Charitable Law Section
Office 614.466.3181
Fax 614.466.9788
150 East Gay Street, 23
Floor
rd
Columbus, Ohio 43215-3130
REQUEST TO AMEND A CHARITABLE ORGANIZATION
REGISTRATION STATEMENT
THIS FORM MUST BE COMPLETED, AND NOTARIZED, BY EVERY CHARITABLE
ORGANIZATION THAT:
•
Is currently registered with the Ohio Attorney General’s Office pursuant to Ohio Revised Code
Chapter 1716.
•
Has submitted the required financial report(s) and paid the applicable registration fee(s).
•
Wishes to amend the organization’s registration information prior to submitting the required renewal
registration material.
Name of organization: ___________________________________________________________________
Address: _____________________________________________________________________________
Street Address
City
Zip Code
Organization Federal Employer Identification Number (EIN): ____________________________________
Briefly describe the amendment that you would like to make to your registration material.
_____________________________________________________________________________________
_____________________________________________________________________________________
I, ____________________________________________________, being first duly sworn say that I am the
(Please print Name)
_____________________________________ of the above named organization and further state as follows:
(Treasurer or Chief Fiscal Officer)
1.
I am the individual who has completed the foregoing Amendment Request;
2.
I have read the foregoing Amendment Request and know the contents thereof;
3.
The same is true to the best of my knowledge and belief; and
4.
This Amendment Request is made for the purpose of complying with the provisions of Chapter 1716
of the Ohio Revised Code.
______________________________________
Signature
State of _____________________
ss:
County of ___________________
Sworn to and subscribed before me this ______ day of _______________, _______.
Seal
______________________________________
Notary Public
(revised 2/11)