Supplemental Solicitation Report - Washington Secretary Of State
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Charitable Solicitations RCW 19.09
Check all that apply:
□
Supplemental Report
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Expedited Service - If checked, enclose $50
(optional)
Make payable to: “Secretary of State”
REGISTRATION NUMBER:
(1-5 digits) ___________
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SUPPLEMENTAL SOLICITATION REPORT
(CHARITABLE ORGANIZATION)
Complete entire form or type “N/A” if not applicable and check boxes where indicated.
This form should only be used to report financial information following a change in accounting year.
SECTION 1
LEGAL NAME OF THE CHARITABLE ORGANIZATION:
SECTION 2
CHANGE OF ACCOUNTING YEAR INFORMATION:
Effective date of change: ________________
(mm/dd/yyyy)
Previous accounting year begin date ________________ and end date ________________
(mm/dd/yyyy)
(mm/dd/yyyy)
New accounting year begin date: ________________
and end date: ________________
(mm/dd/yyyy)
(mm/dd/yyyy)
Additional comments, if any
(describe)
SECTION 3A
DID THE ORGANIZATION FILE AN IRS FEDERAL RETURN FOR THE ACCT YEAR BEING REPORTED?
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YES, CHECK TYPE
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□
□
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FORM 990
FORM 990EZ
FORM 990PF
FORM 990-N (e-Postcard)
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NO, CHECK REASON
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CHURCH / CHURCH AFFILIATED
GOVERNMENT
ORGANIZATION NOT TAX EXEMPT
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ANNUAL GROSS RECEIPTS LESS THAN $25,000
COVERED UNDER GROUP RETURN
Continued on page 2
Charitable Organization Supplemental
Washington Secretary of State
Revised 11/2010
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