Supplement To Unified Registration Statement

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State of Utah
DEPARTMENT OF COMMERCE
DIVISION OF CONSUMER PROTECTION
SUPPLEMENT TO
UNIFIED REGISTRATION STATEMENT
OFFICE USE ONLY
(To be used only when the Unified Registration Statement is filed in place of the
Charitable Organization Permit Application Form)
Date Issued: ______________________
Permit Number: __________________
Annual Application fee: $75.00 (Non-refundable)
Approved: _______________________
______________________________________________
Exempt: _________________________
Name of Charitable Organization
Denied: __________________________
Expiration: _______________________
______________________________________________
Percentage of total contributions that
Date of Application
are available for the charitable
purpose:__________________________
Please mark the appropriate box:
[ ] INITIAL
[ ] RENEWAL
APPLICATION
APPLICATION
If you have any questions, please contact the Division at (801) 530-6601.
Please make application fee check or money order payable to the State of Utah.
Please return the completed application form and check or money order to:
Department of Commerce
Division of Consumer Protection
160 East 300 South
Box 146704
Salt Lake City, Utah 84114-6704
NOTE: The Charitable Solicitation permit will expire annually on the earlier of January 1, April
1, July 1, or October 1 following the completion of 12 months after the date of initial issuance.
April 2010
1

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