Form Sfn 11300 - Charitable Organization Registration Statement printable pdf download

Form Sfn 11300 - Charitable Organization Registration Statement

CHARITABLE ORGANIZATION

For Office Use Only

REGISTRATION STATEMENT

ID Number:

SECRETARY OF STATE

WO Number:

SFN 11300 (07-2016)

License Number:

Issued By:

FEE: $25.00

Secretary of State

ATTACHMENTS:

State of North Dakota

600 E Boulevard Ave Dept 108

IRS Determination Letter (or first page of pending application)

Bismarck ND 58505-0500

Telephone: (701) 328-3665

Financial State or IRS Form 990

Toll-Free: (800) 352-0867, option 8

List of names and addresses of all directors, officers, and trustees. Indicate the individuals having the

Website:

sos.nd.gov

financial discretion or authority as to the distribution and use of contributions received.

List of total compensation, including salaries, fees, bonues, fringe benefits, severance payments, and

deferred compensation, paid to all employees by the charitable organization and all its affiliated

organizations.

Copy of agreement with professional fundraiser, if any.

SEE INSTRUCTIONS FOR FILING AND MAILING INFORMATION.

TYPE OR PRINT LEGIBLY

For reference, see North Dakota Century Code, Chapter 50-22.

1A. Legal name of organization

1B. Federal ID number

1C. Name(s) under which the organization solicits contributions

1D. Street and mailing address of principal executive office (street/RR, PO box, city, state, ZIP+4) Street address MUST be provided; may not be only a post

office box.

City

State

ZIP code

Telephone number

2A. Registrant is a(n)

Unincorporated nonprofit association

Nonprofit corporation

Nonprofit limited liability company

Trust

2B. State of origin

2C. Year organized

2D. Is the organization exempt from state income tax?

Yes

2E. Is the organization exempt from federal income taxes? If yes, attach a copy of your IRS determination letter. If the application is pending, attach a copy of

the first page of the application.

Yes - Provide status: 501(c)(

)

Application pending

3. Method(s) of soliciting the organization anticipates using (check all that apply to your organization)

Direct mail

Grant writing

Local television

Telemarketing

Magazines or periodicals

Personal contact

Radio