Form Cri-500s - Solicitor Of An Independent Paid Fund Raiser - Initial Registration And Renewal Registration

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New Jersey Office of the Attorney General
Division of Consumer Affairs
Office of Consumer Protection
Charities Registration Section
124 Halsey Street, 7
Floor, P.O. Box 45021
th
Newark, NJ 07101
(973) 504-6215
Form CRI-500S
(As Revised April 2016)
(Previous versions of this form may no longer be used and will not be accepted.)
Solicitor of an Independent Paid Fund Raiser
Initial Registration and Renewal Registration
All of the questions must be answered.
1. Solicitor Registration for the following year:
July 1, 20_____ through June 30, 20 _____
2. Name of Solicitor: ________________________________________________________________________________________
Mailing Address: _________________________________________________________________________________________
Address
City
State
ZIP code
Street Address: ___________________________________________________________________________________________
Street Address
City
State
ZIP code
Please check this box if the solicitor’s address has changed since his/her last registration was filed.
3. Name of the Independent Paid Fund Raiser: __________________________________________________________________
Mailing Address: _________________________________________________________________________________________
Address
City
State
ZIP code
Street Address: ___________________________________________________________________________________________
Street Address
City
State
ZIP code
N.J. Registration Number: PFR-________-00
Please check this box if the independent paid fund raiser’s address has changed since his/her last registration was filed.
Phone Number: (_____)_____________ Fax Number: (_____)_____________
Name of Supervisor: ___________________________________________________
4. List all employment as a solicitor of an independent paid fund raiser, including any anticipated future employment through
June 30th of next year. List future employment first followed by present employment. List all terms of remuneration agreed
upon with the independent paid fund raiser. Attach additional sheets of paper if needed.
Name of Independent Paid
Address
Terms of Remuneration
Period (month/year)
Fund Raiser
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