Form Bco-170 - Solicitation Notice printable pdf download

(Rev. 6-94)

COMMONWEALTH OF PENNSYLVANIA

DEPARTMENT OF STATE

BUREAU OF CHARITABLE ORGANIZATION

P.O. BOX 8723

HARRISBURG, PENNSYLVANIA 17105

TELEPHONE: (717) 783-1720

(1) 800-732-0999

SOLICITATION NOTICE - FORM BCO-170

FEE $25.00

Business name and address of Professional Solicitor

Legal name and address of Charitable Organization as

registered with the Department

as registered, unless exempt from registration:

_________________________________________________

________________________________________________

(FULL BUSINESS NAME)

(FULL LEGAL NAME)

_________________________________________________

________________________________________________

(ADDRESS)

_________________________________________________

________________________________________________

(CITY)

(STATE)

(ZIP CODE)

(CITY)

(STATE)

(ZIP CODE)

Provide a description of the solicitation campaign or event to be conducted. Indicate the date the solicitation campaign or event will begin and terminate within

Pennsylvania. If the campaign involves a show, circus, performance or similar event provide the address and seating capacity of the facility where the event is to

be held and the time and date of each performance:

Is the charitable organization currently registered with the Bureau to solicit contributions? Yes__________________ No_______________

If No, is the charitable organization exempt from registration? Yes _______

No________

State the scope of the solicitation campaign or event:

County __________

State ____________

National _____________

International________________

Give a complete description of the charitable program (purpose) for which the event or campaign is to be conducted:

________________________________________________________________________________________________________________________________

Will you as professional solicitor or anyone acting on your behalf at any time have custody or control of contributions?

Yes__________ No __________

The account number and location of each bank account where receipts from the campaign are to be deposited (may be required to obtain the information from

the charity).

________________________________________________________________________________________________________________________________

7. Give each location and telephone number from which the solicitation Is to be conducted.

________________________________________________________________________________________________________________________________

The legal name and resident address of each person responsible for directing and supervising the conduct of the campaign and each person who Is to solicit

during such campaign (Attach additional sheet If necessary).

________________________________________________________________________________________________________________________________

I, the authorized contracting officer for the professional solicitor, do hereby declare that the information contained herein is true and correct to the best of my

knowledge, information and belief.

________________________________________

___________________________________________

AUTHORIZED CONTRACTING OFFICER

TYPE OR PRINT NAME AND TITLE OF

FOR PROFESSIONAL SOLICITOR

AUTHORIZED CONTRACTING OFFICER

Date_______________________________