Charitable Organizations Investigative Request - State Of Kansas Office Of The Attorney General
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1
2
3State of Kansas
Office of the Attorney General
C
P
D
ONSUMER
ROTECTION
IVISION
120 SW 10
S
, S
430
TH
TREET
UITE
T
, K
66612-1597
OPEKA
ANSAS
P
: (785) 296-3751
HONE
C
O
HARITABLE
RGANIZATIONS
D
S
W
:
EREK
CHMIDT
I
R
EBSITE
NVESTIGATIVE
EQUEST
.I
Y
C
K
.
A
G
WWW
N
OUR
ORNER
ANSAS
ORG
TTORNEY
ENERAL
P
I
I
A
C
ERSONAL
NFORMATION
NFORMATION
BOUT THE
HARITABLE
(S
R
3)
O
IGNATURE
EQUIRED ON PAGE
RGANIZATION
C
N
:
N
: M
. M
. M
.
D
B
:
OMPANY
AME
AME
R
S
RS
ATE OF
IRTH
_______________________________________________________
________________________________________________________
A
:
A
:
A
. #
DDRESS
DDRESS
PT
_______________________________________________________
________________________________________________________
C
, S
, Z
:
C
, S
, Z
, C
:
ITY
TATE
IP
ITY
TATE
IP
OUNTY
_______________________________________________________
________________________________________________________
P
#:
D
P
#:
HONE
AYTIME
HONE
_______________________________________________________
________________________________________________________
S
:
E
A
:
ALESPERSON
MAIL
DDRESS
C
P
:
ONTACT
ERSON
I
A
I
NFORMATION
BOUT THE
NCIDENT
W
?
W
?
HEN WERE YOU FIRST CONTACTED BY THIS ORGANIZATION
HERE DID THIS CONTACT TAKE PLACE
D
:
T
:
ATE
IME
___O
VER THE PHONE
___A
T HOME
___A
T THE CHARITY
F
:
___B
IRST CONTACT BETWEEN YOU AND THE CHARITY
Y MAIL
___P
___O
(
)
ERSON CAME TO MY HOME
THER
EXPLAIN
___I
RECEIVED A TELEPHONE CALL
___I
/
/
RESPONDED TO A RADIO
TV AD
MAILING
___O
(
)
THER
EXPLAIN
D
? Y
/ N
W
-
ID YOU DONATE TO THIS CHARITABLE ORGANIZATION
ES
O
AS YOUR DONATION MADE THROUGH A THIRD
PARTY SOLICITOR
? Y
/ N
/ U
OR PROFESSIONAL FUNDRAISER
ES
O
NKNOWN
I
,
:
I
,
F YES
WHEN DID YOU DONATE
F YES
W
,
,
AS THE NAME
ADDRESS
AND TELEPHONE NUMBER OF THE
A
(
)
:
? Y
/ N
MOUNT
S
DONATED
CHARITABLE ORGANIZATION DISCLOSED
ES
O
W
AS THE REGISTRATION NUMBER FOR THE CHARITABLE
? Y
/ N
ORGANIZATION DISCLOSED
ES
O
P
: ___C
___C
___C
C
AID BY
ASH
HECK
REDIT
ARD
W
AS THE REGISTRATION NUMBER FOR THE PROFESSIONAL
___O
(
)
S
? Y
/ N
THER
EXPLAIN
OLICITOR DISCLOSED
ES
O
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