Charitable Organization Registration Statement Form -Office Of The Attorney General - 2000 Page 2
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43.
List the name or names under which the organization solicits contributions:
_________________________________________________________________________________
_________________________________________________________________________________
4.
Type of legal entity (if the organization is a trust or foundation, attach the creating document):
non-profit corporation
trust
unincorporated association
5.
Place and date the organization was incorporated: _________________________________________
(state)
(date)
6.
Is the organization exempt from federal income taxes? If yes, attach a copy of your IRS determination
letter. If the application is pending, attach a copy of the first page of the application.
Yes
No
Application Pending
Status: 501(c)(_____)
7.
If the organization is not exempt from federal income taxes and uses a fiscal agent, state the fiscal
agent’ s name and address:_____________________________________________________________
_________________________________________________________________________________
8.
Has your organization been denied the right to solicit contributions?
a.
By any government agency.
Yes
No
If yes, attach explanation
b.
By any Court: Yes
No
If yes, attach explanation
9.
Attach list of names and addresses of all directors, officers and trustees.
10. Explain in detail the charitable purposes of the organization, including major program activities.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
11. Please mark all items that describe your charitable mission:
Arts & Culture
Human Services
Civic/Lobbying
International
Environment
Mental Health
Education
Religious
Health
Other_________________________________________________________
12. Which of the above two best describes your primary purpose(s)?
1._______________________________________ 2._____________________________________
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