Form Chr-1 - Registration Statement Of Charitable Organization Page 2

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14b.
Has this exemption been denied,
Yes
If yes, attach copy of letter of decision.
revoked or modified at any time?
No
Please check one or more methods the organization anticipates using:
14c.
Telephone Appeals
Door to Door Solicitation
Other
Grant Writing
Combined Appeals
Auction
Direct mail
Special Events
Bingo/Raffle
15. Names and addresses of all officers, direc-
tors, trustees and the principal salaried ex-
ecutive staff: [All charitable organizations
must appoint an independent governing
board to oversee expenditures, policies,
progress and purposes.]
Name and address of professional fund-
16.
raising counsel and/or solicitor used for fund-
raising activities in West Virginia.
a.
Are current contracts with professional fund-raising counsel
Yes
No
and solictors on file with the Office of the Secretary of State as
required by West Virginia law?
b.
Has the professional fund-raising counsel or professional
Yes
No
solicitor registered and filed a bond with the Office of the
Secretary of State as required by West Virginia Law?
c.
Give the location of any telephone facili-
(Room No.)
(Street Address)
ties to be used in solicitation:
(City)
(State)
(Zip)
d.
Give the location and address of any
(Street Address and Box Number)
mailing facility to be used in the
solicitation of funds:
(City)
(State)
(Zip)
Revised 1 /
Issued by the Secretary of State, State Capitol, Charleston, WV 25305
FORM CHR-1

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