Annual Update Of Registration Form Page 4
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4Annual Update of Registration Form
(This form also used to be known as the Certification Form)
Office of the Secretary of State, State House, Annapolis MD 21401 Telephone: 410-974-5534
1. Fee submitted: $__________
2. Fiscal year end being reported: __________Month
__________Year
3. Name of Charitable Organization: __________________________________________________
4. Mailing address of charity:________________________________________________________
5. Physical address of charity:_______________________________________________________
6. Telephone Number: _____________________ 7. Fax Number: ____________________
8. E-mail address: ______________________________
9. Does your organization engage or have a contract with a professional solicitor or fund-
raising counsel? If yes, please attach a copy of the contract(s). In order to process your
organization's application, you must respond to this question.
Professional Solicitor:
Yes
No
Fund-raising Counsel:
Yes
No
10. Is your organization affiliated with any Maryland State agency (as defined in COMAR
01.02.04.01L)?
Yes
No (If yes, and raised more than $750,000 you must submit an Audit
and Agreed upon Procedures Report with application)
If yes, list the name(s) of the Maryland State agencies of which you are affiliated (use a
separate sheet of paper, if needed): _______________________________
11. I have attached all forms required in the instructions.
I hereby certify that this registration statement and all supporting documents are true to the best of
my knowledge, and the IRS Form 990 or IRS Form 990-EZ for the above noted fiscal year submitted
to the Office of the Secretary of State under section 6-408 of the Business Regulation Article of the
Annotated Code of Maryland is a copy of the form submitted to the Internal Revenue Service.
________________________________
____________________________
Name of Individual Preparing this Form
Signature
________________________________
___________________________
Title
Date
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