Registration Statement For A Charitable Organization - South Carolina Secretary Of State
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4SOUTH CAROLINA
SECRETARY OF STATE
PUBLIC CHARITIES DIVISION
REGISTRATION STATEMENT FOR A CHARITABLE ORGANIZATION
Filing Instructions
Pursuant to Section 33-56-30 of the South Carolina Code of Laws, failure to complete all sections of this form may
cause your registration to be returned to you and may result in a possible violation and/or fine.
If this is a renewal, this form cannot be accepted more than six (6) weeks prior to the current expiration.
This form must be signed and accompanied by a filing fee of $50.00 made payable to the Secretary of State.
If the annual financial report for the immediately preceeding fiscal year has not already been filed with the
Secretary of State’s Office, please submit it with this form. You may submit your financial report on the
Annual
Financial Report for a Charitable Organization
which can be found on our website
or on IRS
Form 990, 990EZ, or 990PF; we cannot accept IRS Form 990-N. If the financial report is not ready you must
submit a copy of the extension request submitted to the IRS.
Please contact our office with any questions regarding this form at 803-734-1790 or email charities@sos.sc.gov.
Mail to South Carolina Secretary of State, Attn: Division of Public Charities, 1205 Pendleton St., Suite 525,
Columbia, SC 29201.
Please type or print clearly.
Check one:
[ ] Initial Registration
[ ] Renewal
Current Fiscal Year Dates ______________ to ______________
(mo/day/year)
(mo/day/year)
Enter Federal Employer’s Identification Number: _____ - _______________ Charity Public ID: ______________
(Renewal only)
1.
Legal Name of Organization: _____________________________________________________________________
a.
Doing Business As (DBA) Names: _____________________________________________________________
(If applicable)
b.
Former Names Used by the Charity: _____________________________________________________________
(If applicable)
c.
Organization’s Website: ______________________________________________________________________
(If applicable)
d.
Please provide a contact person for your organization:
__________________________________________________________________________________________
Name
Title
__________________________________________________________________________________________
Address, City, State, Zip Code
__________________________________________________________________________________________
Daytime Phone
Email
2.
Purpose for which this organization was formed. Attach a statement if necessary.
______________________________________________________________________________________________
3.
Tax-exempt status under the Internal Revenue Code:
[ ] YES [ ] NO
If "Yes," please provide a copy of any determination letter recognizing the charitable organization's tax-exempt
status from the Internal Revenue Service and any changes, amendments, or revocations to that letter.
Charities Registration Statement, Revised December 2016
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