Form Ss-6001 - Application For Initial Registration Of A Charitable Organization - 2016
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1
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3Application for Initial Registration of a Charitable Organization
Division of Charitable Solicitations,
For Office Use Only
Fantasy Sports, and Gaming
Department of State
State of Tennessee
312 Rosa L. Parks Avenue, 8th Floor
Nashville, Tennessee 37243
Tre Hargett
Phone: 615-741-2555
Secretary of State
_________
$_________
Fax: 615-253-5173
sos.tn.gov/charitable
Warning: False or misleading statements subject to maximum $5,000 civil penalty. T.C.A. § 48-101-514
Instructions: Please type or print all items on this form. If you are unable to answer in the space provided,
you may attach additional sheets. Indicate that an item does not apply by placing N/A by its number.
A nonrefundable registration fee of $50.00 must accompany this application. If an organization is
renewing its application, please complete form SS-6007, Application to Renew Registration of a
Charitable Organization.
1. Name of the organization:
Please list the legal name as stated in the organization’s organizing instrument (i.e. Articles of
Incorporation, by-laws, etc.)
FEIN:
Accounting period end date:
(mm/dd)
2. Do you solicit contributions or operate under any other name(s)?
Yes No If yes, list names used and attach any documents authorizing such use:
3. Principal Office or, if no physical office is maintained, Name and Address of Person Having Custody
of Financial Records (P.O. Box not acceptable):
Organization Name:
Attn:
Address:
City:
State:
Zip Code:
County:
4. Primary Contact/Mailing Address (if different from principal). Note: This is the address the
division will use to send official correspondence.:
Salutation:
First Name:
Last Name:
Address:
City:
State:
Zip Code:
County:
5. Phone: (
)
Fax: (
)
Email Address:
Website:
SS-6001 (Revised 11/16), RDA 2994
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Parent category: Legal