Registration Statement For A Charitable Organization Form printable pdf download

St at e of Sout h C arol i na

O f f i ce of t he Secret ary of St at e

M ark H am m ond

Publ i c C hari t i es D i vi s i on

M ai l i ng A ddr ess:

w w w . scsos. com

1205 Pendl et on St . , Sui t e 525

Pos t O f f i ce Box 11350

char i t i es@ scsos. com

Col um bi a, SC 29201

Col um bi a, SC 29211

Phone: ( 803) 734- 1790

Fax: ( 803) 734- 1604

R EG I STR A TI O N STA TEM EN T FO R A C H A R I TA BLE O R G A N I ZA TI O N

Pl eas e pri nt cl earl y or t ype.

FI LI NG FEE: $50

Check one: [ ] I ni t i al Regi s t r at i on

[ ] Renew al / U pdat e

Em pl oyer ’ s I dent i f i cat i on N um ber : ___ ___ - - ___ ___ ___ ___ ___ ___ ___ Regi st r at i on N um ber : ___________

N am e of O r gani zat i on ___________________________________________________________________

O t her O r gani zat i on N am es U sed __________________________________________________________

Cont act Per son’ s N am e __________________________________ Ti t l e ___________________________

Cont act Per son’ s M ai l i ng A ddr ess _________________________________________________________

Ci t y _________________________ Count y _______________________ St at e _____ Zi p ____________

W or k Phone N o. ___________________ H om e N o. ___________________ Fax N o. _________________

Cont act Per son’ s E- m ai l ______________________________ W eb Si t e ___________________________

O r gani zat i on’ s Fi s cal Y ear End D at e ( G i ve m ont h and dat e. ) ______ / ______

I s t hi s a change i n your Fi s cal Y ear End D at e? Ci r cl e one:

Y ES

N O

Pur pose of t hi s or gani zat i on ( at t ach sheet i f necessar y) : ________________________________________

_____________________________________________________________________________________

( a)

Pr i nci pal phys i cal addr es s of t he or gani zat i on:

______________________________________________________________________________

Ci t y _____________________ C ount y _____________________ St at e ______ Zi p___________

( b)

A ddr esses of any of your or gani zat i on’ s of f i ces i n t hi s St at e:

Ci t y _____________________ Count y _____________________ St at e ______ Zi p___________

( c)

I f t he or gani zat i on does not m ai nt ai n an of f i ce, pl ease pr ovi de t he nam e and addr ess of t he per son

havi ng cust ody of t he or gani zat i on' s f i nanci al r ecor ds:

______________________________________________________________________________

Registration Statement For A Charitable Organization Form