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Form Fc - Fund-Raising Counsel Application For Registration - Mississippi Secretary Of State Page 3

FUND-RAISING COUNSEL

APPLICATION FOR REGISTRATION

INSTRUCTIONS

Fill out the Fund-raising Counsel Application for Registration form (FORM FC). Indicate whether initial

registration or renewal.

All questions must be answered completely or the form will be considered deficient and will not satisfy the

filing requirement. If attachments are necessary, indicate the question number on the attachment. Please type

or print clearly.

The form must be signed by the person taking responsibility for the information submitted, and the signature

must be notarized.

A copy of all contract(s) between Registrant and the charitable or other organization(s) must be filed. NOTE:

SEE 79-11-515 of the Mississippi Charitable Solicitations Act for contract requirements.

Enclose the fee of $250.00 made payable to the Mississippi Secretary of State.

Send application, all attachments and fee to:

Mississippi Secretary of State's Office

Charities Registration

P O Box 136

Jackson MS 39205-0136

(601) 359-1633

RENEWAL OF REGISTRATION

All Fund-raising Counsel registrations expire on June 30th of each year. The annual registration renewal is due by

that date.

Form Fc - Fund-Raising Counsel Application For Registration - Mississippi Secretary Of State Page 3