Solicitation License Application - Charitable Or Sponsor Organization printable pdf download

Solicitation License Application

North Carolina Department of the Secretary of State

Charitable or Sponsor Organization

Charitable Solicitation Licensing Division

PO Box 29622

Raleigh, NC 27626-0622

Phone: 919-807-2214 NC only Toll Free: 1-888-830-4989 Email:

Website:

__________________________________________________________________________________________________________________________________________________________________________________________

If applicant received less than $25,000 in N.C.G.S. §131F-2(5) contributions in immediate preceding fiscal year and does

not compensate any officer, trustee, organizer, incorporator, fundraiser, or solicitor, applicant may be eligible for

exemption and may file “Request for Exemption Under 131F-3(3)” and submit supporting documentation available at

in lieu of filing license application.

______________________________________________________________________________________________________________ ____________________________________________________________________________

1. Check appropriate box:

Initial Application

Renewal Application

2. N.C. Charitable Solicitation License Number:________________________(renewal applicants only)

3. Legal Name of Applicant Organization:______________________________________________________________________________

4. Principal Street Address:__________________________________________________________________________________________

5. City: _________________________________________ State: _______________ Zip Code: ___________________________________

6. Mailing address (may not be third party filer):________________________________________________________________________

7. Telephone number: ____________________________________ 8. Email address: __________________________________________

9. Website: ______________________________________________________________________________________________________

10. List all other NC locations:

Street address(es):______________________________________________________________________________________________

Telephone number(s):___________________________________________________________________________________________

11. Charitable purpose for which applicant is organized:__________________________________________________________________

________________________________________________________________________________________________________________

12. Charitable purpose for which solicited contributions will be used:________________________________________________________

________________________________________________________________________________________________________________

13. Major program activities of applicant:______________________________________________________________________________

________________________________________________________________________________________________________________

14. Applicant’s Fiscal Year End Date: (month/day)_______________________________

15. Has applicant received a federal tax exemption determination letter?

Yes

No IRS Tax Exemption Code: ______________

If yes, applicant must provide a copy of their “IRS Tax Exempt Determination” letter to the Department with this application or upon

receipt to obtain a tax exempt license. Once submitted, the Department will keep the applicant’s letter on file.

16. Applicant’s State of Establishment:___________________ Applicant’s Date of Establishment:______________________

For non-NC corporations: Certificate of Existence or Certificate of Good Standing from state of incorporation dated no more

than six months prior to date of signing of current license application must be filed with application.

For non incorporated applicants: Copy of stamped certificate of “doing business as” or “assumed name” filed with local

__________________________________________________________________________________________________________________________________________________________________________________________

The following items must be included with your application package:

17. List of all names used by applicant in the solicitation of contributions. All names must be legally registered and documentation of

legal registration of all names in state where registered must be filed with application.

18. List of all states where applicant is authorized to solicit contributions.

19. List of names and street addresses of directors, officers, trustees, and salaried executive personnel for current fiscal year. (The

applicant’s street address may be used.)

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