Form Ss-6020 - Solicitation Campaign Notice
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State of Tennessee
W A R N ING: Fa l se or m i s lea d in g st ate me nt s
.
subject to maximum $5,000 civil penalty
T.C.A. §48-101-514
Department of State
SOLICITATION CAMPAIGN NOTICE
Division of Charitable Solicitations & Gaming
William R. Snodgrass Tennessee Tower
th
312 Rosa L. Parks Avenue, 8
Floor
Nashville, TN 37243
(615) 741-2555 / (615) 253-5173 - fax
_______________________________________________________________________________
INSTRUCTIONS: Prior to the commencement of each solicitation campaign, a completed solicitation notice form shall be
filed by a professional solicitor with the Secretary of State. Within three (3) days after any modifications or changes in the
required information, the Secretary shall be notified by the professional solicitor of those modifications or changes. If you
are unable to answer in the space provided, attach additional sheets. LABEL ALL ATTACHMENTS ACCORDING TO
APPLICABLE PART AND ITEM NUMBER. PLEASE PRINT OR TYPE.
________________________________________________________________________________
Part I
1.
Name of Professional Solicitor: ____________________________________________________________
2. Name of Charitable Organization on whose behalf the campaign is being conducted: _________________
_____________________________________________________________________________________
3. Beginning and ending dates of this campaign: ________ _____ _______
_______ _____ _____
THROUGH
Month
Day
Year
Month
Day
Year
Note: If the campaign lasts more than one year, a financial report shall be filed within ninety (90) days
after the fiscal year end of any campaign, as well as at the completion of the campaign.
4. Location where campaign will be conducted: _________________________________________________
Street
_____________________________________________________________________(___)____________
City
State
Zip
Telephone
5. Attach a list of the names and resident addresses of all employees or other individuals who will be working
in connection with this campaign.
□
□
6. Have any of the employees been convicted of a felony in the last five (5) years? Yes
No
7. Please provide all bank account numbers and the location of all bank accounts where receipts from the
campaign will be deposited:
____________________________________________________________________________________
____________________________________________________________________________________
Do you intend to utilize a subcontractor to solicit contributions?
Yes □
No □
8.
If yes, list name: ________________________________________________________________________
Note: Subcontractor must be registered as a professional solicitor with this office.
9. What type of fund raising will be conducted during this particular campaign?
□
□
□
□
Direct mail
Door to Door
Telemarketing
Other (Please describe) _________________
10. Does the professional solicitor have a contractual agreement with the charitable organization which
provides that the professional solicitor shall not have access to the funds raised and shall not make
deposits to, or have signature authority or any other authority over the charitable organization’s bank
□
□
accounts? Yes
No
If yes, cite the contract provision or section: ________________________
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