Annual Financial Report Form For Charities - South Carolina Secretary Of State - 2017 Page 3
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5Certification
As required by Section 33-56-60 of the Solicitation of Charitable Funds Act, this form shall be signed by the Chief
Executive Officer and the Chief Financial Officer of the charitable organization. (If one person serves as both CEO
and CFO, he or she should sign in both places below.)
We certify that the information furnished in this statement is true and correct to the best of our knowledge and
belief.
CEO/President
CFO/Treasurer
Name : _________________________________
Name : _________________________________
Signature: _______________________________
Signature: _______________________________
Date: _______________
Date: _______________
Mailing Address: ___________________________________________________________________
Email Address: ______________________________ Phone Number: _________________________
Annual Financial Report, revised January 2017
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