Registration Statement For A Charitable Organization - South Carolina Secretary Of State Page 3
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410. Check all states in which your organization is authorized to solicit contributions.
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ID
IL
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ME
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MT
NC
ND
NE
NH
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OK
OR
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If any other governmental authority that is not listed above has authorized your organization to solicit contributions,
enter the name of the governmental authority. Attach a list if necessary. ___________________________________
11. Check up to three boxes below that best describe the general purpose for which solicited contributions are to be used.
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12. Is your organization currently, or has it in the past, been the subject of a legal or administrative action concerning a
charitable solicitation, fundraising campaign, or campaign with a commercial co-venturer by another local, state or
federal governmental authority including, but not limited to, registration or license revocation or denial, fines,
injunctions or suspensions? [ ] YES [ ] NO If “Yes,” please attach an explanation of all actions.
13. Have any of the organization’s officers, directors, trustees or board members been the subject of a criminal conviction,
including guilty or nolo contendere pleas, involving any charitable solicitations act, fraud, dishonesty, or false
statement in a jursidiction within the United States? [ ] YES [ ] NO If “Yes,” please attach a description and
date of any such conviction.
14. If any of the charitable organization’s officers, directors, trustees or board members are related to one another by blood,
marriage or adoption, please provide a statement as to the relationship(s).
_______________________________________________________________________________________________
15. If any of the charitable organization’s officers, directors, trustees or board members are related by blood, marriage or
adoption to a director or officer of a professional fundraising counsel or professional solicitor under contract with the
charitable organization, please provide a statement as to the relationship(s).
_______________________________________________________________________________________________
Charities Registration Statement, Revised December 2016
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