Application For Exemption From Registration - Secretary Of State

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State of South Carolina
Post Office Box 11350
Telephone: (803) 734-1790
Office of the Secretary of State
Columbia, SC 29211
Fax: (803) 734-1604
Division of Public Charities
Check one:
[ ] Initial Registration
[ ] Renewal
Charity Public ID: _______________________________
Employer’s Identification Number: __ __ -- __ __ __ __ __ __ __
Organization’s Website: ____________________________
Organization's Legal Name _________________________________________________________________________________
Doing Business As (DBA) Names ___________________________________________________________________________
Former Names used by the Charity ___________________________________________________________________________
Demographic Details
Current Fiscal Year End Date (Month/Day/Year):_________________________
Basis for exemption according to the Solicitation of Charitable Funds Act (S.C. Code of Laws §33-56-10 et seq.), check ONE of
the following:
_____ (1) Educational Institution (Schools, colleges, universities, and the foundations of South Carolina colleges and universities)
_____ (2) Solicitation for the relief of a specified individual
_____ (3) Organizations which do not intend to solicit in excess of $20,000 in a calendar year and have a letter of tax exemption
from the IRS, if all of their functions including fundraising activities are conducted by persons who are compensated no
more than $500 annually for their services. (Please attach IRS tax letter.)
_____ (4) Organization which solicits exclusively from within its own membership, including utility cooperatives
_____ (5) Veterans organization which has a congressional charter
_____ (6) The State, its political subdivisions, and any agencies or departments thereof which are subject to the disclosure
provisions of the Freedom of Information Act
_____ (7) Organizations which do not intend to solicit more than $7,500 in a calendar year, regardless of whether or not the
solicitation is conducted by professionals
Charity Physical Address
Organization’s Street Address _______________________________________________________________________________
City ________________________________________________________________State ________ Zip ___________________
Charity Contact Information
Contact Person’s Name __________________________________________ Title _____________________________________
Contact Person’s Mailing Address ____________________________________________________________________________
City ________________________________________________________________State ________ Zip ___________________
Telephone (Daytime) (______)________________________________ Fax (_______) _________________________________
Contact Person’s E-mail
Charity CEO
CEO’s Name: _____________________________________________ Telephone Number: (______)______________________
CEO’s Mailing Address: ___________________________________________________________________________________
City ________________________________________________________________State ________ Zip ___________________
Exemption Form (Revised May 2009)
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