Application For Exemption From Registration - Secretary Of State Page 2
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1
2State 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
charities@sos.sc.gov
Charity CFO
CFO’s Name: _____________________________________________ Telephone Number: (______)______________________
CFO’s Mailing Address: ___________________________________________________________________________________
City ________________________________________________________________State ________ Zip ___________________
Charity Category and Purpose
Complete either Section 1 or Section 2 below which describes both the charity’s category and the purpose of the charity’s solicited donations.
Section 1: Enter up to three NTEE (National Taxonomy of Exempt Entities) Codes here:
____ ____ ____ ____ , ____ ____ ____ ____ , ____ ____ ____ ____
____ ____ ____ ____ , ____ ____ ____ ____ , ____ ____ ____ ____
Section 2: Check up to three boxes below that best describe your organization:
A. Arts, Culture, Humanities
L. Housing, Shelter
T. Philanthropy, Volunteerism,
(inc. historical)
(inc. senior citizen housing)
Grant-making (inc. foundations)
B. Educational Institutions
M. Public Safety, Disaster
U. Science and Technology
(inc. literacy)
Preparedness and Relief
Research Institutes
C. Environment, Beautification
(inc. rescue squads, auto safety)
(inc. computer science, engineering)
(inc. gardening, outdoor education)
N. Recreation, Sports, Leisure,
V. Social Sciences Institutes
D. Animal-Related
Athletics
(inc. institutes for studies on population,
(inc. wildlife sanctuaries)
(inc. social clubs, Special Olympics)
minorities and economics)
E. Health-General, Rehabilitative
O. Youth Development
W. Public Affairs, Society Benefit
(inc. nursing, family planning)
P. Human Services
(inc. citizen participation, con-
F. Mental Health, Crisis Intervention
(inc. thrift stores, YMCAs and YWCAs,
sumer protection, veterans'
(inc. alcoholism, services for rape and abuse
hearing- or sight-impaired orgs.)
orgs., leadership development)
victims)
Q. International, Foreign Affairs,
X. Religion, Spiritual Development
G. Disease, Disorders, Medical Disciplines
National Security (inc. cultural
(inc. religious broadcasters and
interfaith coalitions)
H. Medical Research
exchange)
I. Crime, Legal-Related
R. Civil Rights, Social Action,
Y. Mutual / Membership Benefit
(inc. fraternal organizations,
(inc. prevention of abuse, delinquency)
Advocacy (inc. right to life and
cemeteries)
J. Employment, Job-Related
right to die, reproductive rights)
(inc. voc. rehabilitation, unions)
S. Community Improvement,
Z. Unknown, Other
Please Specify:
K. Agriculture, Food, Nutrition
Capacity Building
(inc. livestock breeding)
(inc. neighborhood associations,
service clubs, bus. development)
___________________________
CERTIFICATION
I certify that the information furnished in this application and all attached supplementary information is true and correct to the best of
my knowledge, information and belief. I understand the giving of false or incorrect information may constitute a misdemeanor carrying a
penalty upon conviction, for a first offense of not more than two thousand dollars or imprisonment for not more than one year, or both.
A second, or subsequent offense is a felony and upon conviction must be fined not more than five thousand dollars or imprisoned not
more than five years, or both.
Chief Executive Officer:
Chief Financial Officer:
Signature
Signature
Print Name
Print Name
Date
Date
Exemption Form (Revised May 2009)
Page 2 of 2
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Parent category: Financial