Charitable Organizations Application Form printable pdf download

Charitable Organizations Application Form

STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS

DEPARTMENT OF BUSINESS REGULATION

SECURITIES DIVISION

CHARITABLE ORGANIZATIONS SECTION

233 RICHMOND STREET, SUITE 232

PROVIDENCE, RI 02903-4232

Charitable Organizations Application

_____ RENEWAL APPLICATION

_______ INITIAL APPLICATION

Include copy of IRS determination letter

Filing Fee $75.00

EIN #_______________________

A charitable organization having annual gross income of more than five hundred

thousand dollars ($500,000) shall file with the Director an audited financial statement

prepared by an independent certified public accountant. Organizations having annual

gross income less that $500,000 shall submit a copy of Form 990 or a compiled financial

statement for the immediate preceding fiscal year. The applicant does not have to submit

a financial statement if a written extension request is submitted to the Division in

accordance with 5-53.1-4(i) of the Solicitations by Charitable Organizations Act. Items

18(a) and 19 do not have to be completed if an extension is requested and such

information is later submitted with the financial information.

Please also note: Charitable organizations must notify the director within 30 days of any

material change in the information provided.

Attach additional sheets if necessary.

A charitable organization is deemed to have met the filing requirements below by

submitting a copy or duplicate original of Form 990; provided, however, that such

organization responds to items numbered 1 through 5, 14 through 18, and 20 below:

Organization’s name: ________________________________________________

Organization’s principal address and phone number(s):

_________________________________________________________

__________________________________________________________________

Contact person and mailing address:

__________________________________________________________________

__________________________________________________________

Charitable Organizations Application Form