Form Ss-6001 - Application For Registration Of A Charitable Organization

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APPLICATION FOR REGISTRATION
Division of Charitable Solicitations and Gaming
Tre Hargett, Secretary of State
OF A CHARITABLE ORGANIZATION
WARNING: False or misleading statements
Subject to maximum $5,000 civil penalty.
State of Tennessee
T.C.A. §48-101-514
312 Rosa L. Parks Avenue, 8th Floor
Nashville, Tennessee 37243
Reset Form
615-741-2555
For Office Use Only
INSTRUCTIONS: Please type or print all applicable items. If you are unable to
Reg. No.
Date Received
answer in the space, attach additional sheets. Indicate that an item does not apply by
placing N/A by its number. A NONREFUNDABLE registration fee of $50.00 must
Exp. Date
accompany this application. If an organization is renewing its application, please
complete form SS-6007, Application to Renew Registration of a Charitable
Organization.
Fee Paid
1. Name of Organization:
The name of the organization should be the legal name as stated in the organization’s organizing instrument (i.e., articles of
incorporation, by laws, etc.)
2. Federal Employer Identification Number:
All organizations must apply for a Federal Employer Identification Number from the Internal Revenue Service, including
organizations that have a group exemption or file group returns.
3. Principal Office Address or, if no office is maintained, Name, Address of Person Having Custody of Financial Records (P.O. box
not acceptable):
Name:
Address:
City:
State:
Zip Code:
4. Mailing/Contact Address, if different from principal office:
Name:
Address:
City:
State:
Zip Code:
Contact Name:
Contact Title:
5. Telephone Number:
Fax Number:
Email Address:
6. Do you solicit contributions under any other name(s)? Yes
No
If yes, list names used and attach any documents authorizing such use.
7. Has any officer, director, manager, operator or principal of the organization been the subject of an injunction,
judgement or administrative order or been convicted of a felony? Yes
No
If yes, attach a detailed explanation.
8. Attach a list of the name, title and address of each officer, director and trustee. (List principal salaried officer first)
9. Describe the purpose of the organization:
10. A. Legal entity of organization:
Corporation
Partnership
Association
Other Specify
B. When and where was the organization legally established? Date:
City:
State:
C. Beginning and ending dates of the organization’s accounting period:
to
Month/Day
Month/Day
11. A. 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.
B. Attach a copy of any amendments to the above.
12. A. Is the organization recognized by the Internal Revenue Service as tax exempt? Yes
No
If yes, attach a copy of the
determination letter.
B. If no, has the organization applied for tax exempt status? Yes
No
If yes, attach a copy of the completed application (IRS
form 1023) and any letters received from the IRS acknowledging receipt.
SS-6001 (Rev. 5/13)
RDA 1745

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