OFFICE OF THE SECRETARY OF STATE
VETERANS ORGANIZATION SOLICITOR'S REGISTRATION STATEMENT
_____New
_____Renewal
(Please print or type. Use additional sheets of paper if necessary)
1.
Name of solicitor:________________________________________________________________
Type of organization: (Corporation, unincorporated entity, partnership, etc.) ____________
_______________________________________________________________________________
Mailing Address: _______________________________________________________________
Telephone Number: (__________) __________________________
2.
Give the name, address, and telephone number of each veterans organization on whose
behalf you solicit or will solicit.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
3.
List all the other states in which you are registered as a solicitor and the status of those
registrations.
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
4.
Number of counties in which you solicit.
_________________________
5.
Have you, as a solicitor, ever forfeited a bond under this Act? ____________________
If so, how many? _____________________________ What was (were) the date(s) of
forfeiture? _________________________________________________________________
Executed this ______________ day of ___________________________, ___________.
___________________________________ ______________________________________
(Signature)
(Printed or Typed Name & Title)
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