Ss-6042 04/09 - Exemption Request - Tennessee Secretary Of State
Download a blank fillable Ss-6042 04/09 - Exemption Request - Tennessee Secretary Of State in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Ss-6042 04/09 - Exemption Request - Tennessee Secretary Of State with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Reset Form
Division of Charitable Solicitations and Gaming
For Office Use Only
Tre Hargett, Secretary of State
EXEMPTION REQUEST
WARNING: False or misleading statements subject to
maximum $5,000 civil penalty. T.C.A. §48-101-514
State of Tennessee
312 Rosa L. Parks Avenue, 8th Floor
Nashville, Tennessee 37243
615-741-2555
INSTRUCTIONS: Complete this form if your organization claims to be exempt from registration because it receives
less than $30,000 in gross contributions from the public. The principal officer of the organization must sign the form.
FEIN:
1. Name of Organization:
2. Physical Address: Street
City:
State:
Zip Code:
3. Mailing Address
: Street
City:
State:
Zip Code:
(if different)
Fax #: (
)
Email:
Phone #: (
)
4.
5. If you solicit contributions under any name(s) other than shown above, indicate names(s) below:
Name:
Name:
6. A. Legal entity of organization:
Corporation
Partnership
Association
Other
(specify)
B. When and where was the legal entity organized? Date:
City:
State:
7. If the organization is a corporation, attach the charter or similar document. If the organization is not a corporation,
attach a copy of the bylaws.
8. Is the organization recognized by the Internal Revenue Service as tax exempt?
Yes
No
(If yes, attach a copy of the determination letter)
9. Does the organization intend to solicit and receive more than $30,000 in gross contributions from the public during any
Yes
No
accounting year?
10. Has the organization received more than $30,000 in gross contributions from the public during any accounting year?
Yes
No
(Submit a copy of the IRS Form 990 from the most recently completed accounting year , or if a 990 is not
required to be filed with the IRS, complete the attached ”Summary of Financial Activities” form with the
financial information from the organization’s most recently completed accounting year.)
Note: You must register with the Secretary of State within thirty (30) days if gross contributions from
the public during any accounting year exceed thirty thousand dollars $30,000.
Signature
This document must be signed by an authorized officer. I certify that the statements in this registration statement and all
supplemental forms, documents, and continuation sheets are true and correct to the best of my knowledge and belief.
Signature of Owner/Authorized Officer:
Print Name:
Title:
Date:
SS-6042 (Rev. 04/09)
RDA 1742
ADVERTISEMENT
0 votes
Related Articles
Related forms
Tn Form Ss-4258 - Application For Motor Vehicle Temporary Lien - State Of Tennessee Secretary Of State
Legal
Form Ss-4512 - Appointment Of Tennessee Secretary Of State As Agent For Service Of Process For Nonresident Fiduciary Pursuant To Tca 35-50-507
Legal
Related Categories
Parent category: Legal