  |  | 108 Northern Dutchess
5. Do not use troop proceeds to cover outstanding balances |  |  |  |  |  |  |  |  |  |  | 109 Pawling
 |  |  |  |  |  |  |  |  |  |  | 110 Pleasant Valley
 |  |  |  |  |  |  |  |  |  |  | 112 Spackenkill
 |  |  |  |  |  |  |  |  |  |  | 113 Sylvan Hills
Service Unit |  |  |  |  | Troop Cookie Manager Name |  |  |  |  |  | 114 Tioronda
 |  |  |  |  |  |  |  |  |  |  | 115 Wappinger's
Troop Number |  |  |  |  | Address |  |  |  |  |  | 208 Pine Bush
 |  |  |  |  |  |  |  |  |  |  | 209 Port Jervis
 |  |  |  |  | City, State |  |  |  | Zip |  | 211 Minisink
 |  |  |  |  |  |  |  |  |  |  | 212 Goshen [NAME]
 |  |  |  |  | Day Phone: |  |  |  |  |  | 213 Middletown
 |  |  |  |  |  |  |  |  |  |  | 215 Montgomery/Marion Wilde
Troop Leader |  |  |  |  |  |  |  |  |  |  | 216 [NAME]
 |  |  |  |  | Evening Phone: |  |  |  |  |  | 218 New Windsor
Home Phone: |  |  |  |  |  |  |  |  |  |  | 219 Cornwall
 |  |  |  |  | Cell Phone: |  |  |  |  |  | 221 [NAME]
Cell Phone: |  |  |  |  |  |  |  |  |  |  | 222 West Point
 |  |  |  |  | email address |  |  |  |  |  | 223 [NAME]
email address |  |  |  |  |  |  |  |  |  |  | 224 Woodbury
 |  |  |  |  |  |  |  |  |  |  | 225 Washingtonville
 |  |  |  |  |  |  |  |  |  |  | 226 [NAME]
 |  |  |  |  |  |  |  |  |  |  | 227 Greenwood Lake
Name of [NAME] with money still due |  |  |  |  |  |  |  |  |  |  | [NAME]
 |  |  |  |  |  |  |  |  |  |  | 323 Hudson Highlands
Parent/Guardian name |  |  |  |  |  |  |  |  |  |  | 402 Minisceongo/Central Haverstraw
 |  |  |  |  |  |  |  |  |  |  | 403 Stony Point
Address |  |  |  |  |  |  |  |  |  |  | 404 Airmont
 |  |  |  |  |  |  |  |  |  |  | 405 Suffern
City/ZIP |  |  |  |  |  |  |  |  |  |  | 409 Hempstead/Hillcrest
 |  |  |  |  |  |  |  |  |  |  | 410 Congers
Phone: |  |  | Cell Phone: |  |  |  |  |  |  |  | 411 [NAME]
 |  |  |  |  |  |  |  |  |  |  | 412 Germonds
[NAME]: |  |  |  |  |  |  |  |  |  |  | 413 Little Tor/Woodglen
 |  |  |  |  |  |  |  |  |  |  | 414 West Nyack
 |  |  |  |  |  |  |  |  |  |  | 415 Nanuet
 |  |  |  |  |  |  |  |  |  |  | 416 Pearl River
 | Total boxes sold by girl |  |  |  |  |  |  |  |  |  | 417 Nyack/Valley Cottage
 |  |  |  |  |  |  |  |  |  |  | 418 [NAME]
 | x $4.00 per box (total owed) |  |  |  |  |  |  |  |  |  | 502 Liberty
 |  |  |  |  |  |  |  |  |  |  | 503 [NAME]
 | Less any payment received on behalf of girl |  |  |  |  |  |  |  |  |  | 531 Highland Lake/Eldred
 |  |  |  |  |  |  |  |  |  |  | 532 Monticello
 | Amount still due Council (balance due) |  |  |  |  |  |  |  |  |  | 533 Jeffersonville/Callicoon
 |  |  |  |  |  |  |  |  |  |  | 601 Rivers Edge
 |  |  |  |  |  |  |  |  |  |  | 602 Wawarsing
Contact made by Troop Cookie Manager: |  |  |  |  |  |  |  |  |  |  | 603 Ashokan
 |  |  |  |  |  |  |  |  |  |  | 605 Sojourner Truth
Date | Type of Contact |  |  | Notes |  |  |  |  |  |  | 606 Kingston
 |  |  |  |  |  |  |  |  |  |  | 608 Apple Valley
 |  |  |  |  |  |  |  |  |  |  | 609 Misty Mountain
 |  |  |  |  |  |  |  |  |  |  | 611 Saugerties
 |  |  |  |  |  |  |  |  |  |  | 612 Wendy's
 |  |  |  |  |  |  |  |  |  |  | 616 Rondout Valley
 |  |  |  |  |  |  |  |  |  |  | 701 Bedford/Byram Hills
 |  |  |  |  |  |  |  |  |  |  | 703 Lakeland East
 |  |  |  |  |  |  |  |  |  |  | 704 Chappaqua
I understand that in submitting this report, I am relieved of the responsibility of collection of this account. |  |  |  |  |  |  |  |  |  |  | 705 West Lakeland
The outstanding amount is now the property and responsibility of [NAME] of the Hudson. |  |  |  |  |  |  |  |  |  |  | [NAME]
I will direct any subsequent payments received to Council Finance in the Pleasantville Regional Office. |  |  |  |  |  |  |  |  |  |  | 710 North Salem
 |  |  |  |  |  |  |  |  |  |  | 712 Pleasantville
 |  |  |  |  |  |  |  |  |  |  | 713 Mt. Pleasant
Signature |  |  |  |  |  | Date |  |  |  |  | 714 [NAME]
 |  |  |  |  |  |  |  |  |  |  | 715 Briarcliff/Pocantico
Report completed By: |  |  |  |  |  |  |  |  |  |  | 716 Croton
 |  |  |  |  |  |  |  |  |  |  | 717 Kings Ferry
Please submit via email to [EMAIL] or via fax to [PHONE]. |  |  |  |  |  |  |  |  |  |  | 718 Ossining
 |  |  |  |  |  |  |  |  |  |  | 719 Tarrytown
 |  |  |  |  |  |  |  |  |  |  | 722 Peekskill
 |  |  |  |  |  |  |  |  |  |  | 724 [NAME]
 |  |  |  |  |  |  |  |  |  |  | 725 Yorktown
 |  |  |  |  |  |  |  |  |  |  | 726 Bronxville
 |  |  |  |  |  |  |  |  |  |  | 727 Tuckahoe/Eastchester
 |  |  |  |  |  |  |  |  |  |  | 730 Mount Vernon
 |  |  |  |  |  |  |  |  |  |  | 731 [NAME]
 |  |  |  |  |  |  |  |  |  |  | 733 Ardsley
 |  |  |  |  |  |  |  |  |  |  | 734 Dobbs [NAME]
 |  |  |  |  |  |  |  |  |  |  | 735 [NAME]
 |  |  |  |  |  |  |  |  |  |  | 736 Irvington
 |  |  |  |  |  |  |  |  |  |  | 738 NE Yonkers
 |  |  |  |  |  |  |  |  |  |  | 739 NW Yonkers
 |  |  |  |  |  |  |  |  |  |  | 740 SE Yonkers
 |  |  |  |  |  |  |  |  |  |  | 741 SW Yonkers
 |  |  |  |  |  |  |  |  |  |  | 746 Larchmont Mamaroneck
 |  |  |  |  |  |  |  |  |  |  | 748 New Rochelle
 |  |  |  |  |  |  |  |  |  |  | 750 [NAME]
 |  |  |  |  |  |  |  |  |  |  | 751 Port Chester/Rye Brook
 |  |  |  |  |  |  |  |  |  |  | 753 Rye
 |  |  |  |  |  |  |  |  |  |  | 754 Greenburgh/Elmsford
 |  |  |  |  |  |  |  |  |  |  | [NAME]
 |  |  |  |  |  |  |  |  |  |  | 759 White Plains