Request To Amend A Charitable Organization Registration Statement - Charitable Law Section

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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)

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