Annual Financial Report For 20__ (Page 2 of 2) in pdf

Annual Financial Report For 20__ Page 2

COMMERCIAL COVENTURER FOR CHARITABLE PURPOSES

ANNUAL REGISTRATION FORM FOR 20 ____

(California Government Code Section 12599)

Page 2

Identify commercial coventurer’s activities:

Auction

Direct Mail

Salvageable Personal Property

Advertising Sales

Discount Coupons

Sports Event

Baby Pageant

Door-to-Door Solicitation

Telemarketing

Beauty Pageant

Entertainment Event

Telephone Solicitation

Car Donations

Honor Boxes

Theater

Circus

Magazine Sales

Thrift Store

Concert

Product Sales

Trash Bags

Dinner

Publication

Vending Machines

Other:

Safety Products

Does any officer, director, partner, or owner of the commercial coventurer have any affiliation with or control directly or indirectly, the charitable organization for which the

commercial coventurer has contracted to solicit?

Yes

If “Yes”, complete the following:

Name of officer, director, partner or owner of commercial

Name and address of charitable organization

Relationship of officer, etc. to charitable organization

coventurer

For each affiliation identified above, attach a copy of the contract between the commercial coventurer and the charity.

Has the commercial coventurer ever had any license, registration or permit denied, cancelled, suspended or revoked, or had any official disciplinary or legal action taken against it?

Is any such action currently pending against the commercial coventurer or any of its representatives in relation to any fundraising activity?

Yes

If “Yes”, complete the following:

Name and address of government agency bringing action Nature of action. Indicate against whom action was taken,

Date

and disposition

“X” box if attachments are included.

I certify under penalty of perjury that I am authorized to sign this registration form and that the information provided herein, including attachments, is true and complete to the best

of my knowledge and belief.

____________________________________________ ___________________________________________ ___________________________ _____________________

Signature

Printed Name

Title

Date

CT-5CF (8/2003)