Form Sc 53-10 - Registration Statement For Solicitations (Page 2 of 3) in pdf

Form Sc 53-10 - Registration Statement For Solicitations Page 2

Names

Street addresses

City

State

Zip

Officers:

Directors:

Trustees:

Principal salaried

employees:

(attach additional pages, if necessary)

10. Person having custody of such organization's financial records:

Name

Street address

City

State

Zip

11. Names of the individuals or officers of the organization who will have responsibility for the custody of contributions:

12. Names of the individuals or officers of the organization who will have responsibility for the distribution of the contributions:

13. Names of the individuals or officers of the organization who will have responsibility for the conduct of solicitation activities:

14. State the general purpose for which the organization intends to solicit contributions:

15. Does the organization intend to solicit contributions directly?

Yes

16. Does the organization intend to have such solicitation done on such organization’s behalf by others?

Yes

If YES, then name the professional fund raiser(s) the organization intends to use:

17. Methods of solicitation used:

Personal contact

Mail

Telephone

Radio

Volunteers

Internet

Vendors

Other

Specify

18. Is this organization authorized by any other states or governmental authorities to solicit contributions?

Yes

If yes, give jurisdiction

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Form Sc 53-10 - Registration Statement For Solicitations Page 2