Establishment Of A Non-Profit Account Form - 2004
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1
2KENAI PENINSULA BOROUGH
**NON-PROFIT ONLY**
(FOR OFFICE USE ONLY)
ESTABLISHMENT OF A NON-PROFIT ACCOUNT
KENAI PENINSULA BOROUGH
REGISTRATION NO:
144 N. BINKLEY
SOLDOTNA, ALASKA 99669-7599
Phone: (907) 714-2175 Fax: (907) 262-8623
DATE ORGANIZATION OPENED ON PENINSULA:
/
/
ALASKA STATE BUSINESS LICENSE NO:
SIC CODE:
ORGANIZATION:
BUSINESS PHONE NO:
ORGANIZATION MAILING ADDRESS:
BUSINESS FAX NUMBER:
EMAIL ADDRESS:
CELLULAR PHONE NO:
ORGANIZATION PHYSICAL LOCATION:
CITY:
STATE:
ZIP:
STREET ADDRESS
CURRENT OFFICERS: (ATTACH ADDITIONAL SHEET IF SPACE REQUIRED)
PRESIDENT
ADDRESS:
CITY:
(Name)
STATE:
ZIP:
PHONE NO:
VICE PRESIDENT
ADDRESS:
CITY:
(Name)
STATE:
ZIP:
PHONE NO:
SEC / TREAS
ADDRESS:
CITY:
(Name)
STATE:
ZIP:
PHONE NO:
CONTACT PERSON
ADDRESS:
CITY:
(Name)
STATE:
ZIP:
PHONE NO:
BUSINESS REFERENCES:
1.
ADDRESS:
CITY:
(Name)
STATE:
ZIP:
PHONE NO:
2.
ADDRESS:
CITY:
(Name)
STATE:
ZIP:
PHONE NO:
BRIEFLY DESCRIBE THE TYPE OF NON-PROFIT ORGANIZATION:
NOTICE:
THE FOLLOWING DOCUMENTATION MUST ACCOMPANY THIS APPLICATION:
1) A copy of the ruling or determination letter recognizing tax-exempt status as 501(c) organization from the Internal Revenue Service.
2) Religious organizations MUST provide the above listed documentation OR a copy of the non-profit certificate from the State of Alaska.
PAGE 1 OF 2
CONTINUE ON OTHER SIDE
(Rev 5/2004)
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