State of South Carolina
Office of the Secretary of State
Mark Hammond
Public Charities Division
Mailing Address:
1205 Pendleton St., Suite 525
Post Office Box 11350
Columbia, SC 29201
Columbia, SC 29211
Phone: (803) 734-1790
Fax: (803) 734-1604
REGISTRATION STATEMENT FOR A CHARITABLE ORGANIZATION
Please print clearly or type.
FILING FEE: $50
Check one:
[ ] Initial Registration
[ ] Renewal/Update
Employer’s Identification Number: ___ ___ -- ___ ___ ___ ___ ___ ___ ___ Registration Number: ___________
1.
Name of Organization ___________________________________________________________________
Other Organization Names Used __________________________________________________________
Contact Person’s Name __________________________________ Title ___________________________
Contact Person’s Mailing Address __________________________________________________________
City _________________________ County _______________________ State _____ Zip ____________
Work Phone No. ___________________ Home No. ___________________ Fax No. _________________
Contact Person’s E-mail ______________________________ Web Site ___________________________
Organization’s Fiscal Year End Date (Give month and date.) ______ / ______
Is this a change in your Fiscal Year End Date? Circle one: YES / NO
2.
Purpose of this organization (attach sheet if necessary): ________________________________________
_____________________________________________________________________________________
3.
(a)
Principal physical address of the organization:
______________________________________________________________________________
City _____________________ County _____________________ State ______ Zip___________
(b)
Addresses of any of your organization’s offices in this State:
City _____________________ County _____________________ State ______ Zip___________
City _____________________ County _____________________ State ______ Zip___________
(c)
If the organization does not maintain an office, please provide the name and address of the
person having custody of the organization's financial records:
1
2
3
