Contracted Fundraiser Solicitation Notice Page 2
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28. Name and resident address of each person responsible for directing and supervising
the conduct of the solicitation campaign:
Name:
Address:
City:
State:
Zip:
Telephone: (
)
ATTACH ADDITIONAL SHEETS IF NECESSARY
I, the undersigned, swear under penalty of the law that the representations made in this
Solicitation Notice are true and accurate.
Contracted Fundraiser Name:
Title:
Contracted Fundraiser Signature:
Subscribed and sworn to before me this
day of
, 20
Notary Public Signature
(NOTARY SEAL)
The following is to be signed by an officer of the Charitable Organization on whose
behalf the Contracted Fundraiser is acting.
I certify that the information stated in the Solicitation Notice is true and complete to the
best of my knowledge.
Name of Charitable Organization:
Name of Officer:
Title:
Signature of Officer:
Subscribed and sworn to before me this
day of
, 20
Notary Public Signature:
(NOTARY SEAL)
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