Form Sc - Registration Statement For Solicitations December 1999 (Page 2 of 2) in pdf

Form Sc - Registration Statement For Solicitations December 1999 Page 2

14. State the general purpose for which the organization intends to solicit contributions:

Yes

15. Does the organization intend to solicit contributions directly?

16. Does the organization intend to have such solicitation done on

such organization’s behalf by others?

If YES, then name the professional fund raiser(s) the

organization intends to use:

17. Is this organization authorized by any other governmental

authority to solicit contributions?

18. Is this organization, or has it ever been, enjoined by any court

from soliciting contributions?

19. Complete this statement of the cost of fund raising incurred or anticipated to be incurred by the organization,

including a statement of such costs as a percentage of contributions received.

Total (all) costs

List all costs - describe below

__________________________________

Total costs as a percent of contributions

received

20. Attach a financial statement (form provided) covering complete disclosure of the fiscal activities of the

organization during the preceding year. The Secretary of State will accept executed copies of federal IRS

returns and reports in lieu of a financial statement. Also, if the organization received contributions exceeding

$100,000, an audited financial statement prepared in accordance with generally accepted accounting

principles and an opinion of an independent CPA on the financial statement must be filed.

I declare (or verify, certify or state) under penalty of perjury under the laws of the state of Kansas that the foregoing

is true and correct. Executed on this _________ day of ___________________________ , ________.

Year

Name (printed or typed)

Authorized Officer

Name (printed or typed)

Chief Fiscal Officer

Mail this registration statement and financial statement, with a $20 registration, fee to:

Ron Thornburgh, Secretary of State, Corporation Division, First Floor, Memorial Hall

120 S.W. 10th Ave.,

Topeka, KS 66612-1594, (785) 296-4564

Note: Solicitation registration expires on the last day of the sixth month following the month in which

fiscal year of charitable organization ends. Solicitation registration must be renewed each year.

Rev. 12/99 kp

Form Sc - Registration Statement For Solicitations December 1999 Page 2