State of South Carolina
Post Office Box 11350
Telephone: (803) 734-1790
Office of the Secretary of State
Columbia, SC 29211
Fax: (803) 734-1604
Division of Public Charities
charities@sos.sc.gov
Charity Board Members
Name _________________________________________________
Title ______________________________________
Address ____________________________________________________________ Phone __________________________
Name _________________________________________________
Title ______________________________________
Address ____________________________________________________________ Phone __________________________
Name _________________________________________________
Title ______________________________________
Address ____________________________________________________________ Phone __________________________
Name _________________________________________________
Title ______________________________________
Address ____________________________________________________________ Phone __________________________
Chapter/Branch/Affiliates
Names and addresses of any chapters, branches or affiliates of your organization in this State. (Attach list if necessary.)
___________________________________________________________________________________________________
Governmental Authority
Other governmental authorities that have authorized your organization to solicit contributions
Enter a “1” if you are already registered, a “2” if your registration is pending and leave blank if you are not registered to
solicit contributions with a particular state.
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
If any other governmental authority that is not listed above has authorized your organization to solicit contributions, enter
the name of the governmental authority ________________________________________________________________
Professional Fundraisers Contracted With
If your organization intends to use professional solicitors, professional fundraising counsel, commercial co-venturers or hire
individuals to solicit, please list their names, addresses, telephone numbers, and dates during which they will be engaged.
Please attach a separate page if necessary.
__________________________________________________________________________________________________
___________________________________________________________________________________________________
Charities Registration Statement Revised May 2009