Fillable Form Char500 - Nys Annual Filing For Charitable Organizations

CHAR500

2013

Send with fee and attachments to:

NYS Office of the Attorney General

Charities Bureau Registration Section

Open to Public

NYS Annual Filing for Charitable Organizations

120 Broadway

Inspection

New York, NY 10271

1. General Information

For Fiscal Year Beginning (mm/dd/yyyy) _______/_______/ 2013 and Ending (mm/dd/yyyy) _______/_______/_____________

Name of Organization:

Employer Identification Number (EIN):

Check if Applicable:

Address Change

Mailing Address:

NY Registration Number:

Name Change

Initial Filing

Telephone:

City / State / Zip:

Final Filing

Amended Filing

Email:

Website:

Reg ID Pending

Check your organization's

Find your registration category in the

7A only

EPTL only

DUAL (7A & EPTL)

EXEMPT

registration category:

Charities Registry at

2. Certification

See instructions for certification requirements. Improper certification is a violation of law that may be subject to penalties.

We certify under penalties of perjury that we reviewed this report, including all attachments, and to the best of our knowledge and belief,

they are true, correct and complete in accordance with the laws of the State of New York applicable to this report.

President or Authorized Officer:

____________________________________________________________________________

Signature

Title

Date

Chief Financial Officer or Treasurer:

____________________________________________________________________________

Signature

Title

Date

3. Annual Reporting Exemption

Check the exemption(s) that apply to your filing. If your organization is claiming an exemption under the category (7A and EPTL only filers) or both

categories (DUAL filers) that apply to your registration, complete only parts 1, 2, and 3, and submit the certified Char500. No fee, schedules, or additional

attachments are required. If you cannot claim an exemption or are a DUAL filer that claims only one exemption, you must file applicable schedules and

attachments and pay applicable fees.

3a. 7A filing exemption: Total contributions from NY State including residents, foundations, government agencies, etc. did not exceed $25,000

and the organization did not engage a professional fund raiser (PFR) or fund raising counsel (FRC) to solicit contributions during the fiscal year.

Or the organization qualifies for another 7A exemption (see instructions).

3b. EPTL filing exemption: Gross receipts did not exceed $25,000 and the market value of assets did not exceed $25,000 at any time during the

fiscal year.

4. Schedules and Attachments

See the following page

4a. Did your organization use a professional fund raiser, fund raising counsel or commercial co-venturer for

for a checklist of

Yes

fund raising activity in NY State? If yes, complete Schedule 4a.

schedules and

attachments to

complete your filing.

Yes

No 4b. Did the organization receive government grants? If yes, complete Schedule 4b.

5. Fee

See the checklist on the

7A filing fee:

EPTL filing fee:

Total fee:

Make a single check or money order

next page to calculate your

$______

payable to:

fee(s). Indicate fee(s) you

are submitting here:

"Department of Law"

CHAR500 Annual Filing for Charitable Organizations (Updated June 2014)

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Form Char500 - Nys Annual Filing For Charitable Organizations - 2013

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