Form Char006 - Notice Of Annual Filing Exemption - State Of New York Department Of Law

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CHAR006
STATE OF NEW YORK
DEPARTMENT OF LAW
NOTICE OF ANNUAL FILING EXEMPTION
CHARITIES BUREAU - REGISTRATION SECTION
120 BROADWAY
Pursuant to the Estates, Pow ers and Trusts Law and
NEW YOR K, NY 10271
The Executive Law
Attorney G eneral’s registration numb er:
Fiscal year ending:
Name of R egistrant:
Mailing add ress:
Tel. N o.:
Em ail Add ress:
I certify, under penalty for perjury, that the organization named above is exempt from filing an annual report or paying
an an nua l filing fee to the NY S Department of Law for the abo ve year becau se (check all that ap ply):
E
, P
& T
L
:
STATES
OW ERS
RUSTS
A W
Total gross receipts for the fisca l year did n ot exceed $25 ,000 ; and
The assets (market value) of the organ ization did not exceed $25 ,000 at any time du ring the fiscal year.
E
L
:
XECUTIVE
A W
Total con tributio ns fro m N ew Yo rk State residents did no t exceed $25,0 00 d uring the fiscal ye ar; and
The organization did not use the services of a Professional Fun d R aiser or Fun d R aising Co unsel to solicit
contributions in New Y ork at any time du ring the fiscal year.
NOTE:
Dual Registrants must satisfy both of the above exemptions in order to be exempt from filing annual
reports with the A ttorney Ge neral’s C harities Bureau. No fee is required when submitting this form.
NAM E (Printed)
TITLE
SIGNATURE
DATE
Daytim e tel. no.:
Em ail address:
*No te:
A Notice of An nual Filing Exem ption Form must be subm itted for each reporting period for w hich an
exemption is claimed. In the case of a corporation, the Notice of Annual Filing Exemption Form must be
signed by o ne officer o f the co rporation . A N otice of Annual Filing Exem ption Form for a tru st or estate
must be signed b y one trustee or executor.
CHA R006
(Rev. 10/02)

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