Annual Financial Report Of Charitable Organization Form - 2011 Page 4
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Part 4 Solicitation of Contributions
Yes
No
1 a.
Did the organization solicit contributions from the general public?
b. Please indicate the amount of contributions received from persons in Ohio.
$ __________
c. For National Organizations or soliciting organizations not located in the State of Ohio, please indicate the
amount of distributions to Ohio recipients.
$ __________
2
Did the organization use the services of a fund-raising counsel, professional solicitor, commercial co-venturer or other
charitable organization to solicit contributions?
If "Yes", complete the following information including the amount of funds received from each. Attach additional
pages, if necessary.
Name
Address
Funds received
Part 5 General Information
Yes
No
1
Were any changes made in the governing documents of the organization?
If "Yes", attach a copy of the new document.
2
Were any changes made to the information contained on the organization's registration statement on file with the
Attorney General?
If "Yes", attach a schedule of the changes.
3
Provide the following information for the location where the organization's books and records are maintained.
Name
Address
Telephone No.
Part 6 Certification by Organization
I certify that I have examined this financial report, including accompanying attachments, and to the best of my knowledge
and belief, it is true, correct, and complete.
Signature of officer
Date
Printed name
Title
Telephone No.
Direct correspondence to the following address (include the organization's state registration number):
Charitable Law Section
Office 614.466.3181
Fax 614.466.9788
150 East Gay Street, 23rd Floor
Columbus, Ohio 43215-3130
(revised 3/11)
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