Form Ss-6007 - Application To Renew Registration Of A Charitable Organization - 2016
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3Application to Renew 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
completed application and attachments must be received on or before the expiration date. Applications
and documents received after the date of expiration will be assessed a $25.00 late fee per month
until completed, unless an extension request was filed on or before that date.
The amount of the filing fee is as follows:
Gross Revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filing Fee
$0 – $48,999.99 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $80.00
$49,000.00 – $99,999.99 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$120.00
$100,000.00 – $249,999.99 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $160.00
$250,000.00 – $499,999.99 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $200.00
$500,000.00 – above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $240.00
* A nonrefundable registration fee must accompany this application.
1. Name of the organization:
If name has changed, please indicate:
FEIN:
Accounting period end date:
(mm/dd)
Has the accounting period changed since your last registration?
Yes No
If yes, please explain:
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:
SS-6007 (Revised 12/16), RDA 2994
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