Form Pf-10/pf-20 - Fund-Raising Firm Annual Registration
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1
2Official Use Only
Oregon Department of Justice Fund-Raising Firm Annual
Registration Form PF-10/PF-20
(Instructions on reverse)
1. Name/Address of professional/commercial fund-raising firm
:
(list all assumed business names)
2. Telephone number:
E-mail or Web address:
(
)
@
3. Fund-raising firm type
(see instructions for definitions) :
Professional
Commercial
4. Form of organization of the professional/commercial fund-raising firm:
Sole proprietorship
Partnership
Corporation, State:
#:
5. Fund-raising method(s)
:
(check all that apply)
Telephone
Direct Mail
Door-to-Door
Vending
Other:
6. Names and addresses of all corporate officers, if any
(attach additional sheets if necessary):
Name
Residential Address
Telephone
President:
(
)
Contact Person:
(
)
7. List all persons who own a 10% or more interest in the professional/commercial fund-raising firm
(to be completed by all registrants, including sole proprietorships - attach additional sheets if necessary):
Name
Residential Address
Ownership Interest
%
%
%
%
8. Name and relationship to fund-raising firm of person completing this registration statement:
Name:
Position in Organization:
I hereby certify that the foregoing information is true and correct to the best of my knowledge and belief. I also certify that
the registrant has filed any assumed business names with the Oregon Secretary of State’s Corporation Division and, if the
registrant is a foreign corporation, has registered to do business in Oregon with that same office, if required by ORS 60.701.
_________________________________________________________
State of ____________________
(signature of affiant)
County of __________________
Subscribed and sworn to before me on __________________, 20____
by ______________________________________________________
(print name of affiant)
__________________________________________
(signature of notarial officer)
Notary Public – State of_______________________
Mail form and $250 registration fee to the address listed in the instructions.
Rev 11/25/03
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