SOUTH CAROLINA SOUTH CAROLINA 
                                      SECRETARY OF STATESECRETARY OF STATE   
                                                                                                                                            
                                            PUBLIC CHARITIES DIVISION PUBLIC CHARITIES DIVISION 
                                                                                                                                            
                ANNUAL APPLICATION FOR REGISTRATION EXEMPTION ANNUAL APPLICATION FOR REGISTRATION EXEMPTION 
                                                                                                                                            
                                                  FilingFiling InstructionsInstructions 
     Pursuant to Section 33-56-50 of the South Carolina Code of Laws, failure to complete all sections of this form may 
      cause your application for exemption to be returned to you and may result in a possible violation and/or fine. 
     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: Public Charities, 1205 Pendleton St., Suite 525, Columbia, SC  29201. 
     There is no fee for the filing of this application.    
                                                                                                                                          
      Name of Organization:   _____________________________________________________________________ 
   
                                   Check one:    [    ] Initial Registration     [    ] Renewal 
                                                                                                                                          
                         Application for Current Fiscal Year  ______________to ______________ 
                                                                                  (mo/day/year)         (mo/day/year) 
                                                                                                                                          
    Enter Federal Employer’s Identification Number: _____ - _______________    Charity Public ID:  ______________ 
                                                                                                                                         (If applicable)                                 (Renewal only) 
   
                             EXEMPTION QUALIFICATION (S.C. Code Section 33-56-50) 
  Select ONE of the following bases for exemption under section A or B, not both. If none of these qualifications 
  for exemption applies to your organization, you must submit a registration statement for a charitable 
  organization. 
   
  A.   Fundraising activities are not conducted by professional solicitors, professional fundraising counsel, or commercial 
      co-venturers and you are: 
  _____ (1)  an educational institution which solicits contributions from only its students and their families, alumni, 
         faculty, friends, and other constituencies, trustees, corporations, foundations, and individuals who are 
         interested in and supportive of the programs of the institution; 
  _____ (2)  a person requesting contributions for the relief of an individual specified by name at the time of the 
         solicitation, when all of the contributions collected, without deductions of any kind, are turned over to the 
         named beneficiary for his or her use, as long as the person soliciting the contributions is not a named 
          beneficiary; 
    
  _____ (3)  a charitable organization which (a) does not intend to solicit or receive contributions from the public in excess of 
         $20,000.00 in a calendar year and (b) has received a letter of tax exemption from the Internal Revenue Service, if all 
         functions, including fundraising activities, of the organization exempted pursuant to this item are conducted by 
         persons who are compensated no more than $500.00 in a year for their services and no part of their assets or income 
         inures to the benefit of or is paid to an officer or a member. 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; 
  _____ (4)  an organization which solicits exclusively from within its own membership, including utility cooperatives; 
  _____ (5)  a veterans’ organization which has a congressional charter;  
    
  _____ (6)  the State, its political subdivisions, and any agencies or departments thereof which are subject to the disclosure 
         provisions of the Freedom of Information Act. 
   
  B.   Regardless of whether your fundraising activities are conducted by professional solicitors, professional fundraising 
      counsel, or commercial co-venturers and you are: 
  _____ (1)  a public school district located in the State and any public school teaching pre-K through grade twelve located 
         within the public school district. 
  _____ (2)  a charitable organization that does not intend to solicit or receive contributions from the public in excess of 
         $7,500.00 during a calendar year.  
  
  Annual Application for Registration Exemption, revised May 2013  Annual Application for Registration Exemption, revised May 2013                                         Page 1 of 2            Page 1 of 2 
   

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. Physical address of your organization: 
 
   _______________________________________________________________________________________________
   Street Address, City, State, Zip Code 
              
3. Purpose for which this organization was formed:  _______________________________________________________ 
 
4. All organizations completing this form must provide the names of any professional solicitors, professional fundraising 
   counsel, or commercial co-venturers conducting fundraising activities for the organization. (Check one) 
    
   ___ Organization does not use professional solicitors, professional fundraising counsel, or commercial co-venturers. 
    
   ___ List of professional solicitors, professional fundraising counsel, or commercial co-venturers is attached. 
  
5. School Districts: Please provide a list of schools and any student organization within the schools that do not maintain 
   separate financial accounts or a separate federal Employer’s Identification Number (EIN) from the school and whose 
   fundraising revenues are deposited in the school’s student activity fund. 
 
I certify that the information furnished in this application and all attached supplementary information is true and correct to 
the  best  of  my knowledge, information and belief. I understand that the giving of false or incorrect information may 
constitute a misdemeanor carrying a penalty upon conviction of a fine of not more than two thousand dollars or 
imprisonment for not more than one year, or both, for a first offense.  A second or subsequent offense may constitute a 
felony carrying a penalty upon conviction of a fine of not more than five thousand dollars or imprisonment of not more than 
five years, or both. 
 
   CHIEF FINANCIAL OFFICER / TREASURER                                                                                              CHIEF EXECUTIVE OFFICER / PRESIDENT 
 
   _________________________________________                                                                                        _________________________________________
   Print Name                                                                                                                       Print Name 
 
   _________________________________________                                                                                        _________________________________________
   Signature                             Date                                                                                       Signature          Date
 
   _________________________________________                                                                                        _________________________________________
   Mailing Address                                                                                                                  Mailing Address 
 
   _________________________________________                                                                                        _________________________________________
   City, State, Zip                                                                                                                 City, State, Zip 
 
   _________________________________________                                                                                        _________________________________________
   Phone Number                                                                                                                     Phone Number 

Annual Application for Registration Exemption, revised May 2013  Annual Application for Registration Exemption, revised May 2013                                  Page 2 of 2            Page 2 of 2