Form Char410 - Registration Statement For Charitable Organizations - 2010

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Registration Statement for Charitable Organizations
CHAR410
New York State Department of Law (Office of the Attorney General)
Form
Open to Public
Charities Bureau - Registration Section
Inspection
120 Broadway
For new registrants only
New York, NY 10271
(Amending use CHAR410-A,
Re-registering use CHAR410-R)
Part A - Identification of Registrant
1. Full name of organization (exactly as it appears in your organizing document)
5. Fed. employer ID no. (EIN)
__ __ - __ __ __ __ __ __ __
2. c/o Name (if applicable)
6. Organization’s website
Room/suite
3. Mailing address (Number and street)
7. Primary contact
City or town, state or country and ZIP+4
Title
4. Principal NYS address (Number and street)
Room/suite
Phone
Fax
City or town, state or country and ZIP+4
Email
Part B - Certification - Two Signatures Required
We certify under penalties for perjury that we reviewed this Registration Statement, including all schedules and attachments, and to the best of our
knowledge and belief, they are true, correct and complete in accordance with the laws of the State of New York applicable to this statement.
1. President or Authorized Officer/Trustee
Signature
Printed Name
Title
Date
2. Chief Financial Officer or Treasurer
Signature
Printed Name
Title
Date
Part C - Fee Submitted
If registering to solicit contributions, fee is $25.
-9
Submit check or money order,
Check
if you are submitting $25 fee to
If not registering to solicit contributions, no fee is owed.
payable to “NYS Department of Law.”
register to solicit contributions.
Part D - Attachments - All Documents Required
Attach all of the following documents to this Registration Statement, even if you are claiming an exemption from registration:
Certificate of incorporation, trust agreement or other organizing document, and any amendments; and
Bylaws or other organizational rules, and any amendments; and
IRS Form 1023 or 1024 Application for Recognition of Exemption (if applicable); and
IRS tax exemption determination letter (if applicable)
Part E - Request for Registration Exemption
G
G
Is the organization requesting exemption from registration under either or both Article 7-A or the EPTL? . . . . . . . . . . . . . . . . . . . . . . . . .
Yes*
No
* If “Yes”, complete Schedule E.
Page 1 of 3
Form CHAR410 (2010)

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