Charitable Organization Registration Statement Form -Office Of The Attorney General - 2000 Page 4
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4BOARD OF DIRECTORS
SIGNATURES AND ACKNOWLEDGMENT
We, the undersigned, state and acknowledge that we are duly constituted officers of this organization,
being the ________________________(Title) and _________________________(Title) respectively, and
that this Registration Statement is executed on behalf of the organization by us pursuant to resolutions of the
___________________________(Board of Directors, Trustees, or Managing Group) adopted on the _____
day of ___________________, 20____, approving the contents of the Registration Statement, and do hereby
certify that the ________________________________(Board of Directors, Trustees or Managing Group)
has assumed, and will continue to assume responsibility for determining matters of policy, and have
supervised, and will continue to supervise, the finances of the organization, and we, the undersigned, state
that the information supplied is true, correct and complete to the best of our knowledge.
______________________________________
______________________________________
Name
(Print)
Name
(Print)
______________________________________
______________________________________
Signature
Signature
______________________________________
______________________________________
Title
Title
______________________________________
______________________________________
Date
Date
All information and documentation provided as part of this registration,
including this form, is a public record.
AG: 2203963,v. 01
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