Registration Statement For A Charitable Organization Form - Secretary Of State Page 4
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4State 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 Organization Category and Purpose
Complete either Section 1 or Section 2 below which describes both the charity’s category and the purpose of the charity’s
solicited donations.
Section 1: Enter up to three NTEE (National Taxonomy of Exempt Entities) Codes here:
____ ____ ____ ____ , ____ ____ ____ ____ , ____ ____ ____ ____
____ ____ ____ ____ , ____ ____ ____ ____ , ____ ____ ____ ____
Section 2: Check up to three boxes below that best describe your organization:
A. Arts, Culture, Humanities
L. Housing, Shelter
T. Philanthropy, Volunteerism,
(inc. historical)
(inc. senior citizen housing)
Grant-making (inc. foundations)
B. Educational Institutions
M. Public Safety, Disaster
U. Science and Technology
(inc. literacy)
Preparedness and Relief
Research Institutes
C. Environment, Beautification
(inc. rescue squads, auto safety)
(inc. computer science, engineering)
(inc. gardening, outdoor education)
N. Recreation, Sports, Leisure,
V. Social Sciences Institutes
D. Animal-Related
Athletics
(inc. institutes for studies on population,
(inc. wildlife sanctuaries)
(inc. social clubs, Special Olympics)
minorities and economics)
O. Youth Development
E. Health-General, Rehabilitative
W. Public Affairs, Society Benefit
(inc. nursing, family planning)
P. Human Services
(inc. citizen participation, con-
F. Mental Health, Crisis Intervention
(inc. thrift stores, YMCAs and YWCAs,
sumer protection, veterans'
hearing- or sight-impaired orgs.)
orgs., leadership development)
(inc. alcoholism, services for rape and abuse
victims)
Q. International, Foreign Affairs,
X. Religion, Spiritual Development
G. Disease, Disorders, Medical Disciplines
National Security (inc. cultural
(inc. religious broadcasters and
interfaith coalitions)
H. Medical Research
exchange)
Y. Mutual / Membership Benefit
I. Crime, Legal-Related
R. Civil Rights, Social Action,
(inc. prevention of abuse, delinquency)
Advocacy (inc. right to life and
(inc. fraternal organizations,
cemeteries)
J. Employment, Job-Related
right to die, reproductive rights)
Z. Unknown, Other
(inc. voc. rehabilitation, unions)
S. Community Improvement,
Please Specify:
K. Agriculture, Food, Nutrition
Capacity Building
(inc. livestock breeding)
(inc. neighborhood associations,
service clubs, bus. development)
___________________________
I certify that the information furnished in this application and all attached supplementary information is true and correct
to the best of my knowledge, information and belief. I understand the giving of false or incorrect information may
constitute a misdemeanor carrying a penalty upon conviction, for a first offense of not more than two thousand dollars
or imprisonment for not more than one year, or both. A second, or subsequent offense is a felony and upon conviction
must be fined not more than five thousand dollars or imprisoned not more than five years, or both.
CHIEF FINANCIAL OFFICER:
CHIEF EXECUTIVE OFFICER:
Signature
Signature
Print Name
Print Name
_________________________________________
_____________________________________________
Date
Date
Filing Instructions:
•
This form must be signed and accompanied by a fee of $50. Please make checks payable to the Secretary of State.
•
Please return the form and fee to: South Carolina Secretary of State, Attn: Division of Public Charities, Post Office Box
11350, Columbia, SC 29211
•
If the annual financial report for the immediately preceeding fiscal year has not already been filed with the Secretary of
State’s Office, please attach the report on forms prescribed by the Secretary of State or on IRS Form 990, 990EZ or
990PF.
Charities Registration Statement Revised May 2009
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