501(C)3 Verification Form


Please verify your 501(c)3 status as a charitable organization, which is a requirement for
participation in Birdies for Charity. Attached please find a charitable organization form which
should be signed and returned before you may participate. Your official IRS 501(c)3 form is
not needed at this time, we just need verification that 501(c)3 status is still current for your
organization. This form must be signed for checks to be written to your organization. Money
collected by Birdies for Charity for organizations without 501(c)3 verification will be applied to
the Birdies for Charity Fund to benefit ALL participating, qualified 501(c)3 organizations.
Charity Name:____________________________________________________________
Bird #:__________________________________________________________________
Charitable Organization 501(c)3 Verification
This form certifies that (Charity name)___________________________________________
is still a valid 501(c)3 charitable organization as reflected in the original submission to the
Birdies for Charity program. It also certifies that the charity agrees to comply with the rules
and regulations of the Birdies for Charity program as stated in the official program rules. The
Birdies for Charity program is intended to support charitable organizations, services, operations,
and programs. It is not intended to be used for endowment or brick and mortar charitable
purposes. Charitable contributions may not be part of a capital campaign and must come from a
designated donor.
Signature and Title of person signing
Updated contact information if changed from prior year:
Contact Person:___________________________________________________________
Contact Address:__________________________________________________________
(required) Email address: ___________________________________________________
Contact Phone:____________________________________________________________
Please sign and return as soon as possible to:
Birdies for Charity
Attention: Amy Finn
15623 Coaltown Road
East Moline, IL 61244
Fax: (309)762-4668


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Parent category: Financial