Form Agtax-1 - Registration Statement For Professional Fundraising Counsel - 2012
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2(Rev.1-12)
STATE OF HAWAII
DEPARTMENT OF THE ATTORNEY GENERAL
TAX DIVISION
425 QUEEN STREET
HONOLULU, HAWAII 96813
(808) 586-1480
FAX (808) 586-8116
REGISTRATION STATEMENT FOR
PROFESSIONAL FUNDRAISING COUNSEL - FORM - AGTAX-1
INITIAL
RENEWAL
FEE REMITTED ___________
(
CHECK ONE ABOVE)
1. Business name and address of applicant :
FULL BUSINESS NAME
c/o
STREET AND NUMBER
CITY
STATE
ZIP CODE
COUNTY
TELEPHONE #
800 TELEPHONE #
2. Any other names under which you conduct business:
3. Form of organization:
a. Corporation (State of Incorporation and Date)
c. Individual
b. Partnership
d. Other
4. If principal place of business is located outside Hawaii, do you have any offices in Hawaii?
Yes
No
If “Yes”, attach address(es) and telephone number(s).
5.
If “Yes” to any of the following you must register as a professional solicitor:
(A) Will you at any time solicit contributions? Yes
No
(B) Will you at any time have control and approval over the content and volume of any solicitations that are conducted by
a charitable organization? Yes
No
(C) Will you at any time have custody or control of contributions? Yes
No
(D) Will your compensation be related to the amount of contributions received? Yes
No
6. Attach a list of the names and residence addresses of all principals of the applicant, including officers, directors and owners.
7. Provide the name of all persons in charge of any counsel services:
Visit our Web site at:
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