Form Fr - Professional Fund Raiser Annual Report (Page 2 of 2) in pdf

Form Fr - Professional Fund Raiser Annual Report Page 2

List names and addresses of professional solicitors (and their ID numbers) retained or employed during the past 12 months, and

indicate for which charitable organization(s) they solicited.

Name

Address

City, State, Zip

ID #

Charitable Organization

____________________________________________________________________________________________________

(Add additional page if necessary.)

Date of this report _______________________

Authorized signature(s) (proprietor, or all partners,or corporate officer and title):

_____________________________________________________

I declare (or verify, certify or state) under penalty of perjury under the laws of the State of Kansas that the foregoing

is true and correct. Executed on this________ day of ____________________________, _______.

Year

____________________________________________

Name (printed or typed)

Authorized Signature

____________________________________________

Title/Position

Note: This form is to be completed and submitted at expiration of

previous registration or at time of re-registration.

Mail to:

Ron Thornburgh

Secretary of State

First Floor, Memorial Hall

120 S.W. 10th Ave.

Topeka, KS 66612-1594

(785) 296-4564

For general information and forms requests, please call: (785) 296-4564

If you have comments or suggestions, you may e-mail us at:

This form may be downloaded from our web site at:

Rev. 12/99 kp

Form Fr - Professional Fund Raiser Annual Report Page 2