Form Cri-200 - Short-Form Registration/verification Statement

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New Jersey Office of the Attorney General
Division of Consumer Affairs
Office of Consumer Protection
Charities Registration Section
153 Halsey Street, 7
th
Floor, P.O. Box 45021
Newark, NJ 07101
(973) 504-6215
Form CRI-200
Short-Form Registration/Verification Statement
(Revised April 2008)
All of the questions must be answered.
Charitable organizations, domiciled or doing business in the State of New Jersey, which receive gross contributions of $25,000 or less
per year, are required to submit an initial registration and to renew registration annually. In both circumstances this form may be used. In
the event an organization receives gross contributions of less than $10,000 per year and does not compensate anyone to solicit or perform
fund-raising activities on its behalf, the organization is exempt from registration, but may still choose to register. The registration fee for
charities with gross contributions between $0 and $25,000 is $30, whether the fee is for an initial or renewal registration. Payment is to
be made by check or money order, made payable to the “New Jersey Division of Consumer Affairs,” and is due at the time of submission
of the form.
1. This statement contains the facts and financial information for the fiscal year ending: _____/ _____/ ________
month
day
year
2. Federal ID Number (EIN) __________________ 2a. N.J. Charities Registration Number: CH- _________________________
(Leave blank ONLY if this is an initial registration.)
Full legal name of the registering organization: ______________________________________________________________
3.
In care of: (if necessary, otherwise leave this line blank) __________________________________________________________
4.
Mailing Address: ____________________________________________________________________ £ Change of Address
Street Address
City
State
ZIP Code
NOTE: If “ in care of,” a postal, private or rural delivery mail box number is used, the street address of the charity must be given below.
5. The principal street address of the registering organization________________________________________________________
£ Same as Mailing Address
Street Address
City
State
ZIP Code
6.
Does the organization have any offices in New Jersey in addition to the one listed above?
£ Yes £ No
If “Yes,” attach a list giving the street address and telephone number of each office in New Jersey.
6a. If the street address listed above is not where the organization’s official records are kept, or if the organization does not maintain an
office in New Jersey, indicate the name, full address, phone and fax number of the person having custody of the organization’s records,
and to whom correspondence should be addressed.
_______________________________________________________________________________________________________
Contact person
Street address
City
State
ZIP Code
________________________________ ________________________________
Telephone number (include area code)
Fax number (include area code)
7.
Organization’s contact information:
________________________________ ________________________________
Telephone number (include area code)
Fax number (include area code)
________________________________ ________________________________
E-mail address
Web site
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