Form Ss-6007 Application To Renew Registration Of A Charitable Organization

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Division of Charitable Solicitations and Gaming
APPLICATION TO RENEW REGISTRATION
Tre Hargett, Secretary of State
OF A CHARITABLE ORGANIZATION
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
Reset Form
615-741-2555
INSTRUCTIONS: Please type or print all items on this form which are applicable to your
For Office Use Only
organization. If you are unable to answer in the space provided, you may attach additional
Reg. No.
Date Received
sheets. Indicate that an item does not apply by placing N/A by its number.
The amount of the filing fee is as follows:
Exp. Date
Organization’s Gross Revenue
Filing Fee
$0-$48,999.99 ………………………………….
$100.00
$49,000.00-$99,999.99 ……………………...…
$150.00
Fee Paid
$100,000.00-$249,999.99 ……………………...
$200.00
$250,000.00-$499,999.99 ……………………...
$250.00
$500,000.00-ABOVE ………………………….
$300.00
A NONREFUNDABLE registration fee must accompany this application.
1. Name of the organization:
If name has changed, please indicate:
FEIN:
Accounting period end date:
Has the accounting period changed since your last registration? Yes
No
If yes, please indicate:
2. Do you solicit contributions under any other name(s)? Yes
No
If yes, list names used and attach any documents authorizing such use.
3A. Principal Office Address or, if no office is maintained, Name and Address of Person Having Custody of Financial Records (P.O.
box not acceptable):
Name:
Address:
City:
State:
Zip Code:
Has principal address changed since last registration? Yes
No
3B. Mailing/Contact Address/Title:
Organization Name:
Address:
City:
State:
Zip Code:
4. Telephone Number:
Fax Number:
Email Address:
Has information in number 4 changed since last registration? Yes
No
Telephone Number:
Fax Number:
Email Address:
5. Have you added any Chapters, Branches or Affiliates in Tennessee since your last registration?
If yes, list name and address:
Are you registering and reporting the financial activities of these organizations? Yes
No
(Note: a chapter, branch or affiliate that solicits or receives contributions from any source other than the parent organization or a
governmental agency must register independently and pay its own filing fee)
6. Have you amended the organization documents submitted with your last registration? Yes
No
If yes, attach a copy of the amendment(s).
7. Has the organization obtained tax exemption or has the tax exempt status been revoked by the Internal Revenue Service since your last
registration? Yes
No
If granted tax exemption, attach determination letter.

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