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        Standardized Registration  

                                  for  

        Nonprofit Organizations©
                                                     
        Under State Charitable  

                    Solicitation Laws 
                                   
   A product of an ongoing project of the National 

 Association of Attorneys General (NAAG) and the 

   National Association of State Charities Officials 

                          (NASCO) 

        In collaboration with the Multi-State  

                    Filer Project, Inc. (MFP) 
                    http://www.multistatefiling.org 
                                   
                    v. 4.0 2 February 201 4
 
©  201 4MULTI-STATE FILER PROJECT

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NAAG/NASCO Standardized Reporting URS v. 4.0 2 Introduction Pg. 1

Introduction & Contents

Why must my organization “register?”
The simple answer is “it’s the law.” Typically, states exercise regulatory authority over nonprofits
based on one (or both) of two premises: the nonprofit is physically “present” in the state (e.g., has an of-
fice, owns real estate, or conducts program activities) or the nonprofit raises funds in the state.
In either case, a state may require the nonprofit to “register”, that is, to provide identifying infor-
mation about the nonprofit and its operations. It is the latter premise for registration -- raising funds --
that provides the impetus for the Unified Registration Statement and the movement for standardized re-
porting in general. Organizations of any size and any means may find that raising funds from the public -
-even when conducted modestly from a single location -- will give rise to regulatory obligations to multi-
ple states.
In fact, today most states regulate fundraising. They do so through statutes -- usually called “so-
licitation laws” -- that are primarily concerned with the solicitation of charitable contributions from the
general public. The centerpiece of most of the regulatory schemes is comprehensive reporting, by non-
profits and by the outside fundraising firms and consultants they employ.

What is “registration?”
Compliance reporting under solicitation laws is divided into two pieces: (1) registration, which
provides an initial base of data and information about an organization's finances and governance; and (2)
annual financial reporting, which keeps the states apprised about the organization's operations with an
emphasis on fundraising results and practices. Typically, states require both registration (at least an initial
registration) and annual financial reporting.
With forty jurisdictions regulating in this manner, there is inevitably little consistency of approach.
Some states have one-time registration; others require annual renewal of registration; some will require
submission of every common governance and financial document; others make do with just an IRS Form
990; and so forth. But each has its own registration form (or forms) and, until the advent of the URS, re-
quired its submission, verbatim.
PLEASE TAKE SPECIAL NOTE: The URS and this packet are designed for registration only.
For many states, the URS cannot be used to fulfill annual financial reporting requirements. A project
is underway to produce a standardized format -- like the URS -- for annual financial reporting (see be-
low). For now, the URS is the sole device for standardized, multi-state filing and it applies only to regis-
tration and registration renewal (which may be required yearly but, we say again, may be distinct from
annual financial reporting).

Which nonprofits must register (and when)?
Generally, any nonprofit conducting a charitable solicitation within the borders of a state, by any
means, is subject to that state’s law and is therefore required to register (and must do so before soliciting).
Also, generally, the operative terms “charitable” and “solicitation” are defined very broadly and could in-
clude, for example, a website posting by an environmental organization inviting contributions from the
public.
In other words, the soliciting organization need not be a “charity” in a strict sense nor have any
physical presence of any kind in the state. So, a letter, phone call, or newspaper ad requesting financial
support from a state's residents is enough, in the unchallenged legal opinion of the states, to trigger the
coverage of (i.e., give jurisdiction to) that state's solicitation law.
However, Internet fundraising does not neatly conform to existing models -- neither jurisdictional
models nor fundraising models. The ultimate jurisdictional question, roughly put, is “Has someone pur-
posefully directed a charitable solicitation to a resident of our state?” A “yes” provides a state with a ra-
tionale for exercising jurisdiction. The question and answer get very fuzzy in cyberspace.
The National Association of State Charity Officials (NASCO), recognizing the challenges posed
for both nonprofits and regulators, has developed a protocol to aid all concerned (see the “Charleston

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NAAG/NASCO Standardized Reporting URS v. 4.0 2Introduction Pg. 2

Principles” at www.nasconet.org). The protocol will guide state officials in exercising jurisdiction over
Internet transactions and it will help nonprofits determine whether (and when) their Internet fundraising
activity will subject them to solicitation law registration and reporting.
Against this framework of all-inclusiveness is a patchwork of exclusions from coverage. These
are the product of each state's constitutional and political considerations. Either through exemption from
registration requirements or out-and-out exclusion from the law, each state excuses some nonprofits from
registering. For example, every state grants an exemption (or exclusion) to “religious organizations,” as
the term is respectively defined, and most have exemptions for colleges and universities or for organiza-
tions raising only small amounts (say, under $5,000). Please see the Appendix for details on each state.
Significantly, technical compliance with any state's registration law requires initial registration
before the first solicitation has been directed into the state. The fact remains that many nonprofits have
not done the necessary legal homework before launching fundraising campaigns. If your nonprofit is one
of these, you should be very concerned. But you should not be deterred from going ahead with registra-
tion because you fear you are breaking a law already and it's too late to comply.
Failure to register before soliciting isa violation of law and could subject the organization (and in
some circumstances, its officers or directors) to whatever sanctions (e.g., a substantial fine) exist in each
state's law. But, the states generally wish to encourage honest efforts to comply with registration laws and
tend to employ sanctions only when enforcement officials deem it necessary. So, an organization able to
demonstrate its good faith which promptly registers after discovering its obligation (albeit tardily) stands
a good chance of avoiding or minimizing sanctions. The bottom line: registration is the law and you
must comply as soon as possible.

What is the Unified Registration Statement?
The URS represents but a single part of an effort to consolidate the information and data require-
ments of all states requiring registration. Organized by the National Association of State Charities Offi-
cials and the National Association of Attorneys General, the project’s aim is to standardize, simplify, and
economize compliance under the states' solicitation laws.
The URS effort consists of three phases: (1) compiling an inventory of registration information
demands from all states, (2) producing a format (or form) which incorporates all (or most) of these de-
mands, and (3) encouraging the states to accept this “standardized” format as an alternative to their own
forms. The effort is dynamic and ongoing, now represented by version 4.0 of the URS, which is accepted
by thirty-seven of the forty jurisdictions requiring registration. Reflecting this dynamic,the URS will be
updated continually by way of its website (http://www.multistatefiling.org/). See Item #6 in the “Re-
minders” section (URS Instructions, pg. 4) for more information on URS packet updates.

How do you use the URS?
The URS is an alternative to filing all of the respective registration forms produced by each of the
cooperating states. In those states, a registering nonprofit may useeither the state form orthe URS. Thus,
the URS proves most useful to nonprofits soliciting regionally or nationally and, therefore, subject to the
registration laws of multiple states. But the URS may be used by any nonprofit that is registering in a state
accepting it.
Conceptually, the process is simple. You fill out the URS by following its accompanying instruc-
tions; photocopy the completed URS (with state-specific items, including signature lines, left blank); fill
in any state-specific items; execute (i.e., sign with or without notary) according to each state's require-
ments; collect and attach the specified governance (for initial filings) and other documents; write a check
for the prescribed registration fee (if any); and mail the package, covered by the URS, to the respective
state's administering agency. Please see the Appendix for a listing of state-specific items, necessary doc-
uments, fee for filing, and address of each state’s administering agency. Important note: do NOT send
completed URS forms to the Multi-state Filer Project; we do not process these. They must go to each
state in which you are registering.

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NAAG/NASCO Standardized Reporting URS v. 4.0 2Introduction Pg. 3

What's in this packet?
The URS is presented here along with additional materials and information. The goal is to enable
most users to complete their registrations (for URS states) without the need to acquire information or ma-
terials outside this packet. Please read the following description of the packet's contents to learn what's
here and where to find it:
* URS (3 pgs) and Instructions (4 pgs.) – Only one copy of the URS is provided with this packet. Make a
back up photocopy of the blank form before you begin work. Note that the submitted URS will be consid-
erably longer than the 3 pages of the form due to several required attachments. Please consult the instruc-
tions while filing out the URS for information on how to answer each question.
* Supplementary Forms (22 forms/instructions from 15 jurisdictions) – A number of states wished to co-
operate with the URS effort but found it necessary for legal or other reasons to request information and/or
offer instruction on forms designed to supplement the URS. For those states, the respective supplementary
form or information must accompany the URS.
* Appendix (15 pgs.) – Provides state-by-state filing details for each of the thirty-six cooperating states
and DC. Please closely attend to the following notes for helpful information about the Appendix:
(1) The Exemptions entries are NOT verbatim from the laws. If you believe your organization may be ex-
empt in one or more states, be cautious and refer to the law (See Governing law in the Appendix for cita-
tion), regulations, and/or applicable form from the respective states.
(2) Due date refers to the day that the first filing subsequent to the initial registration is due (initial regis-
tration is required before solicitation begins). This subsequent filing may be termed a “registration re-
newal” or an “annual financial report.” See (7), below, for information on due dates for annual financial
reports.
(3) Fund Raiser contracts refer to the actual contractual documents establishing your relationship with
outside fundraising professionals described in URS Item 20. A “yes” here in a state's entry means you
must copy and submit all such contracts, along with the URS, to that state. Note too that subsequent con-
tracts may have to be submitted (either when entered into, with registration renewal, or as part of required
annual financial reporting).
(4) Your Certificate of Incorporation,Bylaws , and IRS Determination Letter (official letter from Internal
Revenue Service establishing federal tax-exempt status) are one-time submissions with initial registration.
Unless amended after initial registration, they need not accompany renewal filings.
(5) In obvious contrast, Audit and IRS Form 990 change from year to year. A “yes” means that the most
recently completed versions must be submitted with the URS. Note that while a state (e.g., Oregon) may
not require either for purposes of registration, it might require the current version of either or both as part
of annual financial reporting. Also note that states articulate the need to submit an audit very differently –
pay close attention to the requirements listed in the Appendix to the URS, as the actual terminology of
each state is used for this entry.
(6) Information about registration for States not yet accepting the URSis included.
(7) Basic information on annual financial reporting (and/or registration renewal) for all URS states is in-
cluded in a separate section. Although the URS has not been officially sanctioned for use in fulfilling an-
nual financial reporting/renewal requirements, the information is provided here to help filers understand
and coordinate their reporting obligations.
* Help (3 pgs.) – Provides several aids for filers, itemized below:
(1) The Checklist recapitulates much of the Appendix in an easy-to-read, yes-no format. It serves as a use-
ful tool when, for example, you are submitting multiple registrations and need to be assured that each
state receives the necessary components.
(2) Changes to the URS detail changes to each version of the URS packet since v. 2.00.
(3) Site List provides sources for printed copies of the URS packet.

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NAAG/NASCO Standardized Reporting URS v. 4.0 2Introduction Pg. 4

What's next for the Standardized Reporting Project?
In every sense, both the URS and the Project are a work in progress. There are four components
to reporting under the solicitation laws: registration for nonprofits, annual reporting for nonprofits, regis-
tration for outside professionals, and annual reporting for outside professionals. Although work on the
additional four components is under way, the URS (nonprofit registration) is the sole product in service.
While the “standardized” approach implies continual change, even the threshold work on the URS
is not complete. For example, page 12 of the Appendix lists the three remaining states that, for one rea-
son or another, have not yet chosen to participate by accepting the URS. Neither the URS nor any subse-
quent products will achieve maximum utility untilall states are cooperating.
Version 4.0 2of the URS packet contains numerous refinements, many of them the product of user
comments. Consequently, your feedback is very important. Please direct any comments you may have
about suggested improvements (or about errors you believe you've discovered) to the URS, its instruc-
tions, or to the accompanying materials to:

Karin K. Goldman and/or Robert Tigner
Charities Trusts Bureau General Counsel
New York State Attorney Gen- Multi-State Filer Project
eral Office 1612 K Street, NW
120 Broadway Suite 510
Third floor Washington, DC 20006-2802
New York, NY 10271-0002 (202) 463-7980
(212) 416-8060
chnkkg@oag.state.ny.us

Note: Please do not send the Multi-State Filer Project your completed URS form. These go directly
to the state(s) you are registering in.

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NAAG/NASCO Standardized Reporting URS v.4.02 Pg1

Unified Registration Statement (URS) for Charitable Organizations© (v. 4.02)
Initial registration Renewal/Update
This URS covers the reporting year which ended (day/month/year)
Filer EIN
State State ID

1. Organization’s legal name ___________________________________________________________________________
If changed since prior filings, previous name used ________________________________________________________
All other name(s) used

2. (A) Street address __________________________________________________________________________________
City County _________________________________
State Zip Code _________________________________
(B) Mailing address (if different) ______________________________________________________________________
City County _________________________________
State Zip Code _________________________________
3. Telephone number(s) Fax number(s) _________________________________
E-mail Web site _________________________________

4. Names, addresses (street & P.O.), telephone numbers of other offices/chapters/branches/affiliates (attach list).

5. Date incorporated _______________________________ State of incorporation ______________________________
Fiscal year end: day/month _______________________________________

6. If not incorporated, type of organization, state, and date established __________________________________________
________________________________________________________________________________________________

7. Has organization or any of its officers, directors, employees or fund raisers:
A. Been enjoined or otherwise prohibited by a government agency/court from soliciting? Yes No
B. Had its registration denied or revoked? Yes No
C. Been the subject of a proceeding regarding any solicitation or registration? Yes No
D. Entered into a voluntary agreement of compliance with any government agency or in a case before a court or
administrative agency? Yes No
E. Applied for registration or exemption from registration (but not yet completed or obtained)? Yes No
F. Registered with or obtained exemption from any state or agency? Yes No
G. Solicited funds in any state? Yes No
If “yes” to 7A, B, C, D, E, attach explanation.
If “yes” to 7F & G, attach list of states where registered, exempted, or where it solicited, including registering agency,
dates of registration, registration numbers, any other names under which the organization was/is registered, and the dates
and type (mail, telephone, door to door, special events, etc.) of the solicitation conducted.

8. Has the organization applied for or been granted IRS tax exempt status? Yes No
If yes, date of application OR date of determination letter .
If granted, exempt under 501(c) . Are contributions to the organization tax deductible? Yes No

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NAAG/NASCO Standardized Reporting URS v. 4.02 Pg2

9 . Has tax exempt status ever been denied, revoked, or modified? Yes No

10. Indicate all methods of solicitations:
Mail Telephone Personal Contact Radio/TV Appeals
Special Events Newspaper/Magazine Ads Other(s) (specify)

11. List the NTEE code(s) that best describes your organization , ,

12. Describe the purposes and programs of the organization and those for which funds are solicited (attach separate sheet if
necessary).
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________

13. List the names, titles, addresses, (street & P.O.), and telephone numbers of officers, directors, trustees, and the principal
salaried executives of organization (attach separate sheet).

14. (A) (1) Are any of the organization’s officers, directors, trustees or employees related by blood, marriage, or adoption to:
(i) any other officer, director, trustee or employee OR (ii) any officer, agent, or employee of any fundraising
professional firm under contract to the organization OR (iii) any officer, agent, or employee of a supplier or
vendor firm providing goods or services to the organization? Yes No
(2) Does the organization or any of its officers, directors, employees, or anyone holding a financial interest in the
organization have a financial interest in a business described in (ii) or (iii) above OR serve as an officer, director,
partner or employee of a business described in (ii) or (iii) above? Yes No
(If yes to any part of 14A, attach sheet which specifies the relationship and provides the names, businesses, and
addresses of the related parties).
(B) Have any of the organization’s officers, directors, or principal executives been convicted of a misdemeanor or felony?
(If yes, attach a complete explanation.) Yes No

15. Attach separate sheet listing names and addresses (street & P.O.) for all below:
Individual(s) responsible for custody of funds. Individual(s) responsible for distribution of funds.
Individual(s) responsible for fund raising. Individual(s) responsible for custody of financial records.
Individual(s) authorized to sign checks. Bank(s) in which registrant’s funds are deposited (include account
number and bank phone number).

16. Name, address (street & P.O.), and telephone number of accountant/auditor.
Name __________________________________________________________________________________________
Address ________________________________________________________________________________________
City State Zip Code Telephone ______________________
Method of accounting _____________________________________________________________________________

17. Name, address (street & P.O.), and telephone number of person authorized to receive service of process. This is a state-
specific item. See instructions.
Name __________________________________________________________________________________________
Address ________________________________________________________________________________________
City State Zip Code Telephone ______________________

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 NAAG/NASCO Standardized Reporting                                                                                                                                                       URS v. 4.02 Pg3 
  
 18. (A)  Does the organization receive financial support from other nonprofit organizations (foundations, public charities, combined 
         campaigns, etc.)?     Yes       No    
    (B)  Does the organization share revenue or governance with any other non-profit organization?     Yes       No                                                                              
    (C)  Does any other person or organization own a 10% or greater interest in your organization OR does your organization 
         own a 10% or greater interest in any other organization?     Yes       No    
    (If “yes” to A, B or C, attach an explanation including name of person or organization, address, relationship to your 
    organization, and type of organization.) 

 19.  Does the organization use volunteers to solicit directly?       Yes       No    
     Does the organization use professionals to solicit directly?       Yes       No    

 20. If your organization contracts with or otherwise engages the services of any outside fundraising professional (such as a 
     “professional fundraiser,” “paid solicitor,” “fund raising counsel,” or “commercial co-venturer”), attach list including 
     their names, addresses (street & P.O.), telephone numbers, and location of offices used by them to perform work on 
     behalf of your organization. Each entry must include a simple statement of services provided, description of 
     compensation arrangement, dates of contract, date of campaign/event, whether the professional solicits on your behalf, 
     and whether the professional at any time has custody or control of donations. 
 21.  Amount paid to PFR/PS/FRC during previous year:  $                            
 22. (A)  Total contributions:  $                          
    (B)  Program service expenses:  $                            
    (C)  Management & general expenses:  $                                
    (D)  Fundraising expenses: $                                      
     (E)  Total expenses:  $                                                                             
  
    (F)  Fundraising expenses as a percentage of funds raised: ______________%  
    (G)  Fundraising expenses plus management and general expenses as a percentage of funds raised:  _________% 

    (H)  Program services as a percentage of total expenses: ___________%  

 Under penalty of perjury, we certify that the above information and the information contained in any 
 attachments or supplement is true, correct, and complete. 
  
 Sworn to before me on (or signed on)                                 , 20          
  
 Notary public (if required)                                           
  
   __________________                                                 _______________________
 Name (printed)                                                       Name (printed) 
  
                                                                        ________________________________________   
 Name (signature)                                                     Name (signature) 
  
                                                                        ________________________________________   
 Title (printed)                                                      Title (printed) 
  
Consult  the state-by-state appendix to the URS to determine whether supporting documents, supplementary state 
forms or fees must accompany this form.      Before submitting your registration, make sure you have attached or 
included everything required by each state to the respective copy of the URS. 
 
Attachments may be prepared as one continuous document or as separate pages for each item requiring elaboration. 
In either case, please number the response to correspond with the URS item number. 
 
© 2014 M U L T I - S T A T E  F I L E R  P R O J E C T

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NAAG/NASCO Standardized Reporting URS v. 4.0 2Instructions Pg. 1

INSTRUCTIONS for Unified Registration Statement ©(URS)

Preliminary identifying information: Indicate whether registration is initial or renewal by checking the correct
box at top of page.
Reporting period: Insert state-specific end date for registration period covered by this URS—applicable to
renewals and to states with a fixed-date reporting cycle (“N/A” as to states with one-time registration. Leave
blank for initial registration in states with “anniversary” due dates.)
Filer EIN: Enter the organization’s federal Employer Identification Number (EIN).
State: Enter state to which this particular copy of the URS will be submitted.
State ID: Enter state-specific ID, ifthis is a renewal or update, and the state to which this particular copy of
the URS will be submitted has assigned the organization a unique file, license or identifying number.

Item #1: Enter organization's legal name; previous name used if an immediately prior filing was made under the
previous name; and any other names the organization may be identified as or known as. Under “other names,”
include any distinctive names, such as one given to a particular campaign, the organization uses for purposes of
public solicitation (e.g., “The Citywide Dance Project” of Houston Arts Advocates, Inc).
Item #2(A, B): Fill out complete street address in item #2A. Fill out complete mailing address (e.g., a generally
used P.O. Box) in item #2B, if different from above.
Item #3: List primary telephone and facsimile numbers. Also, provide address for electronic mail or web site(s)
if used to provide information to or to communicate with the public.
Item #4: Attach list of all other offices, chapters, branches and/or affiliates with complete names and addresses.
PLEASE NOTE Kansas, Maine, Mississippi, and Tennessee require you specifically indicate the offices,
chapters, etc. for their states in your respective URS submission to them.
Item #5: Fill out organization's date of incorporation, the state where it was incorporated, and the day and
month of its fiscal year end. Go to Item #7.
Item #6: If your organization is not incorporated, list the type of organization, state in which it is located, and
date of establishment (if a partnership, include the partners’ names, addresses, and telephone numbers).
Item #7: Answer questions A through G by checking the appropriate box. If you answer “yes” to A, B, C, D,
and/or E, you must attach a written explanation. If you answer “yes” to F and/or G, attach a listing of all states
where registered, or from whom an exemption was obtained, or in which your organization solicited
contributions (include agencies, dates of registration, registration numbers, any other names organization was/is
registered under, and the dates and types of solicitation conducted).
VERY IMPORTANT: In answering 7G for an initial registration in a given state, make sure you have
provided a specific date when solicitation began (if your answer to 7G is “yes”) in that state; OR, if “no” (or
“no” as to the state in question) but you intend to begin soliciting, give the approximate date you expect to
begin soliciting in that state.
Item #8: Check the appropriate box. If you answer “yes,” list date of application or the date of the IRS
determination letter. If exempt status has been granted, supply the IRS Code section number (e.g., “501(c)(3)”
or “501(c)(4)”) under which the organization secured its exemption. Please note some states also require a
copy of the organization’s IRS determination letter or application for exemption (see state-by-state Appendix).
Item #9: Answer by checking the appropriate box. If you answer “yes,” please attach a written explanation.
Item #10: Answer by checking all appropriate boxes. Use “other” blank to specify any solicitation method not
listed (if your organization raises funds by operating or sponsoring games of chance, such as bingo or “casino
nights”, you must report that fact, specifying the game, in the “Other” blank).
Item #11: The National Taxonomy of Exempt Entities (NTEE) is a system for classifying nonprofits developed
by the National Center for Charitable Statistics. From the twenty-six major groupings of the NTEE system,
below, select the code letter best describing the organization’s primary purpose or field of endeavor (you may
enter a second or third code letter if no single code seems adequate):

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NAAG/NASCO Standardized Reporting URS v. 4.0 2Instructions Pg. 2

A Arts, culture, humanities J Employment, job related S Community improvement, capacity
B Educational institutions & related K Food, nutrition, agriculture building
activities L Housing, shelter T Philanthropy, voluntarism and
C Environmental quality, protection & M Public safety, disaster preparedness & Grantmaking foundations
beautification relief U Science and technology research
D Animal related N Recreation, sports, leisure, athletics V Social science research
E Health-general & rehabilitative O Youth development W Public affairs, society benefit
F Mental health, crisis intervention P Human services X Religion, spiritual development
G Disease, disorders, medical disciplines Q International, foreign affairs, national Y Mutual/membership benefit
H Medical research security Z Unknown, unclassifiable
I Crime, legal related R Civil rights, social action, advocacy
Item #12: Explain purposes and programs of organization for which funds are solicited. If programs are
directed to specific beneficiaries, list or describe the beneficiaries. Attach a separate sheet of paper if necessary.
Item #13: Attach list of officers, directors and executives of organization complete with their residence
addresses and telephone numbers. At your discretion, you may supply a daytime phone number instead, so long
as the person can generally be reached at the number during normal business hours.
Item #14: (A) (1&2) Answer by checking the appropriate box. If you answer “yes” to any of the relationships
described, attach the requested information for all the related parties.
(B) Answer by checking appropriate box. If you answer “yes,” attach a written explanation. A “misdemeanor
or felony” is a crime and does not include violations of civil ordinances, such as minor traffic offenses.
Item #15: On an attached sheet, provide the names and addresses of the people with the specified re-
sponsibilities. Please clearly indicate the respective responsibility for each name listed. Also include the
names, addresses, and phone numbers of all banks, and all accounts (provide numbers), in which organization's
funds are deposited. “Custody” means legal custody of the organization’s funds, typically the charge of the
treasurer. Person responsible for “distribution” means the person, typically the president or chief executive,
who has primary day-to-day authority over disposing of the organization’s funds.
Item #16: List name, address and telephone number of organization’s outside accountant and/or auditor.
Exclude from this item an outside accountant or accounting firm employed solely as a bookkeeper.
Item #17: This item should be left blank, expect for a few selected instances, specified below. Some states
require you to appoint one of their residents to receive legal notices (“service of process”) in order to affect your
registration. This person is variously termed a “resident agent” or “registered agent.” Of the states requiring
such an appointment, some permit you to make it by filling in this item on the URS. Fill in this item only for
each such state, and then, only with the name, address and telephone number of the agent for that state.
Consult the state-by-state Appendix for further information.
Item #18: Answer by checking the appropriate box. Provide all the requested information for all persons or
organizations producing a “yes” (and if yes for 18C, specify the percentage interest). For “type of
organization”, include both organizational structure (such as “corporation,” “partnership,” or “unincorporated
association”) and whether the organization is for-profit or nonprofit.
Item #19: Answer by checking the appropriate box. A person solicits “directly” when they have actual contact
with potential donors, such as when placing telephone calls or when going door-to-door.
Item #20: Attach a list of outside professionals providing fundraising services to your organization. Include in
the list companies who are conducting “cause-related marketing” for your benefit (such companies are subject
to regulation—typically as “commercial co-venturers”—under the solicitation laws of several states). Supply a
complete address (street & P.O. Box) and phone number for each office location providing services.
The terms employed (e.g., “fund raising counsel”), although commonly used, are illustrative only. In
practice, the precise and operative definitions of the categories of professionals derive from each state's law and,
therefore, vary from state to state. In some instances, two (or more) states will use the same term to describe a
different group of professionals; in other instances, identical categories of professionals will be described by
different terms.
To accommodate the disparity in terminology, you must either (1) determine the correct term for your
professionals by reference to each state's law and customize each URS submission accordingly or (2) provide

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NAAG/NASCO Standardized Reporting                                                     URS v. 4.0 2Instructions Pg. 3 

generic information on the URS from which each state can readily make the necessary determinations under its 
law. 
     You may comply with Item #20's requirements by choosing option (1), above, but the item is structured 
to implement option (2).  The two examples that follow illustrate complete option (2) replies: 
     (a) “Great Telemarketing, Inc., 543 First Ave, New York, NY, 10036, 212-555-1212; plans and 
     manages telephone campaign for public support and awareness; GTI charges us $4.50 per completed 
     call plus $1.50 per pledge; our contract with GTI is from January 1, 2004 to December 31, 2005; the 
     campaign will run from April 2004 to October 2004; GTI, through another firm it employs, solicits 
     donations on our behalf; GTI does not itself handle donations but employs a caging company that 
     receives, logs and deposits contributions.” 
     (b) “John James & Associates, 325 Mason St, San Francisco, CA, 94111, 415-989-8765; designs and 
     manages direct mail campaigns for recruiting and retaining members; we pay JJA a fee of $1,000 per 
     month plus $45 per thousand letters mailed; our contract with JJA runs from July 1, 2004 through June 
     30, 2005; the campaign is continuous; JJA does not solicit contributions; JJA does not have custody or 
     control of contributions, replies come directly to our P.O. Box.” 
     [There is no specified format for responding to Item 20.  However, especially if you are reporting 
     multiple professionals, organizing the required information in a chart or table may help assure 
     that your response is complete and clear.] 
     Finally, and VERY IMPORTANT, you must provide accurate information as to whether the listed 
professionals are engaged in fundraising in each state in which you are filing the URS.  You may address this 
issue by listing the respective states with each firm entry (e.g., to the GTI entry above, you might add: “only 
conducts campaigns for us in New York, New Jersey, Ohio, Illinois, and Pennsylvania”).  Regardless of 
method, absent a clear indication to the contrary, each state receiving the URS will assume all firms listed are 
subject to its law and will proceed accordingly with enforcement. 
     NOTE:  Some states require you to submit copies of all of your contracts with retained outside 
fundraising professionals.  See the state-by-state listing in the Appendix.  
Item #21: List the total amount paid in fees and attributable expenses to any outside fundraising professionals 
during the previous reporting year.  Specify the period covered by this total (e.g., “fiscal year running from July 
1, 2009 through June 30, 2010”).  All or most of this entire total should derive from line 16(A) of the IRS 990.  
Item #22: (A) List total contributions for reporting year.  Item #22A should be the result of taking the number 
on Form 990, Part VIII, Line 1h, and subtracting Line 1b (membership dues).  (Or Line 1 on the 990-EZ) 
     (B) List total program services expenses for reporting year.  Item #22B should be the same number 
appearing onpart IX, line 25(b) of the IRS 990. (there is no equivalent on the 990EZ). 
     (C) List total management & general expenses for reporting year.   Item #22C should be the same 
number appearing on line 25(c) of the IRS 990. (there is no equivalent on the 990EZ). 
     (D) List total fundraising expenses for reporting year.  Item #22D should be the same as the number 
appearing online 25(d) of the IRS 990 (there is no equivalent on the 990EZ). 
     (E) List total expenses for reporting year.  Item #22E should be the same as the number that appears on 
line 18 of the IRS 990 (or on line 17 on the 990EZ). 
     (F) Express fundraising expenses as a percentage of contributions raised (divide Item #22D by Item 
#22A). 
     (G) Express fundraising expenses plus management and general expenses as a percentage of total 
contributions.  (divide Item #22C + Item #22D by Item #22A). 
     (H) Express program services as a percentage of total expenses (divide Item #22B by Item #22E). 
Signature Box: Signatures may not be photocopied.   The URS must be executed with original signatures.  
Requirements vary as to who must sign (i.e., which nonprofit official) and whether the signatures must be 
notarized.  Refer to the state-by-state listing in the Appendix to ensure the designated official(s) has signed for 
the respective state and the signature(s) has been notarized, if required.  Some states stipulate signers are 
making certain specific representations by signing and submitting the URS.  This information can be found in 
the “required signatures” entry in the Appendix.

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NAAG/NASCO Standardized Reporting URS v. 4.0 2Instructions Pg. 4

A few IMPORTANT REMINDERS:

1. Before submitting a URS to any state, make sure you have checked the state-by-state listing in the Appendix
for all items that must accompany the URS.

2. Renewal registrants need not re-submit governance documents unless they have been amended (see #5,
below).

3. Please do not leave any URS items blank. Entering “N/A” (not applicable), or some other appropriate
message, will assure the reviewing official that you have not inadvertently omitted a required reply.

4. The URS is to be used for registration filings (initial or renewal). Officially, it cannot be used for annual
financial reporting. Annual financial reporting is a parallel, but separate and distinct from registration, filing
requirement under most state solicitation laws (see page 1 of Introduction to URS, “What is ‘registration’?”).

5. Registrants in all states assume a continuous obligation to keep their registrations accurate and up to date.
So, for example, in a state with one-time registration, a registrant is required to forward changes in governing
documents, a task that would otherwise be accomplished with registration renewal. Similarly, in states
requiring copies of fundraising contracts as part of registration, new or amended contracts entered into after
registration (or during the registration period, in renewal states) must be filed immediately upon execution
(since a filed contract is a prerequisite to solicitation in many jurisdictions).

6. All filers of the URS should check the website (http://www.multistatefiling.org/) for updates to this packet.
Continual changes will be made to this version of the URS packet as the need arises. In effect, the Web
version of the URS packet will always be the “official,” up-to-date version. Visitors to the site will find the
most recent packet and they will be directed to information that itemizes, cumulatively, all changes introduced
to the version 4.00 packet.
So filers and state officials may more readily identify the documents with which they are working, we have
developed the following protocol for reflecting changes to the original 4.00 document:
• Minor (but material) changes to instructions, filing information, etc. (such as mailing address or fees)
will be indicated by successive changes to the last digit in the version number. So, for example, the first
batch of minor changes was introduced into ver. 4.01 (and so on, to 4.02, 4.03, etc.).
• Significant changes (such as the addition of new states or the elimination of a supplement) will be
indicated by successive changes to the first digit after the decimal. So, for example, when Florida agrees
to accept the URS and the Appendix is revised to reflect this addition, the changes will be introduced
into ver. 4.10.

7. All filers should check the Appendix of Cooperating States for information that must be included and/or
attached to the URS to ensure a complete registration filing in each state. Please pay particular attention to the
respective requirements and submit only each state’s indicated items.

Filers and state officials please note: Only a material change to the URS form itself (such as the addition or
elimination of existing questions), will produce a change in the first digit of the version number (e.g., to ver.
5.00). Therefore, absent intervening circumstances such as statutory changes (which would be posted on the
website as soon as we have the information), all states currently accepting ver. 4.0 2will also accept successive
URS versions beginning with the number four (4.xx).

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  Required Supplementary Forms 

               for filing in addition to the 

      Unified Registration Statement (URS) 
 
Arkansas 
 * Irrevocable Consent for Service: Charitable Organization (1 pg) 
California 
 * Annual Registration Renewal Fee Report (1 pg) 
District of Columbia 
 * Basic Business Licensing Information (3 pgs)  
 * Basic Business License Application (2 pgs) 
Georgia 
 * Georgia Supplement to URS (1 pg) 
Maine 
 * Maine State Specific Cover Page for Initial Registration (5 pgs) 
 * Maine State Specific Cover Page for Renewal Registrations (6 pgs) 
Minnesota 
 * Minnesota Supplement to URS (4 pgs) 
Mississippi 
 * Annual Financial Report Form (4 pgs) 
North Carolina 
 * Fundraising Disclosure Form instructions (4 pgs) 
 * Fundraising Disclosure Form (1 pg) 
North Dakota 
 * Registered Agent Consent to Serve (3 pgs) 
 * Certificate of Authority (2 pgs) 
Tennessee 
 * Tennessee Supplement to URS (1 pg)  
 * Summary of Financial Activities (2 pgs) 
Utah 
 • Utah Supplement to URS (4 pgs) 
 • Utah Instructions for Statement of Functional Expenses (5 pages) 
 • Utah Financial Report/Statement of Functional Expenses (1 pg) 
Washington 
 * Washington URS Addendum (3 pgs)  
West Virginia 
 * West Virginia Supplement to URS (1 pg)  
Wisconsin 
 * Wisconsin Supplement to Financial Report ( 5pg)

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                                                              DUSTIN McDANIEL 
                                                              ATTORNEY GENERAL 
                                                             OFFICE OF THE ATTORNEY GENERAL 
                                                             323 CENTER STREET, Suite 200 
                               LITTLE ROCK, AR   72201-2610 (501) 682-2007 

                                                             CONSENT FOR SERVICE 
                               CHARITABLE ORGANIZATION 

_____________________________________________, a Charitable Organization, hereby appoint(s) the 
Attorney General of the State of Arkansas as agent for service in case of any and all lawsuits, proceedings and 
actions growing out of the violation of any provisions of Ark. Code Ann. § 4-28-401 et  seq., or as a result of any 
activities conducted in the State of Arkansas giving rise to a cause of action.

It is hereby agreed that consent for service is irrevocable, and service on the Attorney General of the State 
of Arkansas shall be binding on this organization as if due service has been made on its agents in person. 

_______________________                                        ___________________________________________ 
Date Signed                                                    Legal Name of Charitable Organization        
       ___________________________________________ 
       Signature 
       ___________________________________________ 
       Printed Name 
       ___________________________________________ 
       Title/Official Position 

                                                              NOTARY

STATE OF_______________      )
                                                       ) SS. 
COUNTY OF _____________     ) 

Subscribed and sworn to, before me, a Notary Public in, and for, said County and State, this _______ day 
of ________________, 20____. 

My Commission Expires:                                        ________________________________________ 
______/______/_______                                         Signature of Notary Public 

County of Residence                                           _________________________________________ 
____________________                                          Printed Name 

STAMP or SEAL:

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ANNUAL graphic of the Attorney General Logo
MAIL TO:
Registry of Charitable Trusts REGISTRATION RENEWAL FEE REPORT
P.O. Box 903447
Sacramento, CA 94203-4470 TO ATTORNEY GENERAL OF CALIFORNIA
Telephone: (916) 445-2021 Sections 12586 and 12587, California Government Code
11 Cal. Code Regs. sections 301-307, 311 and 312
WEB SITE ADDRESS: Failure to submit this report annually no later than four months and fifteen days after the
http://ag.ca.gov/charities/ end of the organization’s accounting period may result in the loss of tax exemption and
the assessment of a minimum tax of $800, plus interest, and/or fines or filing penalties
as defined in Government Code section 12586.1. IRS extensions will be honored.

State Charity Registration Number Check if:
G Change of address
Name of Organization G Amended report

Address (Number and Street) Corporate or Organization No.
City or Town, State and ZIP Code Federal Employer I.D. No.

ANNUAL REGISTRATION RENEWAL FEE SCHEDULE (11 Cal. Code Regs. sections 301-307, 311 and 312)
Make Check Payable to Attorney General’s Registry of Charitable Trusts
Gross Annual Revenue Fee Gross Annual Revenue Fee Gross Annual Revenue Fee
Less than $25,000 0 Between 100,001 and $250,000 $50 Between $1,000,001 and $10 million $150
Between $25,000 and $100,000 $25 Between $250,001 and $1 million $75 Between $10,000,001 and $50 million $225
Greater than $50 million $300
PART A - ACTIVITIES
For your most recent full accounting period (beginning ______/______/______ ending ______/______/______ ) list:
Gross annual revenue $ Total assets $
PART B - STATEMENTS REGARDING ORGANIZATION DURING THE PERIOD OF THIS REPORT
Note: If you answer “yes” to any of the questions below, you must attach a separate sheet providing an explanation and details for each “yes”
response. Please review RRF-1 instructions for information required.
Yes No
1. During this reporting period, were there any contracts, loans, leases or other financial transactions between the organization and any
officer, director or trustee thereof either directly or with an entity in which any such officer, director or trustee had any financial interest?
2. During this reporting period, was there any theft, embezzlement, diversion or misuse of the organization’s charitable property or funds?
3. During this reporting period, did non-program expenditures exceed 50% of gross revenues?
4. During this reporting period, were any organization funds used to pay any penalty, fine or judgment? If you filed a Form 4720 with the
Internal Revenue Service, attach a copy.
5. During this reporting period, were the services of a commercial fundraiser or fundraising counsel for charitable purposes used? If “yes,”
provide an attachment listing the name, address, and telephone number of the service provider.
6. During this reporting period, did the organization receive any governmental funding? If so, provide an attachment listing the name of
the agency, mailing address, contact person, and telephone number.
7. During this reporting period, did the organization hold a raffle for charitable purposes? If “yes,” provide an attachment indicating the
number of raffles and the date(s) they occurred.
8. Does the organization conduct a vehicle donation program? If “yes,” provide an attachment indicating whether the program is operated
by the charity or whether the organization contracts with a commercial fundraiser for charitable purposes.
9. Did your organization have prepared an audited financial statement in accordance with generally accepted accounting principles for this
reporting period?

Organization’s area code and telephone number ( ) -
Organization’s e-mail address
I declare under penalty of perjury that I have examined this report, including accompanying documents, and to the best of my knowledge and belief,
it is true, correct and complete.

Signature of authorized officer Printed Name Title Date

Save As Print Reset Form
RRF-1 (3-05)

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Bank of America                                                                               DCRA Business License Center
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11333 McCormick Road                                               or                         First Floor
Hunt Valley  0'   031                                                                         :DVKLQJWRQ  '&      

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GLVDELOLWLHV  VRXUFH RI LQFRPH  RU SODFH RI UHVLGHQFH RU EXVLQHVV  'LVFULPLQDWLRQ LQ YLRODWLRQ RI WKLV DFW ZLOO QRW EH WROHUDWHG  9LRODWRUV ZLOO EH VXEMHFW WR GLVFLSOLQDU\ DFWLRQ

- 20 -

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APPLICANT’S NAME: 

                                     CONTROL PERSONS 

The applicant must provide the following information for each person who directly or indirectly, 
has the power to direct or cause the direction of the management and policies of the applicant. 
The term control person includes, but is not limited to,
each executive officer or person holding similar position. 
Make additional copies of this form as needed. 
(Please type or print) 

Name:                                                                               Title: 
                                                                                       
Address:                                                                               
                                                                                       
City:                                                                               State:                  Zip Code: 

Date of Birth:                                                                      Social Security Number: 

         The person named above MUST provide a ten year employment history 
                          beginning with the most recent employment.   
                          Attach separate sheets if needed. 

All persons who have custody of charitable donations must submit to a criminal background check. By 
signing this form, the person named above authorizes the Secretary of State to conduct a criminal history 
check pursuant to the charitable organization’s registration in the State of Georgia. 

         Signature of Control Person 

                          This                                                      Day of 
     
                         Official Witness (Notary)                        Signature 
      
Form C100  Rev. Sept 2008                           Page   5

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                                           STATE OF MAINE  
                            DEPARTMENT OF PROFESSIONAL  
                            AND FINANCIAL REGULATION 
                           OFFICE OF LICENSING AND REGISTRATION  
                      CHARITABLE SOLICITATIONS APPLICATION  

                                           APPLICANT INFORMATION  (please print) 
FULL LEGAL NAME          
FEIN OR SSN 
PHYSICAL ADDRESS  
CITY                                                           STATE                          ZIP                          COUNTY 
MAILING ADDRESS  
CITY                                                           STATE                          ZIP                          COUNTY 
PHONE #  (       )                                        FAX #  (       )                                E-MAIL 
By my signature, I hereby certify that the information provided on this application is true and accurate to the best of my knowledge and belief.  
By submitting this application, I affirm that the Office of Licensing and Registration will rely upon this information for issuance of my license 
and that this information is truthful and factual.  I also understand that sanctions may be imposed including denial, fines, suspension or 
revocation of my license if this information is found to be false. 
SIGNATURE                                                          DATE 

                           CHARITABLE SOLICITATIONS PROGRAM 

                            Charitable Organization Application 

                                           Required Fee: $50.00  

                             CHARITABLE ORGANIZATION  -  NON-PROFIT  & TAX-EXEMPT (CO1421) 
                      ͖     
   
                                                                            Office Use Only:                                      Office Use Only: 
                                                                                                                                  Check #_____________ 
                                                                            1421 - $25.00                                         Amount:_____________ 
                                                                            1446 - $25.00                                         Cash #______________ 
                                                                                    
                                                                                                                                  Lic.  #_______________ 
                                                                                                                                  Issue Date___________ 
                                                                                                                                  Exp.  Date___________ 

                                           PAYMENT OPTIONS:   
   Make checks payable to “Maine State Treasurer” - If you wish to pay by Mastercard or Visa, fill out the following: 
NAME OF CARDHOLDER (please print)          FIRST                                  MIDDLE INITIAL                          LAST             
I authorize the Department of Professional and Financial Regulation, Office of Licensing and Registration to charge my             
͖  VISA                  ͖  MASTERCARD         the following amount:  $____________ 
                      Card number:         XXXX-XXXX-XXXX-XXXX                                    Expiration Date   mm /yyyy              
SIGNATURE                                                                   DATE

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   STATE OF MAINE   DEPARTMENT OF PROFESSIONAL & FINANCIAL REGULATION - OFFICE OF LICENSING & REGISTRATION 
  Mailing Address:  35 State House Station, Augusta, Maine  04333  Courier/Delivery address:  122 Northern Avenue, Gardiner, Maine  04345 
    Phone:  (207) 624-8603    Fax:  (207) 624-8637   Hearing Impaired:  (888) 577-6690 web:  www.maine.gov/professionallicensing 

                                           Frequently Asked Questions 
  
 x Where do I send my application?  Our mailing address is 35 State House Station, Augusta, Maine  
   04333-0035 
    
 x Where are you located? 76 Northern Avenue, Gardiner, Maine. 
    
 x What hours are you open? 8:00 AM to 5:00 PM weekdays 
    
 x Can I come to Gardiner to drop off my application? Yes.  You will not leave with a license, though. 
    
 x Can I come to Gardiner to pick up my license?  No.  Your license will be mailed to you. 
    
 x How long does it take to process an application?  You can check our website: 
   www.maine.gov/professionallicensing.  Your license will show up as PENDING at first; as soon as  
   your status is ACTIVE you are authorized to practice. 
    
 What if I have other questions?  Visit our website at: http://www.maine.gov/pfr/professionallicensing/
 professions/charitable/organization.htm   or contact Marlene McFadden, Office Specialist I, Tel. 207/624-
 8624, e-mail: Marlene.M.McFadden@Maine.gov or Elaine Thibodeau, Program Administrator, Tel. 
 207/624-8617, e-mail: Elaine.M.Thibodeau@Maine.gov 
  
                                                             NOTICE 
 
PUBLIC RECORD:  This application is a public record for purposes of the Maine Freedom of Access Law (1 MRSA §401 et seq).  Public 
records must be made available to any person upon request.  This application for licensure is a public record and information supplied as part 
of the application (other than social security number and credit card information) is public information.  Other licensing records to which this 
information may later be transferred will also be considered public records.  Names, license numbers and mailing addresses listed on or 
submitted as part of this application will be available to the public and may be posted on our website. 
 
 Before you seal the envelope, did you: 
  
    x               Complete every item on the application (incomplete applications may be returned) 
    x               Sign and date your application 
    x               Include correct amount (payable to Maine State Treasurer)  orcredit card information (plus signature) 
    x               Make a copy of your application to keep for your records 
    x               DO NOT SEND CASH.

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                                     For Your Information 
 
The State of Maine accepts, and you may submit, either the Unified Registration Statement or 
this State of Maine Charitable Organization Application. 
                                             
What is the Unified Registration Statement? 
 
The Unified Registration Statement (URS) represents an effort to streamline the collection of informa-
tion and data by states that require licensure/registration of nonprofit organizations performing charita-
ble solicitations within their jurisdictions.  The National Association of State Charities Officials and the 
National Association of Attorneys General together have established the Standardized Reporting Pro-
ject to facilitate and simplify compliance with State laws. 
 
The Unified Registration Statement form and instructions can be downloaded from the following Inter-
net website (Please be sure to complete the entire form.):  
http://www.multistatefiling.org/ 
 
If you decided to use the URS, then please note that -- 
 
x The first page of this form should be attached to the front of the URS, and the information on the 
  second page, noted. 
   
x A notarized signature is required. 
   
What is the Charitable Organization Application? 
 
This State of Maine’s Charitable Organization Application is an alternative to the Unified Registration 
Statement.  It can be downloaded from the Charitable Solicitations website:  
http://www.maine.gov/pfr/professionallicensing/professions/charitable/ 
 
Application, Renewal, and Annual Fundraising Activity Report forms are available at that site. 
 
                                            Fees 
                                              
The fees which must accompany the application are:  
    
   x $25 application 
      
   x $25 license 
      
                                     Regulations 
                                             
Please read the laws and rules governing Charitable Solicitations prior to submitting your 
application.  These are available at the following website: 
http://www.maine.gov/pfr/professionallicensing/professions/charitable/laws.htm

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                                                 Definitions 
                                                         
A Charitable Organization must be licensed with this office prior to conducting solicitation activities, 
or having contributions solicited on its behalf, in the State of Maine. Qualification as a “Tax Exempt 
Organization” under IRS regulations does not exempt a Charitable Organization from the licensure 
requirement. 
 
"Charitable Organization" is defined as: “Any person or entity, including any person or entity  
organized in a foreign state, that is or holds itself out to be organized or operated for any charitable 
purpose or that solicits, accepts or obtains contributions from the public for any charitable purpose 
and by any means, including, but not limited to, personal contact, telephone, mail, newspaper  
advertisement, television or radio. Status as a tax-exempt entity does not necessarily qualify that en-
tity as a charitable organization.  A chapter, branch, area office or similar affiliate or any person solic-
iting contributions for any charitable purpose within the State for a charitable organization that has its 
principal place of business outside the State is considered a charitable organization.  
However, an organization established for and serving bona fide religious purposes is not a charitable 
organization.” 
 
“Contribution” is defined as: “The promise or grant of any money or property of any kind or value,  
including the payment or promise to pay in consideration of a sale, performance or event of any kind 
which is advertised in conjunction with the name of any charitable organization.  This definition does 
not include: 
 
A. Payments by members of an organization for membership fees, dues, fines or assessments, or 
for services rendered to individual members, if membership in the organization confers a bona fide 
right, privilege, professional standing, honor or other direct benefits, other than the right to vote, elect 
officers or hold offices; 
 
B. Money or property received from any governmental authority; or money or property received from 
a foundation established for charitable or educational purposes.”

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.
Instructions for Application

x Licenses will not be issued to prospective licensees who submit incomplete applications, or whose
applications omit required documentation. All questions on the application must be answered, and
supporting documentation must be provided, where requested. Otherwise, the application will be
considered incomplete and returned for completion. If you need additional room to answer a question,
then please attach a separate sheet of paper to the application and state on the application that you
have done so.

x The principal officer of the organization must sign this document. Signatures must be original, and all
applications must be notarized.

x Please submit a photocopy of the organization’s IRS Determination Letter.

x If your organization contracts with, or otherwise engages the services of, any outside fundraising
professional (such as a paid “Professional Solicitor,” “Fundraising Counsel,” or Commercial
Co-venturer”), then attach a list, including their names, addresses (street & P.O.), telephone numbers,
e-mail addresses and the physical location of offices used by them to perform work on behalf of your
organization. Also include fees, expenses and any other costs paid to the fund-raising professional(s).
Each entry must include a simple statement of: services provided, dates of contract, date of campaign/
event, whether the professional solicits on your behalf, and whether the professional at any time has
custody or control of donations.

x Before you enter into a contract with an entity to provide fundraising services on your behalf in the State
of Maine, please confirm that it is properly licensed here. (You can verify the entity’s license status at:
http://pfr.informe.org/almsonline/almsquery/welcome.aspx?board=4076.)

It is illegal for a Charitable Organization to enter into a contract with an unlicensed Professional
Solicitor, Professional Fundraising Counsel, or Commercial Co-venturer, and doing so could subject you
to disciplinary action (9 M.R.S.A., Section 5005-B(3)). Note: An entity that, in exchange for a fee or
other compensation, solicits contributions from the public on behalf of a Charitable Organization,
exercises custody or control over contributions, or employs someone who does so, must become
licensed as a Professional Solicitor, and not as a Professional Fundraising Counsel.

x Licenses expire on 11/30 of each year, so you will need to submit a renewal application by next 11/30,
even if this falls within the same calendar year as the effective date of the license for which you are cur-
rently applying. If your renewal license application is postmarked after that date, then it will be consid-
ered late, and you will be charged a $50 late fee. This would make the total renewal fee $75. In this
st
event, you would remain eligible to be considered for renewal only until March 1 , or within the first 90
th st
days after your license has lapsed. During the interim (November 30 to March 1 ), you may not con-
duct activities in Maine. Thereafter, you would be required to make application to become a new licen-
see, as you would not be eligible for renewal. The renewal application is different from this one, and it
can be downloaded at: http://www.maine.gov/pfr/professionallicensing/professions/charitable/
organization.htm#renewal

x An application for a license or renewal of a license can be denied for fraud, misrepresentation or
deception on an application, or for a violation of any provision of the Charitable Solicitations Act or rules
adopted under authority of the Act.

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                                                 STATE OF MAINE  
                                                 DEPARTMENT OF PROFESSIONAL  
                                                 AND FINANCIAL REGULATION 
                                           OFFICE OF LICENSING AND REGISTRATION  
                           CHARITABLE SOLICITATIONS APPLICATION—RENEWAL  

                                                 APPLICANT INFORMATION  (please print) 
FULL LEGAL NAME          
FEIN OR SSN 
PHYSICAL ADDRESS  
CITY                                                           STATE                          ZIP                          COUNTY 
MAILING ADDRESS  
CITY                                                           STATE                          ZIP                          COUNTY 
PHONE #  (       )                                        FAX #  (       )                                E-MAIL 
By my signature, I hereby certify that the information provided on this application is true and accurate to the best of my knowledge and belief.  
By submitting this application, I affirm that the Office of Licensing and Registration will rely upon this information for issuance of my license 
and that this information is truthful and factual.  I also understand that sanctions may be imposed including denial, fines, suspension or 
revocation of my license if this information is found to be false. 
SIGNATURE                                                          DATE 

                           CHARITABLE SOLICITATIONS PROGRAM 

                           Charitable Organization Renewal Application 

                                                 License Fee: $25. 

                           Late Fee: $50. (if filed after November 30th) 

                             CHARITABLE ORGANIZATION  -  NON-PROFIT  & TAX-EXEMPT (CO1427) 
                        ͖   
   
                      Please check appropriate boxes: 
           
                                                                            Office Use Only:                                      Office Use Only: 
                      ͖ Renewal Fee of $25                                                                                        Check #_____________ 
                                                                            1427 - $25.00                                         Amount:_____________ 
                      ͖ Late Fee of $50                                     2090 - $50.00                                         Cash #______________ 
                                                                                                                                  Lic.  #_______________ 
                                                                                                                                  Issue Date___________ 
                                                                                                                                  Exp.  Date___________ 

                                                 PAYMENT OPTIONS:   
   Make checks payable to “Maine State Treasurer” - If you wish to pay by Mastercard or Visa, fill out the following: 
NAME OF CARDHOLDER (please print)                FIRST                                  MIDDLE INITIAL                          LAST       
I authorize the Department of Professional and Financial Regulation, Office of Licensing and Registration to charge my             
͖  VISA                  ͖  MASTERCARD         the following amount:  $____________ 
                      Card number:         XXXX-XXXX-XXXX-XXXX                                    Expiration Date   mm /yyyy              
SIGNATURE                                                                   DATE

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   STATE OF MAINE   DEPARTMENT OF PROFESSIONAL & FINANCIAL REGULATION - OFFICE OF LICENSING & REGISTRATION 
  Mailing Address:  35 State House Station, Augusta, Maine  04333  Courier/Delivery address:  122 Northern Avenue, Gardiner, Maine  04345 
    Phone:  (207) 624-8603    Fax:  (207) 624-8637   Hearing Impaired:  (888) 577-6690 web:  www.maine.gov/professionallicensing 

                                           Frequently Asked Questions 
  
 x Where do I send my application?  Our mailing address is 35 State House Station, Augusta, Maine  
   04333-0035 
    
 x Where are you located? 76 Northern Avenue, Gardiner, Maine. 
    
 x What hours are you open? 8:00 AM to 5:00 PM weekdays 
    
 x Can I come to Gardiner to drop off my application? Yes.  You will not leave with a license, though. 
    
 x Can I come to Gardiner to pick up my license?  No.  Your license will be mailed to you. 
    
 x How long does it take to process an application?  You can check our website: 
   www.maine.gov/professionallicensing.  Your license will show up as PENDING at first; as soon as  
   your status is ACTIVE you are authorized to practice. 
    
 What if I have other questions?  Visit our website at: http://www.maine.gov/pfr/professionallicensing/
 professions/charitable/organization.htm   or contact Marlene McFadden, Office Specialist I, Tel. 207/624-
 8624, e-mail: Marlene.M.McFadden@Maine.gov or Elaine Thibodeau, Program Administrator, Tel. 
 207/624-8617, e-mail: Elaine.M.Thibodeau@Maine.gov 
  
                                                             NOTICE 
 
PUBLIC RECORD:  This application is a public record for purposes of the Maine Freedom of Access Law (1 MRSA §401 et seq).  Public 
records must be made available to any person upon request.  This application for licensure is a public record and information supplied as part 
of the application (other than social security number and credit card information) is public information.  Other licensing records to which this 
information may later be transferred will also be considered public records.  Names, license numbers and mailing addresses listed on or 
submitted as part of this application will be available to the public and may be posted on our website. 
 
 Before you seal the envelope, did you: 
  
    x               Complete every item on the application (incomplete applications may be returned) 
    x               Sign and date your application 
    x               Include correct amount (payable to Maine State Treasurer)  orcredit card information (plus signature) 
    x               Make a copy of your application to keep for your records 
    x               DO NOT SEND CASH.

- 28 -

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For Your Information

The State of Maine accepts, and you may submit, either the Unified Registration Statement or
this State of Maine Charitable Organization Application.

What is the Unified Registration Statement?

The Unified Registration Statement (URS) represents an effort to streamline the collection of informa-
tion and data by states that require licensure/registration of nonprofit organizations performing charita-
ble solicitations within their jurisdictions. The National Association of State Charities Officials and the
National Association of Attorneys General together have established the Standardized Reporting Pro-
ject to facilitate and simplify compliance with State laws.

The Unified Registration Statement form and instructions can be downloaded from the following Inter-
net website (Please be sure to complete the entire form.):
http://www.multistatefiling.org/

If you decided to use the URS, then please note that --

x The first page of this form should be attached to the front of the URS, and the information on the
second page, noted.

x A notarized signature is required.

What is the Charitable Organization Application?

This State of Maine’s Charitable Organization Application is an alternative to the Unified Registration
Statement. It can be downloaded from the Charitable Solicitations website:
http://www.maine.gov/pfr/professionallicensing/professions/charitable/

Application, Renewal, and Annual Fundraising Activity Report forms are available at that site.

Fees

The fees which must accompany this application are:

x $25 license fee

x $50 late fee (if applicable -- pertains to renewal within 90 days following the expiration
date).

- 29 -

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                                                 Definitions 
                                                         
A Charitable Organization must be licensed with this office prior to conducting solicitation activities, 
or having contributions solicited on its behalf, in the State of Maine. Qualification as a “Tax Exempt 
Organization” under IRS regulations does not exempt a Charitable Organization from the licensure 
requirement. 
 
"Charitable Organization" is defined as: “Any person or entity, including any person or entity  
organized in a foreign state, that is or holds itself out to be organized or operated for any charitable 
purpose or that solicits, accepts or obtains contributions from the public for any charitable purpose 
and by any means, including, but not limited to, personal contact, telephone, mail, newspaper  
advertisement, television or radio. Status as a tax-exempt entity does not necessarily qualify that en-
tity as a charitable organization.  A chapter, branch, area office or similar affiliate or any person solic-
iting contributions for any charitable purpose within the State for a charitable organization that has its 
principal place of business outside the State is considered a charitable organization.  
However, an organization established for and serving bona fide religious purposes is not a charitable 
organization.” 
 
“Contribution” is defined as: “The promise or grant of any money or property of any kind or value,  
including the payment or promise to pay in consideration of a sale, performance or event of any kind 
which is advertised in conjunction with the name of any charitable organization.  This definition does 
not include: 
 
A. Payments by members of an organization for membership fees, dues, fines or assessments, or 
for services rendered to individual members, if membership in the organization confers a bona fide 
right, privilege, professional standing, honor or other direct benefits, other than the right to vote, elect 
officers or hold offices; 
 
B. Money or property received from any governmental authority; or money or property received from 
a foundation established for charitable or educational purposes.”

- 30 -

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.
Instructions for Application and Renewal

x Licenses will not be issued to applicants who submit incomplete renewal applications, or whose applica-
tions omit required documentation. All questions on the application must be answered, and supporting
documentation must be provided, where requested. Otherwise, the application will be considered in-
complete and the license will not be renewed. If you need additional room to answer a question,
then please attach a separate sheet of paper to the application and state on the application that you
have done so.

x The principal officer of the organization must sign this document. Signatures must be original, and all
applications must be notarized.

x If there have been any changes, please submit a photocopy of the organization’s most recent IRS de-
termination letter.

x Licenses expire on 11/30 of each year. If your renewal license application is postmarked after that
date, then it will be considered late, and you will be charged a $50 late fee. This would make the
total renewal fee $75. In this event, you would remain eligible to be considered for renewal only until
st th
March 1 , or within the first 90 days after your license has lapsed. During the interim (November 30
st
to March 1 ), you may not conduct activities in Maine. Thereafter, you would be required to make
application to become a new licensee, as you would not be eligible for renewal.

- 31 -

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                                       Financial Information 
                                                  
The following financial documents should be filed with your renewal application: 
 
x A copy of your most-recent IRS Form 990 and Schedule A or Form 990 EZ; and 
   
x A copy of your organization’s audited financial statement for your most-recently audited fiscal year.  
  (Please contact this office if your organization does not have one.) 
   
x Your Annual Fundraising Activity Report (“AFAR”) for the previous calendar year should already have 
  been filed by September 30 of the current year.  Failure to file it by November 30 will prevent renewal 
  and may result in penalties.  You may submit the AFAR and the renewal application together, if you 
  file them by the earlier due date of September 30th. 
 
                                       Regulations 
                                                  
Please read the laws and rules governing Charitable Solicitations prior to submitting your 
application.  These are available at the following website: 
http://www.maine.gov/pfr/professionallicensing/professions/charitable/laws.htm

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                                                                                                           FORM FS 
                MISSISSIPPI SECRETARY OF STATE 
 ANNUAL FINANCIAL REPORT FORM 
____ Initial 
____ Renewal                                                                                                                        ____Final Report 
  
NAME OF ORGANIZATION               MISSISSIPPI REGISTRATION # 
 
___________________________________________________________________________________________________________ 
CHARITY CONTACT PERSON: 
 
PERSON COMPLETING FORM: 
 
FORM FS must be completed and be in agreement with financial information reported on IRS Form 990 or 
the filed financial statement.  
 
FORM COMPLETED USING:     _______ IRS 990     _______ FINANCIAL STATEMENT                                                               
 
FISCAL YEAR END ________________________                 
 
1.     RECEIPTS AND INCOME   
     
       CONTRIBUTIONS (LIST SEPARATELY FOR EACH PROJECT OR SOURCE) 
 
       1.____________________________________________  $__________________ 
 
       2.____________________________________________   __________________ 
 
       3.____________________________________________   __________________ 
 
       4.____________________________________________   __________________   
 
             SUBTOTAL CONTRIBUTIONS   . . . . . . . . . . . . . . . . . . . . .  . . . . . . $_________________ 
              
       OTHER INCOME (MEMBERSHIP DUES, ENDOWMENTS, ETC.) 
 
       1.____________________________________________  $_________________ 
 
       2.____________________________________________   _________________ 
 
       3.____________________________________________   __________________ 
 
             SUBTOTAL OTHER INCOME  . . . . . . . . . . . . . . . . . . . . . . . . . . . .  $_________________ 
 
TOTAL RECEIPTS AND INCOME: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $____________________

- 37 -

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2. EXPENSES –  
    
   1. PROGRAM SERVICES   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                      $_____________________ 
      ITEMIZE BY CATEGORY THE AMOUNT  DISBURSED  
      FOR  EACH  MAJOR PURPOSE: 
 
   PUBLIC EDUCATION                 $__________________ 
 
    _________________________________ $__________________ 
 
      _________________________________ $__________________ 
  
   2.  ADMINISTRATION (MANAGEMENT & GENERAL) . . . . . . . .                                                  $_____________________ 
    
 3.  FUNDRAISING  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           $_____________________ 
     
 4.  PAYMENTS TO AFFILIATES  . . . . . . . . . . . . . . . . . . . . . . . . . . . .                          $_____________________ 
      
   5.  OTHER   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  $_____________________ 
 
TOTAL EXPENSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$___________________ 

List joint costs reported in Program Services from a combined educational campaign and fundraising solicitation: 
 
Total Amount before allocation : _______________   Amount allocated to Program Services:               ____________________ 
                                      Amount allocated to Fundraising:                         ____________________ 
                                      Amount allocated to Management & General:    ____________________ 

I CERTIFY THAT ALL INFORMATION PROVIDED IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.                                                    
 
___________________________________________________________  Sworn to and subscribed before me this the   
SIGNATURE OF PRESIDENT OR       DATE                          
OTHER AUTHORIZED OFFICER                                     ________ day of __________________________,  20____ 
                                                                                                              
___________________________________________________________  _______________________________________________ 
PRINTED OR TYPED NAME AND TITLE                                                                              NOTARY PUBLIC  
                                                                                                                                           
                                                                                                                             NOTARY SEAL 
 
____________________________________________________________ Sworn to and subscribed before me this the  
CHIEF FINANCIAL OFFICER           DATE                                                                                         
                                                             _______ day  of ___________________________, 20___ 
____________________________________________________________ 
PRINTED OR TYPED NAME AND TITLE                              ________________________________________________ 
                                                                                                             NOTARY PUBLIC 
 
                                                                                                                              NOTARY SEAL

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                            MISSISSIPPI SECRETARY OF STATE 
                                            
                 SUPPLEMENT TO UNIFIED REGISTRATION STATEMENT 
                            ANNUAL FINANCIAL REPORT FORM 
                                             
                             INSTRUCTIONS 
 
The Supplement to Unified Registration Statement – Annual Financial Report Form (FORM FS) must be 
filed along with the Unified Registration Statement.  This form must be completed for the most recently 
completed fiscal year end.  
 
FORM FS should be completed using the financial information on either the IRS Form 990 or the financial 
statement.  (If an extension has been filed with the IRS or an IRS Form 990 is not required to be filed, complete 
Form FS using the organization’s financial statements.)  
 
ENTER THE NAME OF ORGANIZATION & MISSISSIPPI REGISTRATION NUMBER.   
 
PROVIDE THE NAME OF THE CONTACT PERSON FOR THE ORGANIZATION AND, IF DIFFERENT, 
THE NAME OF THE PERSON COMPLETING THE FORM.   
 
ENTER THE FISCAL YEAR END THE REPORT COVERS. 
 
1)  IF COMPLETING FORM FS USING THE IRS FORM 990: 
 
                 RECEIPT AND INCOME (REVENUE) - use Line 1 thru 11 
 
                 TOTAL RECEIPTS AND INCOME – use Line 12 
 
    EXPENSES: 
  PROGRAMS SERVICES – use Line 13 Break out any funds expended for public education. 
 
                 ADMINISTRATION (MANAGEMENT & GENERAL) – use Line 14  
 
                 FUNDRAISING – use Line 15 
 
                 PAYMENTS TO AFFILIATES – use Line 16 
 
2)   IF COMPLETING FORM FS USING THE FINANCIAL STATEMENT – Statement of Activities  
 
                 RECEIPTS AND INCOME (REVENUE) - use Support and Revenue 
 
                 TOTAL RECEIPTS AND INCOME - use Total Support and Revenue 
 
    EXPENSES -  use Statement of Functional Expenses 
 
                 PROGRAM SERVICES:  Program expense on financial statement – break out any funds  
                                                expended for public education. 
 
                       ADMINISTRATION (MANAGEMENT & GENERAL) – use Management and general 
 
                       FUNDRAISING – use Fundraising 
 
NOTE:  The Other category should not be used for any expense that would be considered program services, management and general 
or fund-raising.

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     THE   FOLLOWING                 INSTRUCTIONS               SET OUT           THE           SUPPORTING 
     DOCUMENTS  REQUIRED  TO  BE  FILED                          WITH  THE  FORM  FS                .    PLEASE 
     REVIEW AND SUBMIT THE REQUIRED DOCUMENTATION. 
 
1) CONTRIBUTIONS OVER $500,000 
   A financial statement audited by an independent certified public accountant and IRS Form 990 must be 
   filed  along  with  the  Unified  Registration  Statement and Annual Financial  Statement  Report  if  the 
   organization: 
   A) Received contributions over    $500,000; or 
   B) Engaged  the  services  of  a  professional  fund-raiser  or  fund-raising  counsel;  or  if  fundraising  was 
      conducted by persons who were paid for performing these services.   
    
      The report must be signed by two officers - the president (or other authorized officer) and chief financial 
      officer and the signatures must be notarized. 
     
2) CONTRIBUTIONS OF $250,000 to $500,000 
   A financial statement reviewed by an independent certified public accountant and the IRS Form 990 must 
   be filed with the Unified Registration Statement and Annual Financial Statement Report if the organization: 
    A) Received contributions of  $250,000 to $500,000; and  
    B) Did not engage the services of a professional fund-raiser /fund-raising counsel and if fundraising was 
       conducted by persons who were unpaid for performing these services.   
     
 The report must be signed by the president or other authorized officer and the signature must be notarized). 
        
3) CONTRIBUTIONS LESS THAN $250,000 
   A financial statement and the IRS Form 990 or 990EZ must be filed with the Unified Registration Statement 
   and Annual Financial Statement Report Form if the organization: 
    A)  Received contributions less than $250,000; and  
    B)  Did not engage the services of a professional fund-raiser /fund-raising counsel and if fundraising was 
    conducted by persons who were unpaid for performing these services.   
     
 The report must be signed by the president or other authorized officer and the signature must be notarized. 
 
4)  NEW ORGANIZATIONS 
 The Annual Financial Statement Report must be completed using zeros. 
     
    The  report must be signed by the president or other authorized officer and the signature must be notarized 
 
    A separate Annual Financial Statement Report must be filed for each local division, chapter or affiliate 
    the Organization has included under its registration (See Miss. Code Ann. Section 79-11-503(7)). 
 
           MISSISSIPPI LAW DOES NOT ALLOW FOR AN EXTENSION TO FILE. 
                          Mississippi Secretary of State's Office 
                                        Charities Registration 
                                             Post Office Box 136 
 Jackson, Mississippi  39205-0136 
                                                      
                          (601) 359-1371 or 888-236-6167 (Mississippi only)

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Fund-raising Disclosure Form
North Carolina Department of the Secretary of State Instructions
Charitable Solicitation Licensing for charitable or sponsor organizations
Introduction
G.S. 131F-6(a)(13) requires any charitable or sponsor organization that applies for a license to
submit information about any contract relationship(s) with any fund-raising consultant, solicitor, or
coventurer who has acted or has agreed to act on the applicant’s behalf. The new Fund-raising
Disclosure Form provides a concise format for filing this information.
This new form supersedes and replaces the following previously required forms and attachments:
1 Fund-raiser contract documents ;
2 Schedule C – Fund-Raisers;
3 Schedule H – Special Fund-Raising Events and Activities; and
4 Schedule L – Joint Costs of Multipurpose Activities Involving Fund-Raising.

Instead of completing and submitting these items, complete and attach one (1) fund-raising
disclosure form for each contract to satisfy the disclosure requirement.

Disclosure Basics
Complete the following general steps to determine whether you need to make a fund-raising disclosure and how to
disclose effectively:

1. Identify which contracts, if any, require filing a disclosure.
Step 1: Identify business relationships. Only three (3) types of business relationships require making a
disclosure:
! (1) A contract with a solicitor. A solicitor is a person or business that you compensate to solicit contributions for
your organization. Solicitors may collect contributions directly and may exercise a broad level of control over a
fundraising campaign. Solicitors conducting campaigns that solicit contributions from North Carolina residents must
possess a North Carolina solicitor’s license.
! (2) A contract with a fund-raising consultant. A fund-raising consultant is a person or business that you
compensate to assist your organization with planning fundraising campaigns or training those who will solicit
contributions for your organization. Fund-raising consultants may not lawfully collect contributions directly. Fund-raising
consultants working with campaigns that solicit contributions from North Carolina residents must possess a North
Carolina fund-raising consultant’s license.
! (3) A contract with a coventurer. A coventurer is a person or business that you compensate to conduct a charitable
or sponsor sales promotion informing North Carolina consumers that purchasing the coventurer’s goods or services will
benefit you (usually through your receiving a portion of the good or service purchase price). North Carolina law does not
require coventurers to obtain a license, but the law does require coventurers and you to comply with record keeping and
disclosure requirements concerning the contract(s), promotion(s), and result(s).

Step 2: Identify the appropriate time period for your disclosures. The general rule is that you must
disclose any contracts that were active (services provided), signed, or completed during the period since your
last application filing.
! (1) If you are a renewal applicant filing on time (or with an extension), the period for disclosures is within the
immediate past fiscal year. This is the same period required for your financial filings.
! (2) If you are a renewal applicant filing late, the period for disclosures will be more than the immediate past fiscal
year, extending to the time since your last application filing. However, file only one “consolidated” disclosure for each
contract covering the entire period. You do not need to file a separate disclosure form for each fiscal year on a multiyear
contract.
! (3) If you are an initial license applicant, the period for disclosure is during the immediate past fiscal year (if you
have one) or within the twelve (12) months preceding your application’s filing date (if you do not).

Fund-raising Disclosure Form CSL
Contact Information: Instructions
Agency Internet Site: www.sosnc.com Electronic Mail: csl@sosnc.com
Telephone: (919) 807-2214 -Toll free for NC residents: 1-888-830-4989

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Form Revision: 1
Facsimile: (919) 807-2220
Effective Date: November 19, 2004
Mailing Address: P.O. Box 29622, Raleigh, NC 27626-0622
Page 1of 3

2. Disclose the contract’s compensation terms.
North Carolina law requires applicants to disclose compensation arrangements in covered contracts. Consider the
following points when disclosing compensation terms:
1 Your disclosure is a public document. Consumers researching your organization will review your disclosures.
The Department recommends providing concise statements in plain English describing how you compensate your contract
partner(s). “Cutting and pasting” an exact copy of contract text is not required and may be less useful for the consumer
than a brief, accurate description.
2 Use the format provided to categorize your compensation terms. The statute and the form use terms like
“salaries” and “commissions” that may have several reasonable definitions. When in doubt, if your contract describes a
compensation item using a statutory term, use the description block for that term to describe the item. For example, if your
contract describes a compensation term as a “fee”, put your description of the term in the “fee” block on the form.
! 3. Guide to compensation terms: Use the following basic descriptions for compensation terms to guide your
descriptions of your contract terms:
! “Salary, rate, or fee” generally means a specific amount paid for services or a specific amount paid over a period
of time that recurs (e.g., “per month”).
! “Bonus” generally means additional compensation provided to a contractor if one or more condition(s) occur.
! “Commission” generally means a compensation structure where contractor receives compensation expressed as a
percentage of transactions, products, contributions received, or another similar variable.
! “Expenses” generally means any outlay, charge, or cost paid by the applicant to secure services, benefits, or
results under the contract.
! “Other compensation” is miscellaneous term covering compensation arrangements not otherwise described.

3. Disclose the amount you received under the contract.
Calculate and disclose the amount you received as a result from the contract. North Carolina law does not specify
whether the amount you report must be the gross amount you received under the contract (i.e., the total amount without
subtracting compensation and expenses) or the net amount you received under the contract (i.e, the total amount you
received after subtracting all compensation and expenses) . The Department will accept either or both figures, and
provides a space on the disclosure form for specifying which type(s) you report.

General formatting and attachment instructions
The Department posts this form on its website in Rich Text (RTF) format so that applicants may download the form,
complete it on any standard word processor, and print the completed form for submission with a license application. The
RTF form permits extending answers beyond the original form length of one page. Applicants may also print the empty
form and complete the form using legible handwriting.
The Department accepts attachments to hand-completed forms and accepts word processed forms exceeding one page of
printed text. If you submit multi-page forms or attachments, please submit them in simplex (printed on one side only)
format on standard 8 !” x 11” paper. Doing so expedites processing.

How we process your disclosure(s) with your license application
Upon receipt with the rest of your application, the Department will scan your disclosure form(s) into electronic format.
The Department will examine the form to make sure (1) all form questions have answers and (2) submitted form
information is reasonably consistent with other information in your application. The Department will make your filed
form available for public inspection by consumers.

Form Revision: 1

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Facsimile: (919) 807-2220
Effective Date: November 19, 2004
Mailing Address: P.O. Box 29622, Raleigh, NC 27626-0622
Page 2of 3

Appendix: Specific line item instructions
This section provides specific guidance for completing the form questions on your fund-raising form(s):“Form ___ of ___
filed with Application” Answering this block is requested, but not required. The Department
uses this information to help keep your application documents ordered during processing. For example, if the formis the
first of three you are submitting, mark: “Form 1 of 3 filed with Application”.Item 1. Applicant Name. Enter your
organizations’ name here. This name should match your answer to the “Full
Legal Name” question on your license application.Item 2. Contractor Name. Enter your contract partner’s full legal
name here.Item 3 -Contractor Street Address. Enter your contract partner’s street address (NOT P.O. Box address)
here.Item 4. Contractor Telephone Number. Enter your contract partner’s primary telephone number here.Item 5.
Contractor Type. Determine your contract partner’s TYPE and check the appropriate box, using one of
these choices: Coventurer, Fund-raising Consultant, or Solicitor.

Item 6. Contract signing/execution date. Enter the date you signed the contract here. The Department uses
thisinformation to confirm whether your contract falls within your reporting period.Item 7. Contract services begin
date. Enter the date services began or will begin under your contract here. The
Department uses this information to confirm whether your contract falls within your reporting period.

Item 8. Contract services end date. Enter the date services ended or will end under your contract here. TheDepartment
uses this information to confirm whether your contract falls within your reporting period.Item 9. Is this a continuing or
multiyear contract? Answer YES if your contract has extended or will extend over
multiple years. Otherwise, answer NO. This information helps the Department and consumers match
yourmultiyear contract disclosures to the underlying contract.
Item 10. Are North Carolina residents solicited for contributions as a direct or indirect result of thiscontract?
Answer YES or NO. The Department uses this information to evaluate whether your contract partner, ifnot licensed in
North Carolina, may require a North Carolina solicitation of contributions license.
Item 11. Does contract contain salary, rate, or fee terms? Answer YES or NO. If YES, describe your contract’s
salary, rate, or fee terms in the block provided or in a labeled attachment.Item 12. Does contract contain bonus terms?
Answer YES or NO. If YES, describe your contract’s bonus termsin the block provided or in a labeled attachment.
Item 13. Does contract contain commission terms? Answer YES or NO. If YES, describe your contract’s
commission terms in the block provided or in a labeled attachment.Item 14. Does contract contain expenses terms?
Answer YES or NO. If YES, describe your contract’s expensesterms in the block provided or in a labeled attachment.
Item 15. Does contract contain other compensation terms? Answer YES or NO. If YES, describe your
contract’s other compensation terms in the block provided or in a labeled attachment. Item 16. Amount of funds received
resulting from contract since your last license application filing: In the space provided, state either the gross amount of
funds received (total amount before subtracting compensation and expenses), or the net amount of funds received (total
after subtracting compensation and expenses). You may also opt to provide both amounts.

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                                                                       Fund-raising  Disclosure  Form  CSL 
                                                                       Contact Information: Instructions  
Agency  Internet  Site: www.sosnc.com Electronic  Mail:  csl@sosnc.com 
Telephone: (919) 807-2214 -Toll free for NC residents: 1-888-830-4989  

                                                                       Form Revision:                     1 
Facsimile: (919) 807-2220  
                                                                       Effective Date: November 19, 2004  
Mailing Address: P.O. Box 29622, Raleigh, NC 27626-0622  

                                                                       Page 3of 3

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North Carolina Department of the Secretary of State Fundraising Disclosure Form
Charitable Solicitation Licensing for charitable or sponsor organizations

Form ______ of _______ filed with this application
1. Applicant Name:
2. Contractor Name:
3. Contractor Street Address:
4. Contractor Telephone Number:
5. Contractor Type: Coventurer | Fund-raising Consultant Solicitor
6. Contract Signing/Execution Date:
7. Contract services Begin Date:
8. Contract services End Date:
9. Is this a continuing or multiyear contract? YES | NO
10. Are North Carolina residents solicited for contributions as
a direct or indirect result of this contract? YES | NO

11. Does contract contain salary, rate, or fee terms? YES | NO
If YES, state terms and conditions below:

12. Does contract contain bonus terms? YES | NO
If YES, state terms and conditions below:

13. Does contract contain commission terms? YES | NO
If YES, state terms and conditions below:

14. Does contract contain expenses terms? YES | NO
If YES, state terms and conditions below:

15. Does contract contain other compensation terms? YES | NO
If YES, state terms and conditions below:

16. Amount of funds received resulting from contract since your last license application filing:
(For initial applicants: amount of funds received within past fiscal year or past 12 months):
Answer either or both line items: Gross Amount Received: $___________________________

Net Amount Received: $___________________________

Fund-raising Disclosure Form
CSL Contact Information: for charitable or sponsor organizations
Agency Internet Site: www.sosnc.com Electronic Mail: csl@sosnc.com
Telephone: (919) 807-2214 - Toll free for NC residents: 1-888-830-4989 Form Revision: 1
Facsimile: (919) 807-2220 Effective Date: November 19, 2004
Mailing Address: P.O. Box 29622, Raleigh, NC 27626-0622
Page 1 of 1

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FOR OFFICE USE ONLY
CERTIFICATE OF AUTHORITY System ID Number
FOREIGN CORPORATION
APPLICATION Work Order
SECRETARY OF STATE
SFN 13100 (08-2008) Filed By

1.A. The application MUST be accompanied by ALL of the following: B. The following MAY be required:
Filing fee of $145 if a Foreign Business or Professional Corporation Certification of professional license from the North
Filing fee of $50 if a Foreign Nonprofit Corporation Dakota licensing board for the profession
Current CERTIFICATE OF GOOD STANDING OR CERTIFICATE OF Signed consent to use of name and fee of $10
EXISTENCE verifying corporate existence certified by the incorporating Trade Name Registration and fee of $25
officer of the state or country of incorporation.
SEE PAGE 2 FOR FEES, FILING AND MAILING INSTRUCTIONS
TYPE OR PRINT LEGIBLY For reference, see North Dakota Century Code, Section 10-19.1-135 or 10-33-125.
2. Type of corporation applying for Certificate of Authority (check one)
Foreign Business Foreign Professional Foreign Nonprofit
3.A. Name of corporation EXACTLY as it appears on Certificate of Good Standing or Certificate of Existence from B. Federal ID number
state or country of origin

C. If applicable, provide the trade name and complete the Trade Name Registration form if the selected trade name is not already registered in North
Dakota. Only provide the trade name in this line if:
a) The corporate name is not in the form as required of corporations in North Dakota.
b) The Secretary of State has notified the corporation that its corporate name is the same or deceptively similar to a name already registered, and the
corporation is unable to obtain consent to use of name from the previous filer or a certified copy of a final decree of a court of competent jurisdiction
establishing prior right of this corporation to use of the name in North Dakota.
c) The corporation does not wish to use or protect its corporate name in North Dakota and chooses to use a name other than its corporate name.

4. Complete mailing address of principal executive office which may not only be a post office box: (Street/RR, and PO Box if applicable, city, state, zip+4)

5.A. STATE or country where B. EXACT date incorporated C. Duration of corporation D. Telephone number
incorporated (Month, day, AND year)
Perpetual
Other (Specify) E. Toll-free telephone number

6.A. Name of commercial registered agent in North Dakota 6.B. Name of noncommercial registered agent in North Dakota
OR
6.C. Address of noncommercial registered agent in North Dakota:(Street/RR, PO Box,City, State, Zip+4) May not be only a post office box.

7. Nature of business or activities the corporation intends to conduct in the State of North Dakota

8. Check box if OFFICERS AND DIRECTORS OF THE CORPORATION
OFFICER officer also NAME COMPLETE MAILING ADDRESS
serves as
director Street/RR PO Box City State Zip+4
PRESIDENT
VICE PRES.
SECRETARY
TREASURER
DIRECTOR
DIRECTOR
9. "The undersigned, a person authorized by the corporation to sign this application, knows the contents thereof, and believes the statements to be true. I
further authorize the Secretary of State to correct numbers 3A, 5A, 5B, 6A and 6B if not currently reflected."
Signature Date

10. Name of person to contact if questions about this document E-mail address Daytime telephone number

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SFN 13100 (08-2008) Page 2
INSTRUCTIONS FOR CERTIFICATE OF AUTHORITY FOREIGN CORPORATION APPLICATION
No foreign corporation may transact business, or conduct affairs, in North Dakota, OR obtain any license or permit required by North Dakota law, until the
corporation has obtained a Certificate of Authority from the Secretary of State.
The following numbers correspond to the numbered sections on the front of this form.
1A. The application for Certificate of Authority MUST be accompanied by ALL of the following before the Certificate of Authority can be issued:
FILING FEEof $145 if a foreign business or professional corporation, OR $50 if a foreign nonprofit corporation.
(Checks must be payable to "Secretary of State" and must be for U.S. negotiable funds. Payment may also be made by credit card using Visa,
Master Card, or Discover.)
Current certificate of good standing or certificate of existence verifying corporate existence certified by the incorporating officer of the state or
country of incorporation. A copy of the Articles of Incorporation is not acceptable. The certificate must have been certified within 90 days of the
date of application.
1B. The application for Certificate of Authority MAY BE REQUIRED to be accompanied by the following:
If applicant is a foreign professional corporation, it must submit a certification of professional license from the North Dakota licensing board for the
profession verifying that the practitioners of the corporation have been licensed to provide the professional service.
Asigned consent to use of name AND fee of $10 when the corporation is already aware of a conflict with its corporate name.
Trade Name Registration AND fee of $25 when the corporation assumes a name, other than its corporate name, for use in North Dakota.
2. Indicate whether the application is being submitted for a Certificate of Authority for a foreign business corporation, a foreign professional corporation,
or a foreign nonprofit corporation.
3A. Provide the correct corporate name as incorporated in the state or country of organization. Punctuation and abbreviations must be consistent with
those in the name on the certificate from the incorporating officer of the state or country where incorporated. If the name in number 3A is not the
same as reflected on the Certificate of Good Standing or Certificate of Existence, the name will be corrected by the Secretary of State when the
document is received.
3B. To properly maintain corporate records, the Federal ID number is requested.
Privacy: In compliance with N.D.C.C., Section 10-19.1-149.1, social security or Federal ID numbers are not disclosed to the public. They are used
by the Secretary of State to maintain accurate corporate files. Therefore, while voluntary disclosure is requested, failure to do so will not result in
rejection of the application.
3C. Provide the trade name and the Trade Name Registration form with $25 if the corporation cannot use its corporate name because:
a) The corporate name is not in the form as required of a corporation in North Dakota. The name must be in the English language or in any
other language expressed in English letters or characters.
The name of a foreign business corporation must also include the word "corporation", "incorporated", "company", or "limited", or an
abbreviation of one of these words. If a foreign corporation's name does not contain one of these words or abbreviations, the corporation
must elect one to be used in North Dakota. The application must be rejected if an election is not made and the corporate name in 3.A. is not
in compliance with this requirement. (For reference, see N.D.C.C., Sections 10-19.1-133, 10-31-03, or 10-33-126.)
b) The corporate name may not include such words as "bank", "banker", "banking", "trust", or "trust company", or any other word or words of like
import unless the application is supported by a written approval for the use from the North Dakota Department of Financial Institutions. These
words are preserved by North Dakota law for use by the Bank of NorthDakota, stateand national banks, andtrustcompanies.Contact
information:
ND Dept. of Financial Institutions
2000 Schafer St Ste G
Bismarck ND 58501-1204
Phone: (701) 328-9933
Email: dfi@nd.gov
c) The North Dakota Secretary of State has notified the corporation that its corporate name is the same as or deceptively similar to a name
already registered and the corporation is unable to obtain consent to use of name from the previous filer or a certifed copy of a final decree of
acourtof competentjurisdictionestablishingprior rightofthis corporationtouseof thenamein NorthDakota.
North Dakota law provides that a corporate name may not be the same as, or deceptively similar to, a name previously registered with the
Secretary of State. The name may be used if the corporation obtains a court decree or signed consent to use of name that is submitted with a
fee of $10. The applicant must draft the consent to use of name since a form for the consent is not prescribed by the Secretary of State. If
consent to use of name cannot be obtained, a trade name (dba) must be elected.
d) The corporation does not wish to use or protect its corporate name in North Dakota and chooses to use a trade name instead.
TRADE NAMES: A corporation may choose to use any trade name (dba) in addition to its corporate name in North Dakota. The trade name must be
registered with the Secretary of State. However, the trade name should not be provided in number 3.C, except as described above. Instead,
complete and attach the Trade Name Registration and fee of $25 for each assumed name. Contact the Secretary of State's office for the Trade
Name Registration form.
4. Acomplete address of the corporation's principal executive office wherever located, is required.
In this section, as well as all other sections requiring addresses on this application, an address must include a street or rural address, a postal box
number if applicable, and the city, state, and zip code plus 4-digit extension. THIS ADDRESS MAY NOT ONLY BE A POST OFFICE BOX.
5A. Identify the state or country in which the corporation is incorporated. If the state or country of origin in number 5A is not the same as reflected on the
Certificate of Good Standing or Certificate of Existence, the state or country will be corrected by the Secretary of State when the document is
received.
5B. Provide the EXACT date (month, day AND year) when the corporation was incorporated. This date must correspond to the date if specified in the
Certificate of Good Standing or Certificate of Existence. If the date in5B is not thesameas reflectedon theCertificateofGoodStandingor
Certificate of Existence, the date will be corrected by the Secretary of State when the document is received.
5C. Identify whether the corporation is incorporated with "perpetual" existence or provide the specific date on which it is to be dissolved.
5D. The telephone number of the corporation's principal executive office is required.
5E. Provide a toll-free telephone number if the corporation has one to expedite services to the corporation for the duration of the filing.

(continued)

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SFN 13100 (08-2008) Page 3
INSTRUCTIONS FOR CERTIFICATE OF AUTHORITY FOREIGN CORPORATION APPLICATION (CONTINUED)
Aforeign corporation must continuously maintain a commercial or noncommercial registered agent and address in North Dakota.A foreign corporation
cannot serve itself as its registered agent.
Acommercial registered agent must be registered as a commercial registered agent with the North Dakota Secretary of State. The appointed agent can
verify their status as a commercial registered agent from their acknowledged filing and from the list of commercial registered agents maintained on the
Secretary of State's website at www.nd.gov/sos.
Anoncommercial registered agent may be one of the following:
a) An individual residing in North Dakota,
b) A domestic or foreign corporation, or
c) Adomestic or foreign limited liability company.
Acorporation or limited liability company appointed as a noncommercial registered agent must be registered with the Secretary of State, be in good standing,
and have a business address in North Dakota. If a corporation or limited liability company is named as a noncommercial registered agent, provide the
"correct" name of the organization.
Seek the approval of the party before naming them as the commercial or noncommercial registered agent. Proof of the approval is not required to
be filed with the Secretary of State.

6. A. If a commercial registered agent is being appointed, provide the correct name as registerd with the North Dakota Secretary of State. If the name in number
6A is not the same as registered by the commercial registered agent, the name will be corrected by the Secretary of State when the document is received.
OR
B. If a noncommercial registered agent is being appointed, provide the correct name. If another corporation or limited liability company is appointed as
registered agent and the name of that organization in number 6B is not the same as registered, the name will be corrected by the Secretary of State when
the document is received.
C. If a noncommercial registered agent is being appointed, provide the complete address in North Dakota which may not be only a post office box. Leave this
line blank if a commercial registered agent is appointed.
7. Give a brief explanation of the purposes or nature of business the corporation intends to transact in North Dakota.
If the corporation is involved in the business ofinsurance, clearly definethat thecorporationis a business corporation selling or servicing insurance
products. A corporation that actually backs the claims may not be required to file this application.
8. This section must reflect names and complete addresses of all officers and directors. (See definition of complete mailing address in item 4.)
9. The application must be dated and signed by an individual authorized to sign on behalf of the corporation.
10. Provide the name, email address and daytime telephone number of the person to contact for any issues related to this application.
ASSISTANCE: If assistance is required to complete the application for a Certificate of Authority, call 701-328-2904.
EXPEDITING PROCESS: Be sure to complete item 10. If documents are being submitted by someone other than the corporation, provide a cover letter
with the name and telephone number of the responsible individual so that any deficiencies can be remedied by telephone.
FAX FILING: Documents and Credit Card Payment Authorization may be faxed to 701-328-2992. A faxed filing does not expedite the process of the
application in the office of the Secretary of State.
Email: Email is not a secure utility for the transmission of private information or credit card authorizations. DO NOT EMAIL YOUR DOCUMENT TO THE
SECRETARY OF STATE. Secretary of State
State of North Dakota
600 E Boulevard Ave Dept 108
Bismarck ND 58505-0500
Telephone: 701-328-4284 Toll Free: 800-352-0867 (8-4284) Fax: 701-328-2992 Home Page: www.nd.gov/sos
ANNUAL REPORTS: An annual report is required starting in the year following that in which the Certificate of Authority is issued. An annual report of a
foreign business or professional corporation is due on May 15. The annual report of a foreign nonprofit corporation is due on February 1. The annual report
form is mailed to the registered agent.

CREDIT CARD PAYMENT AUTHORIZATION
SECRETARY OF STATE
SFN 51478 (11-06)

(All items required to complete transaction)
Name Amount Authorized

Address City State Zip Code

VISA Master Card Discover Signature (Required by credit card companies)
Account Number VNumber Card Expires
Month Year
Date:
-

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                                                                                   FOR OFFICE USE ONLY
REGISTERED AGENT                                                            ID#:
CONSENT TO SERVE
SECRETARY OF STATE                                                          WO#:
SFN 7974 (06-2006)
                                                                            Filed:                                                       By:

SEE REVERSE SIDE FOR FILING AND MAILING INSTRUCTIONS

1. FILING FEE: $10.00

TYPE OR PRINT LEGIBLY
2. Name of the organization for which the registered agent is to serve (corporation, limited liability company, limited liability partnership, limited partnership,
limited liability limited partnership or real estate investment trust):

3. Name of the registered agent:

4. Registered agent is (Check one)                                     5. Federal ID # or social security # of registered agent:
An individual North Dakota resident
A corporation
Alimited liability company
Alimited liability partnership
6. According to state law, the newly appointed registered agent must sign a statement of consent to serve in that capacity (see instruction number 6 for
authorized signers).
"The undersigned, as the newly appointed registered agent for the organization named in number 2, consents to act as the registered agent for this
organization until a change or resignation is submitted to the Secretary of State according to the provisions of North Dakota state law."
Signature of Registered Agent:                                         Date:

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SFN 7974 (06-2006) Page 2

INSTRUCTIONS FOR REGISTERED AGENT CONSENT TO SERVE

The following organizations must continuously maintain a registered agent on file with the Secretary of State.
a) Domestic and foreign business corporations
b) Domestic and foreign nonprofit corporations
c) Domestic and foreign professional corporations
d) Domestic farm corporations
e) Domestic farm limited liability companies
f) Domestic and foreign limited liability companies
g) Domestic and foreign professional limited liability companies
h) Domestic and foreign limited liability partnerships
i) Domestic and foreign limited partnerships
j) Domestic and foreign limited liability limited partnerships
k) Real estate investment trusts

Aconsentsigned by the appointed registered agentis required with the appointment.

The following numbers correspond to the numbered sections onthefront of this form.

1. FILING FEE: $10.00.This fee is in addition to that required for the documents in which the registered agent
appointment is included. (Checks must be payable to "Secretary of State" and must be for U.S. negotiable funds.
Payment may also be made by credit card using VISA, Master Card, or Discover).

2. Provide the correct name of the organization for which the appointed registered agent is to serve. (Punctuation and
abbreviations must be consistent with the correct organization name.)

3. Provide the name of the registered agent. The format of the name must be consistent with that on the documents on
which the appointment of the registered agent is declared. Ifa corporation,limited liability company,or limited liability
partnership is named as the registered agent, provide the organization's correct name. (Punctuation and abbreviations
must be consistent with the correct organization name.)

4. Indicate the appropriate status of the registered agent. An individual residing in North Dakota may serve as
registered agent for any organization, or another organization may serve as registered agent. However, an
organization may not serve itself as its own registered agent. Acorporation or limited liability company may serve as
the registered agent for another corporation, a limited liability company, a limited liability partnership, a limited
partnership, a limited liability limited partnership, or a real estate investment trust. A limited liability company may serve
as the registered agent for another limited liability company, a corporation, a limited liability partnership, a limited
partnership, a limited liability limited partnership, or a real estate investment trust. A limited liability partnership may
only serve as the registered agent for another limited liability partnership.

5. As applicable, insert the social security number or the Federal ID number.

Privacy:In compliance with North Dakota laws, the numbers are not disclosed to the public. The numbers are used by
the Secretary of State to maintain accurate files. Therefore, while voluntary disclosure is requested, failure to do so will
not result in the rejection of the Consent to Serve.

6. Whether an individual or an organization, the newly appointed registered agent named in number 2 must sign this
consent. If the newly appointed agent is a corporation, limited liability company, or a limited liability partnership,
the consent may be signed by an officer, a manager, a partner, or other individual authorized by the organization that is
named as the newly appointed registered agent.

ASSISTANCE: If assistance is required to complete the form, contact the Secretary of State.

FAX FILING: Adocumentand CreditCard PaymentAuthorization may be faxedto701-328-2992. A faxedfilingdoes not
expedite the process of the document in the office of the Secretary of State.

EMAIL: Email is not a secure utility for the transmission of private information or credit card authorizations. DO NOT EMAIL
YOUR DOCUMENT TO THE SECRETARY OF STATE.

MAILING INSTRUCTIONS: Send the form and filing fee to:
Secretary of State
State of North Dakota
600 E Boulevard Ave Dept 108
Bismarck ND 58505-0500
Telephone: 701-328-4284 Toll Free: 800-352-0867 (84284) Fax: 701-328-2992 Web Site: www.nd.gov/sos

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                             State of Tennessee 

                              Department of State 
                    Division of Charitable Solicitations &Gaming 
                    William R. Snodgrass Tennessee Tower 
                             312 Rosa L. Parks Avenue, 8th Floor 
                             Nashville, TN  37243 
                             (615) 741-2555 / (615) 253-5173 (fax) 
 
                    FILING INSTRUCTIONS FOR REGISTRATION 
                    OF A CHARITABLE ORGANIZATION 
                              
Each application for registration must include the following documents and fee: 
 
• Completed Application for Registration form 
 
• Completed Summary of Financial Activities form 
 
• IRS Form 990, Form 990EZ or 990N for the most recently completed fiscal year, if the 
  organization is tax exempt 
 
• An audited financial statement if the organization grossed more than $500,000 in   
  revenue, excluding grants from government agencies and 501(c)(3)private foundations 
 
• Governing documents (Articles of Incorporation, if incorporated, By-laws, etc.) 
 
• IRS determination letter granting tax-exempt status, if applicable 
 
• $50.00 filing fee 
 
NOTE: If the application is not complete, the registration will not be approved.

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 State of Tennessee                                            WARNING:  False or misleading statements 
                    Subject to maximum $5,000 civil penalty. T.C.A. §48-101-514                                                         
               
                            SUMMARY OF FINANCIAL ACTIVITIES 
                     
Department of State                                                     OF A 
Division of Charitable Solicitations & Gaming                    CHARITABLE ORGANIZATION 
William R. Snodgrass Tennessee Tower           
312 Rosa L. Parks Avenue, 8 thFloor                     
Nashville, TN  37243                           
(615) 741-2555       FAX (615) 253-5173  
________________________________________________________________________________ 
 
INSTRUCTIONS: Complete this form with financial information from the most recently completed accounting year. The 
form must be signed by two (2) authorized officers.  
 
Name of Organization: _____________________________________________________________________________ 
Address: ____________________________  City: _________________ State: _________ Zip Code ______________ 
Federal ID: __________________________  State ID:  _________________   Telephone: _______________________ 
Accounting Year End:                                        Has your accounting year changed?     Yes _______     No ________ 

A.       Gross Revenue 
 1. Public contributions  ...............................................................$  _______________________________  
 2. Government grants...............................................................$   _______________________________  
 3. Program service revenue.......................................................$  _______________________________  
 4. Special events and activities..................................................$  _______________________________  
 5. Gross sales of inventory.........................................................$  _______________________________  
    6.  Other revenue ........................................................................$  _______________________________  
 7. Total Revenue [add line 1 through line 6] ............................$  _______________________________  
 
B.       Expenses 
 8. Total program expenses ........................................................$           _______________________________         
    9.  Direct expenses from special events .....................................       $  _______________________________  
 10. Cost of goods .........................................................................$  _______________________________  
 11. Management and general expenses......................................$  _______________________________  
 12. Fund raising expenses ...........................................................$  _______________________________  
 13. Other Expenses......................................................................$  _______________________________  
    14.  Total Expenses [add line 8 through line 13]   ........................         $  _______________________________  
    15.  Excess / Deficit for the year [line 7 minus line 14] ..............            $  _______________________________  
 
C.       Changes in Net Assets or Fund balances 
 16. Net assets / fund balances at beginning of year....................$  _______________________________  
    17.  Other changes in net assets or fund balances.......................$  _______________________________  
    18.        Net assets / fund balances [add line 15 through line 17] ....            $  _______________________________  
 19. Total assets............................................................................$ _______________________________  
    20.  Total liabilities.........................................................................$  _______________________________  
    21.  Net assets / fund balances [line 19 minus line 20] ..............              $  _______________________________              
 
D.       Accounting Method Used: 
 
CASH:________________________    ACCRUAL: __________________________                           OTHER: _____________

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                                 SIGNATURES  
 
I certify that the information furnished in this summary and all supplemental forms, documents and continuation sheets is 
true and correct to the best of my knowledge and belief. 
 
________________________________________________          _______________________________________________                  
Signature of Authorized Officer                           Signature of Authorized Officer 
                                                           
________________________________________________          ____________________________________________________ 
Print Name                                                Print Name 
                                                           
________________________________________________          ____________________________________________________ 
Title                                                     Title 
                                                           
_________________________________________________         ____________________________________________________ 
Date                                                      Date 
                                                           
SS-6002 (Rev  7/08/09)                                                                     RDA 1745

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            STATEMENT OF FUNCTIONAL EXPENSE INSTRUCTIONS 
                                       
In General 
 
All organizations who complete the IRS Form 990 N (post card), 990-EZ, 990-PF or who 
do not complete any 990 must complete the Statement of Functional Expense Form. 
 
Column (A) 
Every expense should be listed here.  If the expense includes property other than cash 
report the expense as the fair market value of the property given.  Attach a schedule 
detailing a description of the property given, the fair market value and how the fair 
market value was determined.   
 
Column (B) 
Program Services are those activities that your organization was created to conduct and 
form the basis for the exemption from tax.  They may be funded from current 
contributions, accumulated income, investment income or any other source.  Fundraising 
expenses should not be reported as program service expense even though one of the 
functions of the organization is to raise funds for other organizations.  Program Service 
expenses can also include unrelated trade or business activities.   
 
Column (C) 
Management & General 
This column is used to report expenses for overall function and management that does not 
have a program service or fundraising purpose.  For the most part this will be the 
expenses for licenses and fees paid to state and city governments, the costs associated 
with starting the organization and incidental expenses of board meeting.  If your 
organization was established prior to the current year and only operates in Utah the 
expense reported here will be the $100 fee paid to Consumer Protection and the $7 or $22 
paid to Corporations to register your organization’s name. 
 
Column (D) 
Fundraising 
Fundraising expenses are the total expenses incurred in soliciting contributions, gifts, 
grants etc.  Report all fundraising expenses, including publicizing and conducting 
fundraising campaigns, soliciting grants from foundations and government agencies, 
costs of participating in federated fundraising campaigns, preparing and distributing 
fundraising manuals, instructions and other materials.  Report here the costs of 
conducting events that generate income as special events or sales of goods and services.  
Do not report the direct expenses of the event or the cost of goods and services sold. 
 
Line (1) 
Grants, allocations and contributions

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Report here the amounts given to individuals and organizations selected by the filing
organization. United Way and similar organizations should report here allocations to
member agencies. Report voluntary awards and payments to affiliated organizations.

Line (2)
Specific assistance to individuals
Enter the amount of payments to, or for the benefit of, particular clients including
assistance rendered by others at the expense of the filing organization. Do not include
grants to other organizations who selected the person who received the assistance. For
example report the payment to a medical practioner to cover the expenses of a particular
individual, but do not report a contribution to a medical practioner to provide some
services to the general public or to unspecified charity patients. Report scholarships
given directly to specific individuals selected by the filer. Report on line (1) scholarships
given to individuals selected by other organizations.

Line (3)
Registration fees
Enter the amount paid to federal, state and local governments for fees required to operate.
These include solicitation permit fees, business licenses and fees other than taxes and
penalties paid to the IRS.

Line (4)
Benefits paid to/for members
For organizations that provide benefits to members or dependents report the total here
and attach a schedule of each payee and purpose for the payment.

Line (5)
Compensation of officers/directors
Enter the total compensation paid to current and former officers, directors, trustees, and
key employees. Compensation includes all forms of income earned or received for
services provided.

Line (6)
Other salaries and wages
Enter the total amount of employees’ salaries and wages, fees, bonuses, severance
payments and compensation deferred in prior year that was paid in the current year.

Line (7)
Pension plan contributions
Enter the employer’s share of contributions to qualified and nonqualified pension plans
for the year. Do not include contributions to pension plans that were reported on line 4.

Line (8)
Other employee benefits

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Enter the employer’s contributions to employee benefit programs such as insurance,
health and welfare programs.

Line (9)
Payroll Taxes
Enter the amount of federal, state and local payroll taxes for the year but only those taxes
that are imposed on the organization as an employer. This includes the employer’s share
of Social Security, Medicare taxes, Federal and state unemployment compensation taxes.
Do not include the portion with held from the employee’ earnings.

Line (10)
Professional fundraising fees (including amounts paid to consultants)
Enter the amount paid to outside fundraisers who conduct solicitation campaigns as well
as amounts paid for consultation services connected with a solicitation conducted by the
organization itself. Include all payments made to or through the fundraiser including but
not limited to postage, supplies and labor expenses. Do not include any amount paid to
employees of the organization.

Line (11)
Accounting fees
Enter the total accounting fees paid to outside firms and individuals who are not
employees of the organization.

Line (12)
Legal fees
Enter the total legal fees paid to outside firms and individuals who are not employees of
the organization. Do not include penalties, fine or judgments imposed on the
organization.

Line (13)
Telephone
Enter the total telephone, telegram, cable, internet provider and similar expenses for the
year.

Line (14)
Supplies
Enter the total for office, classroom, medical and other supplies used during the year.

Line (15)
Postage and shipping
Enter the total amount of postage, parcel delivery, trucking and other delivery expenses,
including the cost of shipping materials.

Line (16)
Occupancy

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Enter the total amount paid or incurred for the use of office space or other facilities
including all utilities. Include outside janitorial services, mortgage interest, property
insurance, real estate taxes and similar expenses. Do not include depreciation or any
salaries of the reporting organizations own employees.

Line (17)
Equipment and maintenance
Enter the cost of purchasing, renting and maintaining office equipment and other
equipment other than automobile and truck expenses reportable on line 19.

Line (18)
Printing and publication
Enter the expense and related costs of producing the reporting organization’s own
newsletters, leaflets, films and other informational material on this line. Also include the
cost of any purchased publications on this line. Do not separate or allocate the expense
of printing and publishing provided by outside vendors as part of their contracted
services. For example if a professional fundraiser is paid to solicit through written
appeals, do not report the printing costs on this line.

Line (19)
Travel
Enter the total travel expenses including transportation costs, mileage allowances,
automobile expenses, meals and lodging.

Line (20)
Conferences, conventions and meetings
Enter the total expenses incurred by the organization in conducting meetings related to its
activities other than fundraising. Include the costs of rental of facilities, speakers’ fees
and expenses. Include registration fees paid for sending the organizations officer,
directors and employees. Do not include the salaries or travel expense of the
organization’s own employees who participate.

Line (21)
Interest
Enter the total interest expense for the year. Do not include any interest attritrible to
rental property, or any mortgage interest reported as occupancy.

Line (22)
Depreciation, depletion
If the organization records depreciation, depletion or similar expenses, enter the total for
the year. Attach a schedule explaining each item.

Line (23)
Other
Enter each type and amount of expense for which a separate line is not provided. These
must be separate expense items and not groupings of expenses. Examples include

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unrelated business income taxes, penalties and fines.  Use as many lines as needed.  
Attach a schedule if more space is needed.  No line may exceed 5% of the column total.

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                                              STATE OF UTAH 
                                 DIVISION OF CONSUMER PROTECTION 
                                                 
                            STATEMENT OF FUNCTIONAL EXPENSES  
 For organizations who file the IRS Form 990-EZ, 990-PF or 990 N and organizations that do not file any 
                                              type of IRS Form 990 
                                                 
ORGANIZATION NAME 
 
Contributions                                 
Other Income                                  
Total income                                  
 
           Do not report amounts reported on    A                  B   C          D             
                    other lines                 Total  Program        Management   Fundraising 
                                                       Services        & General 
 1 Grants, allocations and                                                                     1 
   contributions made (attach schedule) 
 2   Specific assistance to individuals                                                        2 
 3 Registration fees                                                                           3 
 4 Benefits paid to/for members                                                                4 
 5 Compensation of officers/directors                                                            5 
 6 Other salaries and wages                                                                    6 
 7 Pension plan contributions                                                                  7 
 8 Other employee benefits                                                                     8 
 9 Payroll Taxes                                                                               9 
10  Professional fundraising fees (including                                                   10 
   amounts paid to consultants) 
11  Accounting fees                                                                            11 
12  Legal fees                                                                                 12 
13  Telephone                                                                                  13 
14  Supplies                                                                                   14 
15  Postage and shipping                                                                       15 
16  Occupancy                                                                                  16 
17 Equipment  rental and                                                                       17 
   maintenance 
18  Printing and publications                                                                  18 
19  Travel                                                                                     19 
20  Conferences, conventions and meetings                                                      20 
21  Interest                                                                                   21 
22  Depreciation, depletion                                                                    22 
23  Other expenses (itemize – no line may                                                      23 
   exceed 5% of column total) 
                                                                                                
24  TOTAL FUNCTIONAL EXPENSES                                                                  24

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DO NOT   
STAPLE 
 
Charities Program  • 801 Capitol Way South   PO• Box 40234   Olympia,•WA 98504-0234 
Phone:  360-725-0378  • Fax: 360-664-4250   E-mail:• charities@sos.wa.gov 
Web Address: www.sos.wa.gov/charities  
 
WASHINGTON STATE UNIFIED REGISTRATION STATEMENT ADDENDUM  
 
  Check here to request EXPEDITED MAIL SERVICE (optional). If checked, please enclose an additional $20 fee. 
Make fees payable to “State of Washington” 
 
Please complete entire form or write “n/a” if not applicable. Incomplete forms will not be accepted. 
All documents must be typewritten or printed legibly in ink. DO NOT staple or bind form or attachments. 
 
SECTION 1 - ORGANIZATION INFORMATION 
Organization’s Full Legal Name: 
 
WA State Registration Number: UBI (Unified Business Identifier) Number (if located in WA): 
  
SPECIFIC BENEFICIARIES 
In the event of dissolution, will assets be distributed to a specific beneficiary whom the organization supports?   Yes     No 
If yes, attach a list containing the names and addresses of specific, named beneficiaries.  
SECTION 2 - FINANCIAL, ADMINISTRATIVE & FUNDRAISING INFORMATION 
THE NEXT TWO QUESTIONS PERTAIN TO FINANCIAL INFORMATION PROVIDED IN SOLICITATION REPORT 
Did the organization solicit or collect contributions in Washington during the fiscal/accounting year reported below? (check one) 
 Yes     No 
If no, please check reason:     New organization     No activity in Washington State      Other: ___________________________ 
                                                                                                                                                                                                                                      (describe) 
If new organization, please provide the fiscal/accounting year end date of the first year during which solicitations will be conducted in 
WA and proceed to Three Highest Paid Officers Or Employees Of The Organization section   : _____/_____/_____  (REQUIRED) 
                                                                                                                                                                                               month      day        year 
Did/will the organization submit a Federal tax return to the Internal Revenue Service for the fiscal/accounting year reported below? 
(check one)    Yes      No   
If yes, check type of return:    Form 990     Form 990 EZ     Form 990PF     990-T     1120     Other: ______________ 
                                                                                                                                                                                                                                                  (describe) 
If no, check reason:    Church/church-affiliated     Government-affiliated     Covered by group return     Annual gross receipts 
less than $25,000     Organization not tax-exempt     Other (describe): _________________________________________ 
REQUIRED ATTACHMENT 
If the organization has/will file an IRS Form 990, 990EZ or 990PF with the Internal Revenue Service for the fiscal/accounting 
year reported below…a complete copy of the tax return MUST be provided with this addendum. Be sure to include Schedule A and all 
attachments except contributor lists/Schedule B. Do not enclose the organization’s bank statements or annual report. DO NOT staple or 
bind Form 990, 990EZ or 990PF, Schedule A, or their attachments. 
NOTE: If the organization’s tax return for the fiscal/accounting year reported below has not yet been completed, please contact our 
office for instructions. DO NOT submit the URS, URS Addendum or filing fee without a copy of the Form 990, 990EZ or 990PF.  
SOLICITATION REPORT 
Please supply fiscal/accounting beginning/ending dates and complete line items 1 - 8 (REQUIRED) 
Suggested guidelines for completing the Solicitation Report using the organization’s federal tax return can be obtained at 
http://www.sos.wa.gov/charities/charities_forms.aspx  or by contacting the Charities Program directly. 
 Fiscal/accounting year begin date:   Fiscal/accounting year end date:  
(Mo/Day/Year) (Mo/Day/Year) 

URS Addendum/Rev 11/09  1

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1. The total gross dollar value of all contributions received $
from solicitations:
“Solicitations” include, but are not limited to, special events, sale of
inventory, and amounts collected on behalf of the charitable organization
by a commercial fundraiser or commercial coventurer.
2. The total gross dollar value of revenue from all other + $
sources (not the result of a solicitation):

3. The total dollar value of gross receipts: = $
"Gross receipts" include, but are not limited to, contributions, gross
revenue from special events, sales of inventory, goods or services
(including tickets to events), and all other revenue from solicitations,
regardless of custody of funds.
Amounts collected on behalf of the charitable organization by a
commercial fundraiser or commercial coventurer must be included on line (line 1 + line 2 = line 3)
3.
4. The total gross dollar value of expenditures used directly $
for charitable program services:
Payments to affiliates may be included if costs involved are not connected
with the administrative or fundraising functions of the reporting
organization.
5. The total gross dollar value of expenditures used for + $
administrative and fundraising:
"Administrative and fund-raising costs" include, but are not limited to, the
following expenses if not directly related to program services: salaries,
wages, compensation, legal, accounting, occupancy, equipment costs,
printing and publications, telephone, postage, supplies, travel, meetings,
fees for services, and cost of goods or inventory sold that are not directly
related to program services.
Amounts paid to or retained by a commercial fundraiser or fundraising
counsel must be included on line 5.
6. The total dollar value of program service, administrative = $
and fundraising expenditures:
Enter on line 6 the sum of the expenditures reported on lines 4 and 5. This
includes, but is not limited to, amounts paid to or retained by a
commercial fundraiser or fundraising counsel, amounts expended for
charitable program services, administrative expenses, fees for services,
and fundraising costs incurred by the charitable organization. (line 4 + line 5 = line 6)
7. Beginning assets (gross): $

8. Ending assets (gross): $

CHARITY’S COMMENTS REGARDING SOLICITATION REPORT (OPTIONAL)
Attach additional information or provide an explanation, if any, which the organization believes would be of assistance in understanding
the financial information provided in Solicitation Report or IRS tax return, or to provide context for reported information. Be sure to
clearly label attachment as “Solicitation Comments”.
THREE HIGHEST PAID OFFICERS OR EMPLOYEES OF THE ORGANIZATION
Officer or Employee Name Title
1.

NOTE: If no one is compensated, write “None”. If less than three persons are compensated, write “n/a” on the appropriate row(s).
REQUIRED ATTACHMENTS FOR FIREFIGHTER, POLICE, SHERIFF OR VETERANS’ SERVICE ORGANIZATIONS
Attach written authorization, signed by two officials from a bona fide police, sheriff, or fire fighter department, if your organization uses
“police,” “sheriff,” “fire fighter,” “firemen” or a similar name during the conduct of solicitations.
Attach written authorization, signed by the highest ranking official in WA State of a Federally chartered or nationally recognized
military veterans’ service organization (as determined by the United States Veterans’ Administration), if your organization uses the
name of said military veterans’ service organization during the conduct of solicitations.

URS Addendum/Rev 11/09 2

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                                              REQUIRED ATTACHMENTS 
                         Please clearly label the attachments that correspond with the following questions 
(A) Does the organization, or a commercial fundraiser operating on its behalf, use any other mailing, street, electronic or Internet 
addresses (excluding those provided above) to conduct solicitations in Washington State? (check one) 
    Yes - Attach a list of other addresses used, including those used by commercial fundraisers, if any. 
    No 
(B) Is the charitable organization a chapter, subsidiary, branch, affiliate, related foundation or supporting organization of a superior or 
parent organization? (check one) 
    Yes - Attach a list of superior or parent organizations. Include the Federal EIN, mailing address, email address, and web address for 
each superior/parent listed.  
    No 
                                 SECTION 3 - SIGNATURE (Required) 
By signing this addendum, the applicant: ( a ) certifies that the information contained in the application and in the attachments are 
accurate and true to the best of the applicant’s knowledge; ( b ) irrevocably appoints the Secretary of State to receive process (notice of 
lawsuits) in non-criminal cases against the applicant, and under the conditions set out in RCW 19.09.305; and ( c ) certifies that neither 
the organization nor any of its officers, directors, and principals have been convicted of a crime involving charitable solicitations, nor 
been subject to permanent injunction or administrative order under the Washington Consumer Protection Act (Chapter 19.86 RCW) in 
the past ten years. 
 
______________________________________     ____________________________________     _______________________     ________________ 
 Signature of applicant                                    Printed name                                                 Title                                       Date 
 
This form may be signed by the President, Treasurer or a comparable officer or, in the absence of officers, person responsible for the organization. 
  
 NOTE: Expedited Mail Service is available for registration documents requiring 48-hour turnaround. To utilize Expedited Mail 
 Service, please enclose $20 per registration document (in addition to regular fees), check (!) the box on page one of this document, 
 and write the word “EXPEDITE” in large, bold letters on the outside of the envelope. Your request will be processed and mailed 
 within TWO business days of receipt by the Charities Program. 

 URS Addendum/Rev 11/09                                             3

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 STATE OF WEST VIRGINIA 
  
 UNIFIED REGISTRATION STATEMENT SUPPLEMENT 
 
 This supplement must be completed in its entirety, attached to the Unified 
Registration Statement and filed with the Secretary of State.  
 
1.  Actual amount of funds raised in West Virginia during the last fiscal reporting 
 year [see §29-19-5(a)(6)]:$____________________________________________. 
 
2.  Amount disbursed for program services in West Virginia during the period 
 covered in this report [see §29-19-5(a)(6)]:$_____________________________. 
 Explain:________________________________________________________. 
 
3.  Amount disbursed for charitable purposes outside West Virginia during the 
 same period:$______________________________________________________. 
 Explain:________________________________________________________.

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                                                                                                                               Reset Form

    Chapter 202, Wis. Stats.                    STATE OF WISCONSIN                                                         Division of Banking 
        Subchapter II                                                                                                                
                                    Department of Financial Institutions 
                                                                                                                           Mailing Address: 
                                                                                                                               PO Box 7876 
   Telephone: (608) 267-1711                                                                                           Madison, WI 53707-7876 
     Fax: (608) 267-6889                                                                                                   Courier Address: 
                                                                                                                       201 W. Washington Ave. 
                                                                                                                                  Suite 500 
        www.wdfi.org                        FORM #1952 - WISCONSIN                                                         Madison, WI 53703 

                                       SUPPLEMENT TO FINANCIAL 
                                                               REPORT  
   
 Purpose:    Charitable organizations t ath ar  ree istered, g or are  re uiredq t   be o registered,  with t e  Departmenth of  Fi ancialn
 Institutions – Division of Ban ingk (“division”) must file an  an ualn   fi ancialn   rep rt witho th  divisione within 9 m nthsoafter t e     h
 organization’s fiscal year-end unless the organization qualifies for an exemption from the annual filing requirement.   
  
 An  organization must fileti s ann alu re ortp o  Fon mr#30   or 8 on  Form #19 2. T5 is fohm, Form  r     #1952, i  a shsrter,om re o
 commonly used version of the annual report form and must be accompanied by the organization’s IRS 990, 990EZ, or 990-PF.  If 
 an organization is unable to submit an IRS 990, 990EZ, or 990-PF, it should submit Form #308 to the division instead of Form 
 #1952.   
  
 Please note that an organization may not have to file a Form #308 or a Form #1952 if: 
         it received $5,000 or less in contributions during its most recently completed fiscal year, or   
         it operates solely in the co ntyu in wh chi its p incipalr o ficef is lo ated c an      dreceived less than  $50,000 in contributi ns o
          during its most recently completed fiscal year.   
 If the organization’s contributions fall into either of the above categories, an Affidavit in Lieu of Annual Financial Report (Form 
 #1943) should be submitted instead of Form #308 or Form #1952. 
  
 Print or type the information requested in the spaces provided. 
  
 1.  Name of charitable organization and any trade names or DBA (doing business as) names the organization uses when soliciting.     
  
 2. WI Charitable Organization Registration Number: 
  
 3. Federal Employer Identification Number:  
  
 4. Provide the following information for the organization’s headquarters office, if any: 
 
     Street: 
      
     City:                                  State:          Zip:                                Daytime Phone Number: 
                                                                                                 
 5. Provide the organization’s mailing address if different than above. 
     
     Street Address:                                                                                             P.O. Box: 
      
     City:                                                                   State:                              Zip: 
                                                                                                                  
  DFI/LFS/1952 (R 3/2014)                             CO WI SUPPLEMENT TO FINANCIAL REPORT                                                            Page 1 of 5

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 6. Provide the following information for the organization’s Wisconsin office, if any.  Attach additional pages, if the organization 
    has more than one Wisconsin office.  This item does not have to be completed if the headquarters office noted on page 1 is the 
    only Wisconsin office. 
 
     Street: 
      
     City:                                   State:         Zip:                                                           Daytime Phone Number: 
                                                                                                                            
 7. Provide the following information for the person(s) who has custody of the organization’s financial records.  Attach additional 
    pages, if necessary. 
 
     First Name:                            Last Name:                                        Street: 
                                                                                               
     City:                                   State:         Zip:                                                           Daytime Phone Number: 
                                                                                                                            
 8. Provide th efollo ingw in ormationf for th  person(s)e with n th i            cheritablea o ganizationr                wh  hasofi al respn           nsibilityo fo  th  r     e
    custody of contributions.  Attach additional pages, if necessary. 
 
     First Name:                            Last Name:                                        Street: 
                                                                                               
     City:                                   State:          Zip:                                                          Daytime Phone Number: 
                                                                                                                            
 9. Provide th efollowing informatio  forn  th  person(s)e   within t e ohganizationr           who i  responsibles                 for t e fi alhdi tributionn         s   of 
    contributions.  Attach additional pages, if necessary. 
 
     First Name:                            Last Name:                                        Street: 
                                                                                               
     City:                                   State:          Zip:                                                          Daytime Phone Number: 
                                                                                                                            
 10. Provide the following information for the person to whom we can ask questions about this form  and other registration related  
     matters.  
 
     First Name:                Last Name:                                        Phone:                                           E-mail: 
                                                                                                                                    
     Street:                                                                    City:                                              State:               Z ip: 
                                                                                                                                                          
 11.Describe   the charitable purpose or purposes for which contributions will be used or attach a document which provides such 
    information.  (You can disregard this item if you are attaching an IRS 990 that already includes this information.) 
          
 12.For solicitations in Wisconsin, did your organization use a professional fund-raiser or fund-raising 
     counsel or did your organization pay a person to solicit contributions, other than a salaried officer 
     or employee of your organization, during the previous fiscal year?                                                                        Yes             No 
          
    If YES, provide the following information about each fund-raiser(s), fund-raising counsel(s), or person.   
    Attach additional pages, if necessary. 
 
     Name:                                                                                                                 Fund-Raiser:                     Fund-Raising Counsel: 
      
     Street:                                                                           City: 
      
     State:        Zip:                              Telephone Number:                        Does the fund-raiser/fund-raising counsel/person have 
                                                                                              custody of contributions  
                                                                                              at any time:                                           Yes                No   
                                                                                               
 DFI/LFS/1952 (R 3/2014)                             CO WI SUPPLEMENT TO FINANCIAL REPORT                                                                                  Page 2 of 5

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13. Has any of the information your organization previously submitted to the division changed
(i.e. name of the organization, address of the principal office, address of any Wisconsin branch Yes No
offices, accounting period, names of persons who have final authority for custody or final
distribution of contributions, articles, by-laws, statement of purpose, etc.)?

If YES, describe the changes below. If the organization’s corporate name has changed, also attach a copy of the name
change amendment. (Please note that you do not need to provide this information if, as required by law, you already
submitted the information to the division within 30 days after the date of the change.)

14. Is your organization authorized by any other state/governmental authority to solicit contributions? Yes No

15. During the past year, has your organization had its authority to solicit contributions denied, Yes No
suspended, revoked, or enjoined by a court or other governmental authority?

If YES, provide a detailed statement of explanation.

16. Does your organization intend to accumulate an increasing surplus in net assets, rather than spend Yes No
current revenue on the organization’s stated purpose?

If YES, please explain.

17. Did the registrant make a grant, award, or contribution to any organization in which any of the Yes No
registrant’s officers or directors hold an interest; or was the registrant a party to any transaction in
which any of its directors, trustees or officers has a material financial interest; or did any officer or
director of the registrant receive anything of value not reported as compensation?

If YES to any of the above, please explain.

18. Check t ehb x t ot e oighth r i t e ref histrantgi a sol spr prietore ow o wi heshf r his /heroi dividuals pen sonal r
identifiers to be excluded from any lists which may be distributed to third parties. Individual personal identifiers
include: social security number, telephone number, street name and number, email address, and post-office box.

DFI/LFS/1952 (R 3/2014) CO WI SUPPLEMENT TO FINANCIAL REPORT Page 3 of 5

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FINANCIAL INFORMATION

Enter the accounting period (month, day, and year) that the following financial information applies to and identify the accounting
method used when preparing the information.

Beginning Date: Ending Date:

Accounting Method: Cash Accrual Other (specify)

1
1. Contribu ions t........................................................................................................................................................
("Contribution" means a grant or pledge of money, credit, property, or other thing of any kind or value, except
used clothing or household goods, to a charitab el organization or for a charit blea purpose. Bequests received
directly from th epublic and in direct public support, such as contributions receiv d through e olicitations
campaigns conducted by federated fundraising agencies like United Way should be included in this amount.
"Contribution" does not include:
 income from bingo or raffles conducted under ch. 563, Wis. Stats.
 government grants
 bona fide f ees, dues, or assessments paid b ya member of a ch ritablea organization, except that, if
initial membership in a charitable org nizationa is conf rrede s lelyo as cons derationi for m kinga a
grant or pledge of money to th echaritable org nizationa in resp nseo to a solicit tion,a that gran ort
pledge of money is a contribution.)

2. tO her Revenues .................................................................................................................................................... 2

3. Total Revenue (line 1 plus line 2) ........................................................................................................................ 3

4. Expenses:

a Expenses Allocated to Program Services ................................................. 4a

b. Expenses Allocated to Management and General ..................................... 4b

c. Expenses Allocated to Fund-raising ......................................................... 4c

d. Expenses Allocated to Payments to Affiliates .......................................... 4d

e. Total Expenses ............................................................................................................................................. 4e

5. Excess or Deficit (line 3 minus line 4e) ................................................................................................................ 5

6. Net Assets at Beginning of Year .......................................................................................................................... 6

7. Other Changes in Net Assets or Fund Balances (See 990, part XI) ....................................................................... 7

8. Net Assets at End of Year .................................................................................................................................... 8

ATTACHMENTS

Check the box next to the items that are attached to your annual report. Items A., B., and C. are required. Item D. or E. is required if
the contributions received by your orga izationn fall into t ehde cribeds ranges. (Note : If you are submitting th sifo mr with yo ru
initial application, DO NOT submit the following attachments. Submit the attachments cited in the application form instead).

A. List of all fficers,o direc ors, t trustees, and principal sal rieda e ployeesm – The list must include eac h
individual’s an me, address , and title . Please note t ath“ rincipalp sala iedrem loyees”p re ersfto t e c iefh h
administrative officers of your organization, but does not include the heads of separate departments or smaller units
within the organization. ( You can disregard this item if yo areu attach ngi an IRS 990 that already i cludesn the
requested information.)

B. A list of states that have issued a license, regis ration,t permit, or other ormal f authoriz tiona to the
organization to solicit contributions. (You can disregard this item if you ar eattaching an IRS 990 that already
includes the requested information.)

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C. IRS Form #990, 990EZ, or 990-PF Do. not include Schedule B of the 990.
(Note: If you file an IRS Form 990-N, you cannot use this form. You must complete a Form #308 or Form #1943
instead.)

D. Audited Fin nciala Statem ntse if the organization received $400,000 or more in contributions uring d its fiscal
year. The financial statements must be prepared in accordance wit hgenerally accepted accounting principles and
be accompanied by the opinion of an independent certified public accountant.

E. Reviewed Financial Statements if the organization received between $200,000 - $399,999 in contributions during
its fiscal year. The financial state ents m must be pre aredp in accorda ce withn enerally g accepted ccountinga
principles by an independent certified public accountant. Audited financial statements are also acceptable.

CERTIFICATION

This document MUST be signed by the chief fiscal officer. Two different officer signatures required.

We swear and affirm that we have reviewed this report, including the accompanying schedules and statements, and to the best of
our knowledge the information furnished is true, correct, and complete.

_______________________________________________ _ _________________________________________________
Signature of President or Authorized Officer Date Signature of Chief Fiscal Officer Date

SUBSCRIBED AND SWORN TO BEFORE ME SUBSCRIBED AND SWORN TO BEFORE ME
THIS________ DAY OF_________________,________ THIS________ DAY OF_________________,___________

________________________________________________ _ __________________________________________________
(Notary Public) (Notary Public)

My Commission Expires: ___________________________ My Commission Expires: ______________________________

RETURN MATERIALS TO:

Department of Financial Institutions
Division of Banking

Mailing Address: Street Address:
PO Box 7876 02 1 West Washington Avenue, Suite 500
Madison, Wisconsin 53707-7876 Madison, Wisconsin 53703

Notice: Completion of this form is required under Section 202.12, Wisconsin Statutes. Failure to comply may result in further action by our
Department. Personal information you provide may be used for secondary purposes.

This document can be made available in alternate formats upon request to qualifying individuals with disabilities.

DFI/LFS/1952 (R 3/2014) CO WI SUPPLEMENT TO FINANCIAL REPORT Page 5 of 5

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  Appendix of Cooperating States ©

                                            (URS v. 4.02) 
 
              A state-by-state compilation of the 

                    basic information necessary to 

            make a complete registration filing 

                in all states accepting the Unified 

                            Registration Statement 
 
© 201  4M U L T I - S T A T E  F I L E R  P R O J E C T

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NAAG/NASCO Standardized Reporting                                                                                    URS v. 4.0 2Appendix Pg 1 
 
Alabama                                                                  Arizona 
Governing law: Al. Code Sec. 13A-9-70 et seq.                            Governing law: ARS 44-6551-44-6561.  
Exemptions: (1)Educational institutions and their related foundations;   Exemptions:  (1)This state or any counties or municipalities of this 
religious organizations; political organizations; (2)fraternal, social,  state or their agencies; (2)political parties, candidates for federal, 
educational, alumni, heath care foundation, historical and civil rights  state or local office and campaign committees required to file 
organizations; (3)civic leagues and civic organizations which solicit    financial information with federal, state or local election agencies.   
solely from their membership; (4)persons requesting any                  Fees: None.  
contributions for the relief of any individual, specified by name at the Check payable to: N/A.  
time of the solicitation, if all of the contributions collected do not   Period covered: One year.  
exceed $10,000 and, without any deductions, are turned over to the       Renewal Due date:  Between September 1 through 30.  
named beneficiary; (5)any charitable organization that does not          Required signatures: Two. President (or equivalent) and 
intend to solicit and receive and does not actually receive              Secretary/Treasurer (or equivalent).  
contributions in excess of $25,000 during the fiscal year, provided all  Notarized signature required: Yes.  
of its fundraising functions are carried out by volunteers; (6)veterans  Fundraiser contracts: No.  
organizations provided all fundraising activities are carried out by     Certificate/Articles of Incorporation: No.  
volunteers.                                                              Bylaws: No.  
Fees: $25                                                                IRS Form 990: Yes.  
Check payable to: “Office of the Attorney General.”                      IRS Determination Letter:  On initial registration.  
Period covered: Indefinite.                                              Resident/Registered Agent required: No.  
Renewal Due date: No renewal of registration but financial reports       Audit: No.  
are due annually within 90 days of Fiscal Year end.                      State forms additional to URS: None 
Required signatures: Two. President or other authorized Officer and      Mailing address: Secretary of State, Charities Division, 1700 W. 
the Chief Fiscal Officer.                                                Washington, 7 thFloor, Phoenix, AZ  85007-2808. 
Notarized signature required: Yes.                                       Information telephone and contact: 602-542-6187, Karie Pesserillo.  
Fundraiser contracts: No.                                                Web: www.azsos.gov/business_services/Charities 
Certificate/Articles of Incorporation: Yes.                               
Bylaws: Yes.                                                             Arkansas 
IRS Form 990: No.                                                        Governing law: Ark. Code Ann. § 4-28-401 et seq. 
IRS Determination Letter: Yes.                                           Exemptions: (1)Nonprofits raising less than $25,000 per year with no 
Resident/Registered Agent required: No.                                  paid staff or fundraisers; (2)religious organizations; (3)parent-teacher 
Audit: No.                                                               associations; (4)accredited educational institutions; (5)nonprofit 
State forms additional to URS: None.                                     hospitals; (6)political candidates and organizations; and 
Mailing address: Ofc. of the Atty General, Consumer Protection           (6)government instrumentalities.  
Section, 500 Dexter Avenue, Montgomery, AL 36130-0152                    Fees: None for charities, $100 for fundraising counsel, and $200 for 
Info. telephone & contact: 334-242-7320, Rhonda Lee Barber               paid solicitors.  
Web: www.ago.state.al.us/consumer_charities.cfm                          Check payable to: Office of Attorney General 
                                                                         Period covered: One year. 
Alaska                                                                   Renewal Due date: Anniversary of initial registration.  
Governing law: AS 45.68.010 et seq. and 9 AAC 12.010 et seq.             Required signatures: One. An authorized officer, director, or an 
Exemptions:  (1) An organization that has a current gaming permit        incorporator. 
through the Alaska Department of Revenue; (2) a church or religious      Notarized signature required: Yes. 
organization that is exept from filing an annual return with the IRS     Fundraiser contracts: Yes. 
(3)an organization that does not intend to or does not receive           Certificate/Articles of Incorporation: Yes. 
contributions, excluding government grants, in excess of $5,000 or       Bylaws: Yes. 
that does not receive contributions from more than ten persons during    IRS Form 990: Yes. 
fiscal year and (i)all functions, including solicitation, are carried on IRS Determination Letter: Yes. 
by volunteers and (ii)an officer or member of the organization is not    Resident/Registered Agent required: No, but related state Form 
paid or does not otherwise receive all or part of the assets or income   required. See below. 
of the organization.                                                     Audit: Yes, if gross revenue exceeds $500,000. 
Fees: $40                                                                State forms additional to URS: One: "Irrevocable Consent for 
Check payable to: “State of Alaska.”                                     Service: Charitable Organization." 
Period covered: One year.                                                Mailing address: Ofc. of Atty. General, Charities Division., 323 
Due Date: September 1st.                                                 Center St #200, Little Rock, AR 72201-2610 
Renewal Due date:  September 1st.                                        Info. telephone & contact: 501-682-1109, Shaunta Belmont-Brown, 
Required signatures:  One.                                               Charitable Registration Specialist. 
Notarized signature required: No.                                        Web: http://ag.arkansas.gov/consumers_protection_charitable_ 
Fundraiser contracts:  Yes.                                              registration.html 
Certificate/Articles of Incorporation:  No.                               
Bylaws:  No.                                                             California 
IRS Form 990: Yes or may submit most recent audited financial            Governing law: Cal. Govt Code §§ 12580-12596; Cal. Code of 
statement.                                                               Regulations, Title 11 §§ 300-310, 999.1-999.4; Bus. & Prof. Code 
IRS Determination Letter: No.                                            Sec. 17510-17510.85; 22930; Cal. Corp Code Sec. 5250. 
Resident/Registered Agent required:  No.                                 Exemptions: (1)Government agencies; (2)religious corporations; 
Audit:  No.                                                              (3)political committees; (4)religious organizations and hospitals; 
State forms additional to URS: None.                                     (5)corporate trustees subject to the jurisdiction of other California 
Mailing address: Alaska Department of Law, Attorney General, 1031        state and federal agencies; (6)any charity organized in another state 
W. 4 thAve. Suite 200, Anchorage, AK 99501-1994                          that is not “doing business” or holding property in California. 
Info. telephone & contact: 907-269-5200, Davyn Williams,                 Fees: Sliding scale dependent on amount of assets or revenue.  $0 if 
davyn.williams@alaska.gov                                                less than $25,000; $25 if $25,000-$100,000; $50 if $100,001-
Web: www.law.alaska.gov/department/civil/consumer/                       $250,000; $75 if $250,001-1 million; $150 if $1 million-10 million; 
cp_topics.html#charity                                                   $225 if $10 million-50 million; $300 if more than $50 million.

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NAAG/NASCO Standardized Reporting URS v. 4.0 2Appendix Pg 2

Check payable to: “Office of the Attorney General.” Fees: $70* (now rolled into a consolidated fee - See Below)
Period covered: One year. Check payable to: "DC Treasurer."
Renewal Due date: Within four and a half months of Fiscal Year Period covered: One year.
end. Extensions granted by the IRS for filing a copy of From 990, Renewal Due date: September 1.
Form 990PF, or Form 990EZ will be honored; however, no Required signatures: Two. President or Vice President, and Secretary
extensions will be granted for filing the RRF-1. or Assistant Secretary.
Required signatures: One. Any authorized officer or director. Notarized signature required: Yes.
Notarized signature required: No. Fundraiser contracts: Yes.
Fundraiser contracts: No. Certificate/Articles of Incorporation: Yes.
Certificate/Articles of Incorporation: Yes. Bylaws: Yes.
Bylaws: Yes. IRS Form 990: Yes.
IRS Form 990: Yes. IRS Determination Letter: Yes.
IRS Determination Letter: Yes. Resident/Registered Agent required: Yes. May use Item #17 on URS.
Resident/Registered Agent required: No. Audit: No.
Audit: Yes, if gross revenue exceeds $2 million (exclusive of grants State forms additional to URS: Yes, see Below.
from, and contracts for services with, governmental entities for which Mailing address: Dept. of Consumer & Reg. Affairs, 941 N. Capital
the entity requires an accounting of the funds received). St. NE, Suite 1000, Washington, DC 20002-4259
State forms additional to URS: One. RRF-1. Info. telephone: 202-442-4513
Mailing address: Registry of Char. Trusts, Ofc. of Atty. General, Web: dcra.dc.gov/dcra/cwp/view,A,1411,Q,642526.asp
P.O. Box 903447, Sacramento, CA 94203-4470 *In addition to the URS, DC requires charities to obtain a basic
Info. telephone: 916-445-2021 business license. Further information on licensing is included in the
Web: http://caag.state.ca.us/charities/index.htm Supplementary Forms section of this packet. The two-year license
costs $208, plus a $70 application fee and $25 endorsement fee.
Connecticut DC accepts the URS, but it does so as a required replacement for
Governing law: C.G.S. §21A-175, et seq. DC’s previous reporting form (not as an optional substitute for it).
Exemptions: Organizations that solicit contributions within Moreover, DC has elected to treat out-of-state nonprofits just as it
Connecticut and (1) are a religious corporation, institution or society, does DC-located organizations. This effectively imposes a host of
(2)are a parent teacher association or an accredited educational local licensure requirements having no logical (nor, perhaps, legal)
institution, (3)are a nonprofit hospital, (4)are a governmental unit or application to organizations outside DC whose sole contact with DC
instrumentality, (5) solicit solely for the benefit of 1 through 4 above, is sending mail or emails or making calls to DC residents.
or (6) normally receives less than $50,000 in contributions annually,
and does not compensate any person primarily to conduct Georgia
solicitations. Exemption must be claimed before any solicitation Governing law: O.C.G.A. §43-17-1, et seq.
occurs in Connecticut, using Connecticut Form CPC-54, available at Exemptions: (1)Organizations with less than $25,000 in annual
www.ct.gov/dcp/cwp/view.asp?a=1629&Q=285170&PM=1 revenues; (2)organizations recognized as religious under IRC
Fees: $50. An additional late fee of $25 per month or part thereof 501(c)(3) and not required to file IRS Form 990; (3)nonprofit
applies if received after the due date or extended due date. educational institutions and their agencies; (4)political parties,
Check payable to: "Dept. of Consumer Protection." candidates, and political action committees; (5)national charities with
Period covered: One year –registration expires the last day of the registered Georgia affiliates.
fifth month after the end of the organization’s fiscal year. Fees: $35 initial. $20 renewal.
Renewal Due date: Within five months of Fiscal Year end. Check payable to: "Secretary of State."
Extensions of 6 months may be granted upon written request if Period covered: Two years.
received before the expiration date by email to Renewal Due date: Anniversary of initial registration.
ctcharityhelp@po.state.ct.us. Mailed and faxed extensions will not be Required signatures: One. Any authorized executive officer.
granted. IMPORTANT NOTE: By signing the URS, the signer irrevocably
Required signatures: Two, any authorized officers. appoints the Secretary of State as the organization’s agent for service
Notarized signature required: No. of process for any action arising from the Solicitation Act [this
Fundraiser contracts: No. condition replaces a separate Georgia form for that purpose].
Certificate/Articles of Incorporation: No. Notarized signature required: Yes.
Bylaws: No. Fundraiser contracts: No.
IRS Form 990: Yes. Certificate/Articles of Incorporation: No.
IRS Determination Letter: No. Bylaws: No.
Resident/Registered Agent required: No. IRS Form 990: Yes.
Audit: Yes, if gross revenue exceeds $200,000 (excluding IRS Determination Letter: Yes.
government grants and fees, and trust revenues). Resident/Registered Agent required: No.
State forms additional to URS: None. Audit: Yes, if gross revenue over $1 million; CPA review for
Mailing address: Public Charities Unit, c/o Ofc. of Atty. General, 55 organizations between $500,000 and $1 million; and below $500K,
Elm St., P.O. Box 120, Hartford, CT 06141-0120 the organization’s own financial statement consisting of a balance
Info. telephone: 860-808-5030 sheet and income/expense statement.
Web: Info: www.cslib.org/attygenl/mainlinks/tabindex8.htm State forms additional to URS: One: “Georgia Supp. to URS”.
Mailing address: Securities and Business Regulation, 2 Martin
District of Columbia Luther King, Jr. Dr. #802 W. Tower, Atlanta, GA 30303-9000
Governing law: D.C. Code §44-1701 (2001 ed.) Info. telephone & contact: 404-656-3920; Charities Unit
Exemptions: (1)Organizations receiving less than $1,500 in gross Web: www.sos.state.ga.us/securities/default.htm
total receipts in a calendar year, provided all functions, including
fundraising, are carried out by individuals who are unpaid; (2)for Hawaii
educational purposes; (3)for a church or a religious corporation or an Governing law: Hawaii Revised Statutes §467B
organization under the control of a church or religious corporation; Exemptions: (1) Any duly organized religious corporation,
(4)by American Red Cross; (5)exclusively among the membership of institution, or society; (2) any parent-teacher association or any
the soliciting agency. Organizations seeking exemption must file educational institution, the curricula of which in whole or in part are
"Form 164." registered or approved by any state or the United States either

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NAAG/NASCO Standardized Reporting URS v. 4.0 2Appendix Pg 3

directly or by acceptance of accreditation by an accrediting body; (3) Kansas
any nonprofit hospital licensed by the state or any similar Governing law: KSA 17-1760 et seq.
provision of the laws of any other state; (4) any governmental unit Exemptions: Any religious corporation, trust or organization;
or instrumentality of any state or the United States; (5) any person Accredited educational institutions or any of their foundations; Any
who solicits solely for the benefit of organizations described in other educational institution confining its solicitation to the student
exemptions 1-4; (5) any charitable organization that normally body, alumni, faculty and trustees; Fraternal, social, alumni
receives less than $25,000 in contributions annually, if the organizations and historical societies when solicitation is confined to
organization does not compensate any person primarily to conduct their membership; Any organization which does not receive
solicitation. contributions in excess of $10,000 per year.
Fees: None (but fees do attach to annual reporting). Fees: $35
Check payable to: “State of Hawaii” Check payable to: “Secretary of State.”
Period covered: Indefinite. Period covered: One year.
Renewal Due date: No renewal of registration, as such, but financial Renewal Due date: Within 6 months of Fiscal Year end.
reports, consisting of the organization’s Form 990 or Form 990EZ, Required Signatures: Two. An Authorized Officer and Chief Fiscal
are due annually (see “Information on Financial Reporting” in this Officer.
Appendix). Notarized signature required: No.
Required signatures: Two. Any authorized officer. Fundraiser contracts: No.
Notarized signature required: No. Certificate/Articles of Incorporation: Yes.
Fundraiser contracts: No. Bylaws: No.
Certificate/Articles of Incorporation: No. IRS Form 990: Yes.
Bylaws: No. IRS Determination Letter: Yes.
IRS Form 990: Yes. Resident/Registered Agent required: No.
IRS Determination Letter: No. Audit: Yes, if receive contributions more than $500,000.
Resident/Registered Agent required: No. State forms additional to URS: None.
Audit: No. Mailing address: Ron Thornburgh, Sec. of State, First Floor,
State forms additional to URS: None. Memorial Hall, 120 SW 10 thAvenue, Topeka, KS 66612-1594
IMPORTANT NOTE: Starting January 1, 2009, charities that solicit Info. Telephone: 785-296-4564
funds in Hawaii must register using the URS but must do so online at Web: www.kssos.org/business/business_charitable.html
http://efile.form990.org/states/Hawaii.
Mailing address: State of Hawaii, Department of the Attorney Kentucky
General, Tax Division, 425 Queen Street, Honolulu, HI 96813-2903 Governing law: K.R.S. §367.650
Info. telephone: (808)586-1470 Exemptions: Solicitations (1) by an organization of contributions
Web: http://hawaii.gov/ag/charities. from its members and their families only; (2) by Religious
organizations soliciting funds for religious purposes; and (3) by a
Illinois publicly-own or nonprofit privately-endowed educational institution;
Governing Law: 760 ILCS 55/1; 225 ILCS 460/1 from alumni, faculty, members, study body of the institution, and
Exemptions: This Act does not apply to the United States, any State, their families. These DO NOT exclude an organization from
territory or possession of the United States, the District of Columbia, registration with the office of Attorney General. An organization
the Commonwealth of Puerto Rico, or to any of their agencies or to may request exemption by sending supporting documentation with a
any governmental subdivision; or to a corporation sole, or other letter of request.
religious corporation, trust or organization which holds property for Fees: None.
religious, charitable, hospital or educational purposes or for the Check payable to: N/A
purpose of operating cemeteries or a home or homes for the aged; nor Period covered: Only the Calendar year in which it is received – the
to any agency or organization, incorporated or unincorporated, URS expires 12/31 annually. Once the organization has submitted a
affiliated with and directly supervised by such a religious corporation 990 to the IRS, a copy of the 990 becomes the registration document
or organization; or to an officer, director or trustee of any such with the same IRS due date.
religious corporation, trust or organization who holds property in his Renewal Due date: “The Form 990 shall be filed with the Attorney
official capacity for like purposes; or to a charitable organization General each year in which contributors are solicited in the
foundation, trust or corporation organized for the purpose of and Commonwealth at the same time the form is filed with the Internal
engaged in the operation of schools or hospitals. Revenue Service. If a Form 990 is not filed with the Internal Revenue
Fees: $15 Service, a new notice of intent to solicit shall be filed with the
Check payable to: “Illinois Charity Bureau Fund.” Attorney General.” K.R.S. 367.657
Period covered: Indefinite. Required signatures: One. Any officer.
Renewal Due date: No renewal of registration but financial reports Notarized signature required: Yes.
are due annually within six months of Fiscal Year end. Fundraiser contracts: Not required, but requested.
Required signatures: Two. President and Chief Financial Officer. Certificate/Articles of Incorporation: Not required, but requested
Notarized signature required: No. Bylaws: Not required, but requested.
Fundraiser contracts: Yes. IRS Form 990: Yes.
Certificate/Articles of Incorporation: Yes. IRS Determination Letter: Yes.
Bylaws: Yes. Resident/Registered Agent required: No.
IRS Form 990: Yes. Audit: No.
IRS Determination Letter: Yes. State forms additional to URS: None.
Resident/Registered Agent required: Yes. May use Item #17 on URS. Mailing address: Cynthia Lowe, Ofc. of Atty. General, Consumer
Audit: Yes, if over $300,000 in gross revenue. Prot. Div., Nonprofit Registration, 1024 Capital Center Dr.,
State forms additional to URS: None. Frankfort, KY 40601-8204
Mailing address: Office of the Illinois Attorney General, Charitable Info. telephone & contact: 502-696-5300, Charity Registration.
Trust & Solicitations Bureau, 100 W. Randolph St., 3 rdfl., Chicago, Web: www.ag.ky.gov/civil/consumerprotection/charity/
IL 60601-3175
Info. telephone: 312-814-2595 Louisiana
Web: www.illinoisattorneygeneral.gov/charities/index.html Governing law: La. R.S. 51:1901-1904; La. Admin. Code, Title 16,
Part III, Chapter 5, Sec. 515.

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Exemptions: Religious organizations, including exempt from federal Audit: Yes, for “most recently audited year.”
income tax under IRC 501(c)(3), if not primarily supported by funds State forms additional to URS: Yes. Forms are included in the URS
solicited outside its own membership or congregation; educational for both initial and renewal registrations.
institutions recognized or approved by the Louisiana Dept. of IMPORTANT NOTE: No later than September 30 of each year, the
Education; voluntary health organizations organized under Louisiana charitable organization must submit Maine’s “Annual Fundraising
or federal law. VERY IMPORTANT NOTE: Only those Activity Report,” available on Maine’s website.
organizations contracted with “professional solicitors” to raise funds Mailing address: Ofc. of Licensing & Registration, Charitable
in Louisiana are required to register with the Louisiana Attorney Solicitation Program, 35 State House Station, Augusta, ME 04333-
General’s Office. 0035
Fees: $25 Info. telephone & contact: 207-624-8624, Marlene McFadden
Check payable to: "Consumer Protection Section." Email: marlene.m.mcfadden@state.me.us
Period covered: One year. Web:www.maine.gov/pfr/professionallicensing/professions/charitable
Renewal Due date: Anniversary of initial registration. /organization.htm
Required signatures: One. Any authorized officer, director or
incorporator. Maryland
Notarized signature required: No. Governing law: Ann. Code, Bus. Reg. Art., Sec. 6-101 et seq.
Fundraiser contracts: Yes. Exemptions: An organization is exempt if it does not employ a
Certificate/Articles of Incorporation: Yes. professional solicitor and is: a religious organization exempt from
Bylaws: Yes. federal tax; an organization soliciting only from its members; an
IRS Form 990: No organization that does not receive more than $25,000 per year in
IRS Determination Letter: Yes. contributions from the public. Please note: Organizations exempt
Resident/Registered Agent required: No. because they receive less than $25,000 in charitable contributions
Audit: No. must file annually “Exempt Organization Fundraising Notice” (Form
State forms additional to URS: None. But note that any LA-based SS-208), which is available from MD.
organization is required to submit documentation demonstrating that Fees: $0 if $0-$24,999.99; $50 if $25,000-$50,000; $75 if $50,001-
it has established its exemption from Louisiana corp. income tax (any $75,000; $100 if $75,001-100,000; $200 if $100,001 or more.
501c organization can claim exemption by submitting its IRS letter of Check payable to: “Secretary of State.”
determination to the LA Dept. of Revenue). Period covered: One year.
Mailing address: Ofc. of the Attorney General, Consumer Protection Renewal Due date: Within six months of Fiscal Year end.
Section, 1885 N. 3 rdSt., Baton Rouge, LA 70802-5146. Required signatures: One. The president, chairman or principal
Info. telephone & contact: 225-326-6474; Stacy Antie. officer.
Web: ladoj.ag.state.la.us/ IMPORTANT NOTE: By signing the URS, the signer (i) consents
to the jurisdiction and venue of the Circuit Court of Anne Arundel
Maine Co. in actions brought under Title 6 of the Business Regulation
Governing law: 9 M.R.S.A. Chapter 385, Sec. 5001-5018 Article of the Annotated Code of Maryland and (ii) certifies that all
Exemptions: Organizations established for religious purposes have no taxes due or due to be collected and paid over to the State, Baltimore
registration requirement. The following organizations are eligible to City, or a Maryland county have been paid or collected and paid over
apply as Exempt Charitable Organizations upon filing of an Exempt and (iii) certifies the copy of the IRS Form 990 or 990EZ accom-
Charitable Organization application and payment of a $10 fee: (1) panying the statement is a true copy of the form filed with the IRS.
Organizations that solicit primarily within their membership, with Notarized signature required: No.
solicitation activities being conducted by the members; (2) Persons Fundraiser contracts: Yes.
soliciting contributions for the relief of any individuals specified by Certificate/Articles of Incorporation: Yes.
name at the time of the solicitation, when all of the contributions Bylaws: Yes.
collected, without any deductions whatsoever, are turned over to the IRS Form 990: Yes.
named beneficiary for that individual’s use; (3) Organizations that do IRS Determination Letter: Yes.
not intend to solicit and receive, and do not actually solicit or receive, Resident/Registered Agent required: No.
contributions from the public in excess of $10,000 during a calendar Audit: Yes, if gross income from charitable contributions equals or
year, or do not receive contribution from more than 10 persons during exceeds $500,000 (CPA review if between $200,000 and 500,000).
a calendar year, if a all fund-raising activities are conducted by State forms additional to URS: None.
persons who are unpaid for their services, and if no part of the assets Mailing address: Office of the Secretary of State, Charitable
or income inures to the benefit of, or is paid to, any officer or Organizations Division, State House, Annapolis, MD 21401-1547.
member; (4) Educational institutions, the curriculums of which in Info. telephone: 410-974-5534.
whole or in part are registered or approved by the Department of Web: www.marylandsos.gov/Charity/RegisterCharity.htm
Education, either directly or by acceptance of accreditation by an
accrediting body recognized by the Department of Education, and Massachusetts
organizations operated by the study bodies of such institutions; (5) Governing law: Mass. Gen. Law, Chapters 12 & 68.
Hospitals that are nonprofit and charitable. Exemptions: Religious corporation, trust, foundation, association, or
Fees: $50 initial (includes $25 license and $25 application fees). $25 organization established for religious purposes and agencies and
renewal. affiliates.
Check payable to: “State of Maine Treasurer.” Fees: Initial: $50.
Period covered: One year (or until Nov. 30 following initial Check payable to: "Commonwealth of Massachusetts."
registration). Period covered: Indefinite.
Renewal Due date: November 30. Renewal Due date: No renewal of registration but financial reports
Required signatures: One. Principal Officer. are due annually within four and half months of Fiscal Year end.
Notarized signature required: Yes. Required signatures: Two. The President or other authorized officer
Fundraiser contracts: No. and the treasurer or Chief Financial Officer.
Certificate/Articles of Incorporation: No. Notarized signature required: No.
Bylaws: No. Fundraiser contracts: Yes.
IRS Form 990: Yes. Certificate/Articles of Incorporation: Yes.
IRS Determination Letter: Yes, for initial licensure. Bylaws: Yes.
Resident/Registered Agent required: No. IRS Form 990: No, only with annual reports.

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IRS Determination Letter: Yes. accept the URS in lieu of its own annual financial reporting form
Resident/Registered Agent required: No. (and as a simultaneous renewal of registration) if the filer completes
Audit: Yes, if gross support and revenue is $500,000 or more (CPA the Minnesota Supplement to the URS, fulfills the audit requirement
review if between $200,000 and 500,000). attached to annual financial reporting (See the Minn. entry in the
State forms additional to URS: None. “Information on Annual Financial Reporting” section of this
Mailing address: Mass. Office of the Attorney General, Non-Profit Appendix) and submits all required items as indicated in the
Organizations/Public Charities Division, One Ashburton Pl., Rm Minnesota Supplement.
1413, Boston, MA 02108-1698 Required signatures: Two. Any authorized officer or director or
Info. telephone: 617-727-2200. incorporator. IMPORTANT NOTE: By signing the URS, the
Web: www.mass.gov/ago/charities signers certify the registration has been executed and submitted
pursuant to a resolution of the board of directors or trustees which has
Michigan approved the content of the registration statement.
Governing law: MCLA §400.271 Notarized signature required: No.
Exemptions: Duly constituted religious organizations; groups Fundraiser contracts: Yes.
receiving $8,000 or less annually, if no one is paid to fundraise and Certificate/Articles of Incorporation: Yes, for initial registration.
financial statements are available to the public; groups soliciting Bylaws: No.
quarterly or less often from members and their immediate families; IRS Form 990: Yes.
educational institutions certified by the Michigan board of education; IRS Determination Letter: Yes, for initial registration.
veterans groups organized under federal law; licensed nonprofit Resident/Registered Agent required: No.
hospitals and their foundations and auxiliaries. Organizations Audit: Yes, if revenue exceeds $750,000.
seeking exemption must file "Request for Exemption form." State forms additional to URS: Minnesota Supplement to the URS.
IMPORTANT NOTE: If a parent corp. wishes to include MI Mailing address: Charities Division, 445 Minnesota Street, Suite
chapters in its license it must include with URS: MI articles of 1200, Bremer Tower, St. Paul, MN 55101-2130
incorporation or certificate of authority; listing of names and Info. telephone & contact: 651-757-1311; Cyndi Nelson
addresses of MI chapters; a copy of the IRS group return; a financial Web: www.ag.state.mn.us/Charities/CharitableForms.asp
report for each chapter; and a copy of the IRS group return, if
applicable. Mississippi
Fees: None. Governing Law: Miss. Code Ann. Sec. 79-11-501, et.seq.
Check payable to: N/A Exemptions: Accredited educational institutions; Educational
Period covered: One year. institutions which solicits solely from its students, alumni, faculty,
Renewal Due date: 30 days prior to license expiration. trustees and families; Fraternal, patriotic, social, educational alumni
Required signatures: One. Trustee or Officer. organizations and historical societies when solicitation of
Notarized signature required: No. contributions is made solely by their membership; Any charitable
Fundraiser contracts: Yes. organization which does not intend to solicit and receive and does not
Certificate/Articles of Incorporation: Yes. actually receive contributions in excess of $4,000, provided all of its
Bylaws: Yes. fundraising functions are carried on by persons who are unpaid for
IRS Form 990: Yes. such services. Organizations seeking exemption must file "Form CE."
IRS Determination Letter: Yes. Fees: $50
Resident/Registered Agent required: Yes. May use item #17 on URS. Check payable to: “Mississippi Secretary of State.”
Audit: Yes, if public support is over $500,000 or more. If between Period covered: One year.
$250,000 and $500,000, CPA review required. Audited financial Renewal Due date: Anniversary of initial registration.
statements must be prepared in accordance with GAAP. Required signatures: Two. President or authorized officer and Chief
State forms additional to URS: None Financial Officer.
Mailing address: Atty. General, Charitable Trust Section, PO Box Notarized signature required: Yes.
30214, Lansing, MI 48909-7714. If overnight mail, send to: Atty. Fundraiser contracts: Yes.
General, Charitable Trust Sec., Williams Bldg., 525 W. Ottawa, 1 st Certificate/Articles of Incorporation: Yes.
Fl., Lansing, MI 48933-1067. Bylaws: Yes.
Info. telephone & contact: 517-373-1152, Patricia Conley, IRS Form 990: Yes.
Administrator IRS Determination Letter: Yes.
Web: www.michigan.gov/ag and click on “Charities." Resident/Registered Agent required: Yes. May use item #17 on URS.
Audit: Yes, if contributions are more than $500,000 or engaged the
Minnesota services of a professional fund-raiser. If contributions are $250,000
Governing law: Minnesota Statutes ch. 309 to $500,000, a review is required. The Secretary has statutory
Exemptions: Religious organizations and churches which are not authority to request audits on a case-by-case basis for registrants
required to file the IRS Form 990; organizations receiving $25,000 or between $25,000 and $250,000.
less annually and whose functions and activities, including State forms additional to URS: One. “Supplement to URS” (includes
fundraising, are performed wholly by persons who are unpaid for Annual Financial Reporting form).
their services; accredited colleges and secondary schools; fraternal, Mailing address: Miss. Sec. of State, Charities Registration, P.O.
patriotic, social, educational, alumni, professional, trade, or learned Box 136, Jackson, MS 39205-0136
societies that limit solicitations to members. Exempt organizations Info. telephone & contact: 601-359-1371 or (toll free) 888-236-6167,
are asked to file "Verification of Exemption” Form. Kathy French
Fees: $25. Web: www.sos.state.ms.us/regenf/charities/charities.asp
Check payable to: "State of Minnesota."
Period Covered: Until annual financial reporting is due (see renewal Missouri
date below) Governing law: Sec. 407.450, et seq., RSMo supp. 1988.
Renewal Due date: Seven months and fifteen days following close of Exemptions: Religious, educational and fraternal organizations;
fiscal year. Four month extension available upon written request. Hospitals, provided fundraising not done by professional fundraiser;
NOTE: MN consolidates registration renewal and annual financial all 501(c) 3, 501(c) 7 and 501(c)(8) organizations. A copy of the
reporting. Organizations that submit the “Charitable Organization organization’s IRS tax exemption determination letter may be filed
Annual Report” (the state’s annual financial report form) are with the state to obtain exemption.
regarded as having also renewed their registrations. The state will Fees: $15. ($50 reinstatement fee).

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Check payable: Check or money order to “Merchandising Practices Bylaws: Yes.
Revolving Fund.” IRS Form 990: Yes.
Period covered: One year. IRS Determination Letter: Yes.
Renewal Due date: Within two and a half months of Fiscal Year end. Resident/Registered Agent required: No.
Required signatures: One. Any authorized officer. Audit: Yes, if over $250,000 in Gross Revenue.
Notarized signature required: Yes. State forms additional to URS: None.
Fundraiser contracts: Yes. Mailing address: N.J. Division of Consumer Affairs, Charities
Articles of Incorporation: Yes. Registration Section, P.O. Box 45021, Newark, NJ 07101-8002.
Bylaws: No. Info. telephone: 973-504-6215
IRS Form 990: Yes. Web: www.state.nj.us/lps/ca/ocp/charities.htm
IRS Determination Letter: Yes, if 501(c)(3), (c)(7) or (c)(8).
Resident/Registered Agent required: No. New Mexico
Audit: No. IMPORTANT NOTE: New Mexico has launched its electronic
State forms additional to URS: One (not a “form,” but required registration system at https://secure.nmag.gov/coros. All Charitable
attachments. See note following). IMPORTANT NOTE: organizations as described by the statute MUST register
organizations must attach copies of all solicitation materials electronically unless granted an exemption from electronic
(including telephone scripts) currently in use. registration. New Mexico ONLY accepts the URS if an organization
Mailing Address: Missouri Attorney General’s Office, Attn: Rhonda has been granted an exemption to electronic registration. To receive
Johnson, P.O. Box 899, Jefferson City, MO 65102-0899 an exemption to electronic registration, an organization must submit
Info. telephone & contact: 573-751-1197, Rhonda Johnson an request for exemption from electronic filing and an affidavit
Web: http://ago.mo.gov/forms/forms.htm affirming under oath that it is unable to register electronically.
Governing law: NMSA 22 §57-22-1, et seq.
New Hampshire Exemptions: Religious organizations as defined by the Act;
Governing law: RSA 7:19 through 7:32-I educational institutions as defined by the Act; and persons soliciting
Exemptions: Religious organizations and their integrated auxiliaries; for an individual or group that has suffered a medical or other
conventions or associations of churches. catastrophe when certain conditions are met.
Fees: $25 initial. $75 renewal. Fees: None. Late fees for failure to register or file may be assessed.
Check payable to: "State of New Hampshire." Check payable to: N/A
Period Covered: One year. Period covered: Indefinite
Renewal Due Date: Within four and a half months of Fiscal Year end Renewal Due date: Once electronically registered, no renewal of
Required signatures: Two. President and treasurer. registration required but financial reports are due annually within 6
Notarized signature required: Yes. months of Fiscal Year end. All organization currently registered
Fundraiser Contracts:No. via mail must re-register electronically by March 1st, 2011. This
Certificate/Articles of Incorporation: Yes. may be done at any time during the year at time of annual report.
Bylaws: Yes. Required signatures: Electronic signature of agent.
IRS Form 990: Yes. Notarized signature required: Yes, if registering via mail copy
IRS Determination Letter: Yes. pursuant to exemption from filing.
Resident/Registered Agent required: No. Fundraiser contracts: Yes.
Audit: Yes, if revenue equals $1 million or more. Certificate/Articles of Incorporation: Yes.
State forms additional to URS: One (not a “form”, but a required Bylaws: Yes.
attachment. See note following). IMPORTANT NOTE: A IRS Form 990: Yes.
registering organization must attach to the URS a copy of its conflict- IRS Determination Letter: Yes.
of-interest policy currently in effect. Resident/Registered Agent required: Yes.
Mailing address: Department of Justice, Charitable Trust Division, Audit: Yes, if total revenue is in excess of $500,000.
33 Capitol St, Concord, NH 03301-6397. State forms additional to URS: None.
Info. telephone & contact: 603-271-3591, Terry Knowles, Assistant Mailing address: Registrar of Charitable Organizations, Ofc. of Atty.
Director General, 111 Lomas Blvd NW, #300, Albuquerque, NM 87102-
Web: doj.nh.gov/charitable/index.html 2368.
Info. telephone & contact: 505-827-6000, Elizabeth K. Korsmo
New Jersey Web: www.nmag.gov/office/Divisions/Civ/charity
Governing law: NJSA 45:17A, et seq.
Exemptions: Any religious corporation, trust, foundation association New York
or organization, or any agency or organization established for Governing law: Art. 7-A, Executive Law. Please Note: Registrants
charitable purposes which is operated by, controlled or supervised by may also be subject to registration pursuant to the Estates, Powers &
a religious organization; any education institution or library Trusts law. See www.oag.state.ny.us or call (212) 416-8400 for
supervised by the Dept. of Education. An organization receiving instructions.
annual gross contributions of $10,000 or less may choose whether or Exemptions: Religious agencies and organizations and charities
not they wish to maintain a registration with the NJ Charities operated, supervised, or controlled in connection with a charity
Registration Section, but is not required to do so. Charities at this organized under the Religious Corporations Law; Educational
level of gross contribution who choose to maintain a registration are institutions confining solicitations to student body, alumni, faculty
required to pay a $30 registration fee. and trustees and their families; Fraternal, patriotic, social and alumni
Fees: Between $10,001 and $25,000 = $30; $25,001 - $100,000 = organizations and historical societies chartered by Board of Regents
$60; $100,001-$500,000 = $150; more than $500,000 = $250. when soliciting memberships; Organization receiving $25,000 or less
Check payable to: “NJ Division of Consumer Affairs.” and not paying professional fundraisers, fundraising counsel, or
Period covered: One year. commercial coventurers; Local post, camp, chapter or county unit of
Renewal Due date: Within six months of Fiscal Year end. a veteran's organization; educational institutions or libraries that file
Required signatures: Two. Any authorized officers, one being the annual financial reports with Regents of University of State of New
chief fiscal officer. York or with an agency having similar jurisdiction in another state.
Notarized signature required: No. Organizations seeking exemption must file "Schedule E."
Fundraiser contracts: Yes. Fees: $10 if revenue is below $250,000. $25 if revenue is $250,000+
Certificate/Articles of Incorporation: Yes. (Other fees required by those registered under EPTL).

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Check payable to: "NYS Department of Law." soliciting contributions for any person specified by name at the time
Period covered: Indefinite. of the solicitation if all the contributions received are transferred
Renewal Due date: No renewal of registration but financial reports within a reasonable time after receipt to the person named or that
are due annually within four and a half months of Fiscal Year end. person’s parent, guardian or conservator with no restrictions on their
Required signatures: Two, President and director or chief fiscal expenditure and with no deduction; religious organizations;
officer. institutions of higher learning; a private or public elementary or
Notarized signature required: No. secondary school; any candidate for national, state, or local elective
Fundraiser contracts: No (these are filed by the fundraiser). office or political party or other committee required to file
Certificate/Articles of Incorporation: Yes. information with the federal election committee, a state election
Bylaws: Yes. commission, or an equivalent office or agency.
IRS Form 990: Yes. Fees: $25 initial. $10 renewal.
IRS Determination Letter: Yes. (Must also submit copy of IRS Form Check payable to: "Secretary of State."
1023 or 1024). Period covered: One Year.
Resident/Registered Agent required: No (Secretary of State may be Renewal Due date: September 1.
designated). Required signatures: One. An authorized officer of the charitable
Audit: Yes, if over $250,000 in revenues (CPA review if between organization.
100,000-$250,000). Notarized signature required: Yes.
State forms additional to URS: None. Fundraiser contracts: Yes.
Mailing address: Dept. of Law, Charities Bureau, 120 Broadway 3 rd Certificate/Articles of Incorporation: Yes.
fl., New York, NY 10271 Bylaws: No.
Info. telephone & contact: 212-416-8401, Karin K. Goldman, Asst. IRS Form 990: Yes.
Attorney General IRS Determination Letter: Yes.
Web: www.charitiesnys.gov Resident/Registered Agent required: Yes (see below for required
form).
North Carolina Audit: No.
Governing law: Chapter 131 F. State forms additional to URS: Two. “Certificate of Authority “ (SFN
Exemptions: Qualifying religious institutions, government agencies, 13100), with an additional $50 fee and “Registered Agent” (SFN
persons or organizations receiving less than $25,000 in contributions 7974), with an additional $10 fee.
in a calendar year that do not compensate any officer, trustee, Mailing address: Sec. of State, State of North Dakota, 600 E.
organizer, incorporator, fund-raiser or solicitor, educational Boulevard. Ave., Dept. 108 Bismarck, ND 58505-0500
institutions and foundations, hospitals and hospital foundations, Info. telephone & contact: 701-328-3665 or 800-352-0867 ext.83665
noncommercial broadcast stations, qualified community trusts; Web:www.nd.gov/sos/nonprofit/charitableorg/index.html
volunteer fire departments, rescue squads, emergency medical
services; YMCAs or YWCAs; nonprofit continuing care facilities, Ohio
and certain tax exempt nonprofit fire or emergency medical service Governing law: OHIO REV CODE Chapt. 1716
organizations involved in the sale of goods or services that do not ask Exemptions: (A) Any religious agencies and organizations, and
for donations. charities, agencies, and organizations operated, supervised, or
Fees: $0 if contributions received for last fiscal year total less than controlled by a religious organization; (B) Any charitable
$5,000. $50 if between $5,000 and $100,000. $100 if between organization that meets all of the following requirements: (1) It has
$100,001 and $200,000. $200 if $200,001 or more. been in continuous existence in this state for a period of at least two
Check payable to: “North Carolina Department of Sec. of State.” years; (2) It has received from the IRS a determination letter that is
Period covered: One Year. currently in effect, stating that the charitable organization is exempt
Renewal Due date: Within four months and fifteen days after Fiscal from federal income taxation under subsection 501(a) and described
Year end. in subsection 501(c)(3) of the IRS; (3) It has registered with the
Required signatures: One. Treasurer or Chief Fiscal Officer. attorney general as a charitable trust pursuant to section 109.26 of the
Notarized signature required: Yes. Revised Code; (4) It has filed an annual report with and paid the
Fundraiser contracts: No, but see below for certain Fundraising required fee to the attorney general pursuant to section 109.31 of the
disclosures required. Revised Code. (C) Any educational institution, when solicitation of
Certificate/Articles of Incorporation: No. contributions is confined to alumni, faculty, trustees, or the student
Bylaws: No. membership and their families; (D) Every person other than an
IRS Form 990: Yes (No, if filing NC Annual Financial Report individual, when solicitation of contributions for a charitable purpose
Form). or on behalf of a charitable organization is confined to its existing
IRS Determination Letter: Yes, for initial filing only. membership, present or former employees, or present or former
Resident/Registered Agent required: No. trustees; (E) Any public primary or secondary school, when
Audit: No. solicitation of contributions is confined to alumni, faculty, or the
State forms additional to the URS: One, “Fundraising Disclosure general population of the local school district; (F) Any booster club
Form.” This form is required if charity has a contractual relationship that is organized and operated in conjunction with and for the benefit
with any fundraising consultant, solicitor, or coventurer. of students of public primary or secondary schools; (G) Any
Mailing address: NC Dept. of Secretary of State, Charitable charitable organization that does not receive gross revenue, excluding
Solicitation Licensing, P.O. Box 29622, Raleigh, NC 27626-0622. grants or awards from the government or an organization in excess of
Info. telephone & contact: 919-807-2214. Angelia Boone-Hicks, $25,000 during its immediately preceding fiscal year, if the
Licensing and Filing Supervisor. organization does not compensate any person primarily to solicit
E-mail: csl@sos.nc.com contributions.
Web: www.secretary.state.nc.us/csl Fees: $0-$4999.99: $0; $5000-$24,999.99: $50; $25,000-$49,999.99:
$100; $50,000+: $200
North Dakota Check payable to: “Treasurer of the State of Ohio.”
Governing law: No.Dak. Century Code, Chapter 50-22. Period covered: One year.
Exemptions: An organization using volunteer fundraisers and Renewal Due date: Within 4 !months of Fiscal Year end.
soliciting funds for a political subdivision, government entity, or for a Required signatures: One. Treasurer or Chief Fiscal Officer.
civic or community project in which the contributions received are Notarized signature Required: Yes.
used solely for the project; a charitable organization or person Fundraiser contracts: No.

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Certificate/Articles of Incorporation: Yes. Info. telephone & contact: 717-783-1720, Tracy McCurdy, Dir.
Bylaws: Yes. Web: www.dos.state.pa.us/char/site/default.asp
IRS Form 990: Yes.
IRS Determination Letter: Yes. Rhode Island
Resident/Registered Agent required: No. Governing law: R.I.G.I. Title 5, Chapter 53.1
Audit: No. Exemptions: Churches and religious organizations operated,
State forms additional to URS: None. supervised or controlled by a religious organization; institutions
Mailing Address: Atty. General’s Ofc., Charitable Law Sect., 150 E. indirectly affiliated with any religious organization that maintain and
Gay St., 23 rdfl., Columbus, OH 43215-3130. operate homes for the aged, orphans or unwed mothers; Accredited
Info. telephone & contact: 614-466-3180; Public Information Unit. educational institutions; Organizations raising $25,000 or less in a
Web: www.ag.state.oh.us/business/charitable.asp calendar year, whose fundraising activities are carried on by
volunteers; Nonprofit hospitals; Organizations soliciting exclusively
Oregon from their membership; Public libraries; Veterans organizations and
Governing law: Ore. Rev. Stat. 128.610 - 129. their auxiliaries; Public art museums.
Exemptions: A religious corporation; Educational institutions that do Fees: $90.
not hold property in the state or whose solicitations of individuals Check payable to: "General Treasurer of Rhode Island."
residing in the state are confined to alumni. Period covered: One year.
Fees: None (but fees do attach to annual reporting). Renewal Due date: Anniversary of initial registration.
Check payable to: Oregon Department of Justice Required signatures: Two authorized officials, one of who must be a
Period covered: Indefinite. director or trustee.
Renewal Due date: No renewal of registration but financial reports Notarized signature required: Yes.
are due annually within four and a half months of Fiscal Year end. Fundraiser Contracts: Yes.
Required signatures: One. An authorized trustee, officer or director. Certificate/Articles of Incorporation: Yes.
Notarized signature required: No. Bylaws: No.
Fundraiser contracts: No. IRS Form 990: Yes.
Certificate/Articles of Incorporation: Yes. IRS Determination Letter: Yes.
Bylaws: Yes. Resident/Registered Agent required: No.
IRS Form 990: Yes. Audit: Yes, if annual gross budget exceeds $500,000.
IRS Determination Letter: Yes. State forms additional to URS: Either (1) a copy of Form 990 and
Resident/Registered Agent required: No. additional information including organization’s address, percentage
Audit: No. of contribution spent for fund raising and administration, and whether
State forms additional to URS: None. organization or officers have been enjoined from fund raising or
Mailing address: Oregon Dept. of Justice, Charitable Activities, 1515 convicted or found liable for fraudulent activities; or 2) financial
S.W. 5th Ave. #410, Portland, OR 97201-5446 statements comprising a statement of activities and statement of
Info. telephone: 971-673-1880 financial position. IMPORTANT NOTE: An organization must list
Web: www.doj.state.or.us/charigroup/howto.shtml the names and compensation of the organization’s five most highly
compensated individuals in excess of the amount specified as
Pennsylvania requiring disclosure by IRS Form 990.
Governing law: 10 P.S. §162.1 et seq. Mailing address: Dept of Business Regulations, Securities Division,
Exemptions: Religious institutions and separate groups or The John O. Pastori Center, 1511 Pontiac Avenue, 69-1, Cranston, RI
corporations that form an integral part that are tax exempt and 02920-4407
primarily supported by fees charged for services rendered, VERY IMPORTANT NOTE: Rhode Island requires that all
government grants or contracts, or solicitations from their own registration applications and all associated documents be submitted
memberships, congregations, or previous donors; Accredited on CD-ROM. Paper filings are no longer accepted. Please attach a
educational institutions; hospitals subject to regulation by the Dept. transmittal letter including an email address where you can be
of Health or Dept. of Public Welfare and any foundation which is an reached, and the appropriate filing fee.
integral part; Nonprofit libraries filing an annual fiscal report with the Info. telephone & contact: 401-222-1754; Alicia Mildner
state library system; Senior citizen centers and nursing homes that are Web: www.dbr.state.ri.us/divisions/securities/charitable.php
nonprofit, charitable and tax exempt, and have all fundraising
activities carried out by volunteers; Organizations raising $25,000 or South Carolina
less annually that do not compensate anyone; Local post, camp, or Governing law: §33-56-10 South Carolina Code of Laws
chapter of any veterans organization chartered under federal law and Exemptions: Religious organizations or groups affiliated with and
any service foundations recognized in their by-laws. forming an integral part do not have to file at all with our division.
Fees: $15 if $25,000 or less; $100 if $25,001-$100,000; $150 if The following are not required to file registration statements (but
$100,001-$500,000; $250 if $500,001 and over. must file an application for exemption) with the Secretary of State if
Check payable to: "Commonwealth of Pennsylvania." their fundraising activities are not conducted by professional
Period covered: One year. solicitors, professional fundraising counsel, or commercial co-
Renewal Due date: 135 days after end of Fiscal Year. venturers: (1) An educational institution which solicits contributions
Required signatures: Two authorized officers. from only its students and their families, alumni, faculty, friends, and
Notarized signature required: No. other constituencies, trustees, corporations, foundations, individuals
Fundraiser contracts: No. who are interested in and supportive of the programs of the
Certificate/Articles of Incorporation: Yes. institution; (2) a person requesting contributions for the relief of an
Bylaws: Yes. individual specified by name at the time of the solicitation when all
IRS Form 990: Yes. of the contributions collected, without deductions of any kind, are
IRS Determination Letter: Yes. turned over to the name beneficiary for his use, as long as the person
Resident/Registered Agent required: No. soliciting the contributions is not a named beneficiary; (3) a
Audit: Yes, if gross contributions exceed $300,000 (CPA review charitable organization which (a) does not intend to solicit or receive
$100,000 to $300,000). contributions from the public in excess of twenty thousand dollars in
State forms additional to URS: None. a calendar year and (b) has received a letter of tax exemption from
Mailing address: Dept. of State, Bureau of Charitable Orgs., 207 the Internal Revenue Service, if all functions, including fundraising
North Office Building, Harrisburg, PA 17120-0103. activities, of the organization exempted pursuant to this item are

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NAAG/NASCO Standardized Reporting URS v. 4.0 2Appendix Pg 9

conducted by persons who are compensated no more than five Exemptions: (a) A solicitation that an organization conducts among
hundred dollars in a year for their services and no part of their assets its own established and bona fide membership exclusively through
or income inures to the benefit of or is paid to an officer or a member. the voluntarily donated efforts of other members or officers of the
(4) an organization which solicits exclusively from its membership, organization; (b) a bona fide religious, ecclesiastical, or
including an utility cooperative; (5) a veterans’ organization which denominational organization if: (i) the solicitation is made for a
has a congressional charter; and (6) the State, its political church, missionary, religious, or humanitarian purpose; and (ii) the
subdivisions, and an agency or department of the State which are organization is either: (A) a lawfully organized corporation,
subject to the disclosure provisions of the Freedom of Information institution, society, church, or established physical place of worship,
Act. (7) An organization which raises less than $7,500 in at which nonprofit religious services and activities are regularly
contributions annually regardless of whether it hires a professional conducted and carried on; (B) a bona fide religious group: (I) that
solicitor, counsel or commercial co-venture. does not maintain specific places of worship; (II) that is not subject to
Fees: $50 for registration, application for exemption is free. federal income tax; and (III) not required to file an IRS Form 990
Check payable to: "Secretary of State" under any circumstance; or (C) a separate group or corporation that is
Period covered: One year. an integral part of an institution that is an income tax exempt
Renewal Due date: 4 !months after the close of the fiscal year. organization under 26 U.S.C. Sec. 501(c)(3) and is not primarily
Required signatures: Two. Chief Executive Officer and Treasurer. supported by funds solicited outside its own membership or
Notarized signature required: No. congregation; (c) a solicitation by a broadcast media owned or
Fundraiser contracts: No, contracts are not required of the charity operated by an educational institution or governmental entity, or any
but of the professional fundraiser. entity organized solely for the support of that broadcast media; (d)
Certificate/Articles of Incorporation: No. except as provided in Subsection 13-22-21(1), a solicitation for the
Bylaws: No. relief of any person sustaining a life-threatening illness or injury
IRS Form 990: Yes. specified by name at the time of solicitation if the entire amount
IRS Determination Letter: Yes. collected without any deduction is turned over to the named person;
Resident/Registered Agent required: Yes. (e) a political party authorized to transact its affairs within this state
Audit: No. and any candidate and campaign worker of the party if the content
State forms additional to URS: None. and manner of any solicitation make clear that the solicitation is for
Mailing address: Public Charities Section, Office of the Secretary of the benefit of the political party or candidate; (f) a political action
State, PO Box 11350, Columbia, SC 29211-1350 committee or group soliciting funds relating to issues or candidates
Info. telephone: 803-734-1790 on the ballot if the committee or group is required to file financial
Web: www.scsos.com/Public_Charities information with a federal or state election commission; (g) any
school accredited by the state, any accredited institution of higher
Tennessee learning, or club or parent, teacher, or student organization within
Governing law: TCA 48-101-501 et seq. and authorized by the school in support of the operations or
Exemptions: Religious groups and their integrated auxiliaries which extracurricular activities of the school; (h) a public or higher
are not subject to federal income tax and are not required to file an education foundation established under Title 53A or 53B; (i) a
IRS From 990 and which are not primarily supported by funds television station, radio station, or newspaper of general circulation
solicited outside their own membership or congregation; that donates air time or print space for no consideration as part of a
Organizations which do not intend to solicit and receive and do not cooperative solicitation effort on behalf of a charitable organization,
actually receive gross contributions from the public in excess of whether or not that organization is required to register under this
$30,000; Accredited educational institutions, including organizations chapter; (j) a volunteer fire department, rescue squad, or local civil
of parents, students and others operated in support of the institutions; defense organization whose financial oversight is under the control of
Volunteer fire departments, rescue squads or local civil defense a local governmental entity; and (k) any governmental unit of any
organizations. state or the United States.
Fees: $50 initial. Renewal: 0-48,999.99: $100; $49,000-$99,999.99: Fees: $100.
$150; $100,000-$249,999.99: $200; $250,000-$499,999.99: $250; Check payable to: “State of Utah - Div. of Consumer Protection.”
$500,000+: $300 Period covered: One Year.
Check payable: “Secretary of State” Renewal Due date: One year from Jan. 1, April 1 or Oct. 1.
Period covered: One year. Required signatures: Two. Charity officers.
Renewal Due date: Within 6 months of Fiscal Year end. Notarized signature required: Yes.
Required signatures: Two authorized officers of the organization, Fundraiser contracts: Yes.
one of whom must be the Chief Fiscal Officer. Certificate/Articles of Incorporation: Yes.
Notarized signature required: Yes. Bylaws: Yes.
Fundraiser contracts: Yes. IRS Form 990: Yes.
Certificate/Articles of Incorporation: Yes. IRS Determination Letter: Yes.
Bylaws: Yes. Resident/Registered Agent required: Yes, but not required to reside in
IRS Form 990: Yes. the State of Utah.
IRS Determination Letter: Yes (and if the determination is still Audit: No.
pending, a copy of the application OR the IRS letter acknowledging State forms additional to URS: One: “Utah Supplement to URS”.
the application’s receipt). Also, any organization that files a 990-EZ, 990-PF, or 990-N, or any
Resident/Registered Agent required: No. organization that is not required to file a 990, is required to file a
Audit: Yes if gross revenue over $500,000. Financial Report.
State forms additional to URS: Two: “Summary of Financial Mailing address: Dept. of Commerce, Div. of Consumer Protection,
Activities” and “Supplemental Registration Form” 160 East 300 South, Box 146704, Salt Lake City, UT 84114-6704.
Mailing address: Div. of Charitable Solicitations, 312 Eighth Ave. Info. telephone and contact: 801-530-6601. Francine Giani.
North, 8 thfl., William Snodgrass Tower, Nashville, TN 37243 Web: consumerprotection.utah.gov/registrations/charities.html
Info. telephone: 615-741-2555
Web: www.state.tn.us/sos/charity.htm Virginia
Governing law: §57-48 to 57-69, Code of Virginia
Utah Exclusions: Any church or convention or association of churches;
Governing law: UCA 13-22-1 et. seq. American Red Cross and any of its local chapters; Political parties or
action committees that register with an election commission or board.

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NAAG/NASCO Standardized Reporting URS v. 4.0 2Appendix Pg 10

Exemption from annual registration upon request: Accredited one or more individuals on a repeated or ongoing basis are excluded
educational institutions or related foundations, and any other from exemption. A summary of registration exemptions is available
educational institution confining its solicitation of contributions to its online or from state office. Organizations seeking an exemption from
students, alumni, faculty and trustees, and their families; registration under the Charitable Solicitations Act may choose to file
Organizations that do not, in a calendar year or the three preceding an "Optional Statement for Exempt Organization" but this is not
years, receive contributions from the public in excess of $5,000, all of required. There is a $20 filing fee.
whose functions are carried out by volunteers; Organizations that Fees: As of August 1, 2010, fees are $60 initial, $40 renewal. A
solicit only within their membership; Organizations that have no complete fee schedule is available online or from state office.
office within the Commonwealth and solicit within the state, solely Check payable to: “The State of Washington”
by means of telephone, telegraph, direct mail or advertising in Period covered: One Year.
national media and have a registered Virginia chapter, branch or Renewal Due date: Eleven months after the organization’s
affiliate; 501(c)(3) tax-exempt health care institutions licensed by fiscal/accounting year-end (includes automatic extension).
their state Dept. of Health or Mental Health and any supporting Required signatures: One. The President, Treasurer, or comparable
foundation, free clinics and clinics certified by HCFA; Civic officer or, in cases of the absence of officers, a person responsible for
organizations such as a local service club, veterans' post, fraternal the organization.
society or association, volunteer fire or rescue group, or local civic Notarized signature required: No.
league or association; trade associations, and labor organizations; Fundraiser contracts: Yes, but only for contracts with “commercial
nonprofit debt counseling agencies licensed by the Virginia State fundraisers” (solicitors). Contracts must be submitted with a
Corporation Commission; 501(c)(3) organizations that solicit solely “Fundraising Service Contract Registration Form” (available online
through grant proposals. Organizations seeking exemption must file or from state office) and a $10 fee.
"Form 100" as applicable. $10 exemption application fee. Certificate/Articles of Incorporation: No.
Fees: $100 initial surcharge, plus sliding scale: less than $25,000 in Bylaws: No.
gross contributions = $30; $25K-50K = $50; $50K-100K = $100; IRS Form 990: Yes, a copy of the Federal information return must
$100K-500K = $200; $500K-$1 million = $250; $1 million+ = $325. accompany the URS (do not include a contributor list - Schedule B).
Check payable to: “Treasurer of Virginia." (Please take note that the Also, the Form 990 for a filer with more than $1 million in gross
following information must be included on the face of the check. (1) revenue (averaged over preceding three years), must be prepared or
The Employer Identification Number (EIN) and (2) code 910-02184 reviewed by a CPA or other qualified, independent professional (see
if the check is for the initial registration fee or code 910-02619 if the full text of rule at Wash. Admin. Code 434-120-107).
check is for the annual registration fee). IMPORTANT NOTE: Consolidated returns are no longer accepted
Period covered: One year. by the state, unless the organization is a central organization that files
Renewal Due date: Within 4 !months of Fiscal Year end. a consolidated return with the IRS on behalf of itself and its
Required signatures: Two. Chief fiscal officer and President or subordinates. And, in any event, consolidated registrations are no
another authorized official. longer accepted. Unless otherwise exempted from the registration
IMPORTANT NOTE: By signing the URS, the signers certify, on requirements, each subordinate with its own separate existence for
behalf of the organization, that “No funds have been or will legal or tax purposes must register independently of its central
knowingly be used, directly or indirectly, to benefit or provide organization and report its own financial activity.
support, in cash or in kind, to terrorists, terrorist organizations, IRS Determination Letter: Yes (one-time submission).
terrorist activities, or the family members of any terrorists.” Resident/Registered Agent required: No.
Notarized signature required: No. Audit: Yes, if the annual gross revenue is over $3 million (based
Fundraiser contracts: Yes. upon a three-year average of annual gross revenue). If $1 million to
Certificate/Articles of Incorporation: Yes. 3 million, the organization may need to file a “Confirmation of
Bylaws: Yes. Independent Third-Party Review” if the IRS 990 is not signed by a
IRS Form 990: Yes or may submit audited financial statement. qualified preparer.
IRS Determination Letter: Yes. State forms additional to URS: One: “Washington URS Addendum”.
Resident/Registered Agent required: Optional. May use Item #17 on This form includes a solicitation report required for registration with
URS. the state.
Audit: Yes if revenue $25,000 or more. This requirement may be Mailing address: Secretary of State, Charities Program P.O. Box
satisfied by filing IRS Form 990. 40234, 801 Capitol Way South, Olympia, WA 98504-0234
State forms additional to URS: None. Info. telephone: 800-332-4483 (toll-free in WA) or 360-725-0378.
Mailing address: Ofc. of Consumer Affairs, Dept. of Agriculture & Web address: www.sos.wa.gov/charities
Consumer Services, PO Box 1163, Richmond, VA 23218-0526
Info. telephone & contact: 804-786-1343, J. Michael Wright, West Virginia
Manager of Regul. Programs Governing law: Sec. 29-19-5 et. seq.
Web: www.vdacs.virginia.gov/allforms.shtml Exemptions: Educational institutions, the curriculums of which in
whole or in part are registered or approved by the state board of
Washington education; Persons requesting contributions for the relief of any
Governing law: Chapt. 19.09 et seq. RCW individual specified at the time of solicitation when all of the
Exemptions: (1) Churches and their integrated auxiliaries are contributions collected without any deduction are turned over to the
excluded from the definition of a “charitable organization”; (2) a named beneficiary; Hospitals which are nonprofit; Organizations
political organization whose activities are subject to the reporting which solicit only within the membership of the organization by
requirements of the State Public Disclosure Act or the Federal members thereof: provided the term “membership” shall not include
Elections Campaign Act; (3) a charitable organization raising less those persons who are granted membership upon making a
than $25,000 in any accounting year, if all the activities of the contribution as the result of solicitation; churches, synagogues,
organization, including fundraising, are carried on by persons who associations or conventions of churches, religious orders or religious
are unpaid for their services (volunteers) and no part of the charitable organizations that are an integral part of a church which qualifies as
organization’s assets or income inures to the benefit of or is paid to tax exempt under 501(c)(3); Organizations such as local youth
any officer or member of the organization. The use of a commercial athletic organizations, community service clubs, fraternal
fundraiser is considered a paid service; and (4) appeals for funds on organizations, volunteer fireman or auxiliaries are exempt if they do
behalf of a specific individual named in the solicitation, if all of the not employ a professional solicitor or fund-raiser or do not intend to
proceeds of the solicitation are given to or expended for the direct solicit or receive contributions in excess of $10,000 during the
benefit of that individual. Organizations that conduct solicitations for calendar year.

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NAAG/NASCO Standardized Reporting                                        URS v. 4.0 2Appendix Pg 11 
 
Fees: $15 if gross contributions received is less than $1 million. $50 
of gross contributions is more than $1 million.  
Check payable to: “West Virginia Secretary of State.”  
Period covered: One Year.  
Renewal Due date: Anniversary of initial registration 
Required signatures: One.  An authorized officer.   
Notarized signature required: Yes.  
Fundraiser contracts: Yes.   
Certificate/Articles of Incorporation: No.   
Bylaws: No.   
IRS Form 990: Yes.   
IRS Determination Letter: Yes.   
Resident/Registered Agent required: No.   
Audit: Yes, if contributions more than $100,000.   
State Forms Additional to URS: One: “State of West Virginia Unified 
Registration State Supplement”. 
Mailing address: Charitable Organizations Assistant, Secretary of 
State, Building 1, Suite 157-K, 1900 Kanawha Blvd East, Charleston, 
WV 25305-0770 
Info. telephone & contact: 304-558-6000, Catherine Frerotte  
Web: www.wvsos.com/charity/ 
 
Wisconsin 
Governing law: Chapter 202, Subchapter I and II, Stats;  
Chapter DFI-Bkg 60, Wis. Admin. Code. 
Exemptions: Candidate for national, state or local office or a political 
party or other committee or group required to file financial 
information with the federal elections commission; Organizations 
that do not raise or receive contributions in excess of $5,000 if all 
functions are performed by persons who are unpaid;Fraternal, civic, 
benevolent, patriotic or social organizations that solicit contributions 
solely from their membership; Veterans organizations; Nonprofit 
post-secondary educational institutions; A person soliciting 
contributions for relief of a named individual if all contributions are 
given to the named individual.  
Fees: $15 
Check payable to: “Department of Financial Institutions” 
Period covered: One year. 
Renewal Due date: August 1st. 
Required signatures: Two. The president or an authorized Officer 
and the Chief Fiscal Officer. 
Notarized signature required: Yes. 
Fundraiser contracts: Yes. 
Certificate/Articles of Incorporation: Yes. 
Bylaws: Yes. 
IRS Form 990: Yes, may file Wisconsin form #308 instead of IRS 
Form 990. 
IRS Determination Letter: Yes (and if determination is still pending, 
a copy of the IRS tax exemption form #1023). 
Resident/Registered Agent required: No. 
Audit: Yes, if contributions in excess of $400,000. If contributions 
are between 2 $ 00,000-$400,000, a CPA review is required. 
State forms additional to URS: One: Form 1952 (if filing IRS form 
990 instead of Wisconsin form #308.) 
Mailing address: Department ofFinancial Institutions,Division of 
Banking, P.O. Box 7876, Madison, WI 53707-7876. 
Info. telephone & contact: (608) 267-1711; 
Hearing and Speech impaired: TTY# (800)947-3529 
Email:  DFI_LFS@wisconsin.gov
Web: www.wdfi.org

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NAAG/NASCO Standardized Reporting                                                                                            URS v. 4.0 2Appendix Pg 12 
 
                                      States Requiring Registration but NOT Accepting the URS 
                                                   Colorado                  Florida                  Oklahoma
PLEASE NOTE: The following registration information for the above states is to assist users in independently registering with states that do NOT 
accept the URS. The URS cannot be used for registration in any of these states.  
 
Colorado 
Governing law: Colo. Rev. Stat. § 6-16-101 et seq.  Exemptions: Organizations exempt from filing a Form 990 because they are church for federal 
tax purposes; Political parties, candidates for federal or state office, and political action committees required to file financial information with federal 
or state elections commissions; and Charitable organizations that do not intend to and do not actually raise or receive gross revenue (excluding 
grants) in excess of $25,000 during a fiscal year  ordo not receive contributions from more than ten persons during a fiscal year. Fees  $10. :Check 
payable to:Checks will not be accepted except to establish a prepaid account.  Otherwise Visa, MasterCard, or American Express will be accepted.  
Period covered: One year.  Due date: Prior to raising funds in Colorado.  Required signatures: One. Authorized Officer, including the CFO.  
Notarized signature required: No. Fundraiser contracts: Yes. Certificate/Articles of Incorporation: No. Bylaws: No. IRS Form 990: No.  IRS 
Determination Letter: Yes.  (Only the date of the letter is required.)  Resident/Registered Agent required: Yes.  Audit: No.  Mailing address: (See 
note following.) Charitable Solicitations Program, Ofc. of the Secretary of State, 1700 Broadway, #200, Denver, CO 80290.  IMPORTANT NOTE:  
All filings must be made electronically via the Secretary’s web site.  Web: http://www.sos.state.co.us/pubs/charities/charitable.htm. Info, phone & 
contact: 303-894-2200, ext. 6487, Terry Long. 
 
Florida 
Governing law: F.S. 496.405 et seq. Exemptions: Religious organizations; an organization which limits solicitation to its membership. Fees: $10 if 
gross revenue is less than $5000; $75 if between $5000 and $100,000; $125 if between $100,001 and $200,000; $200 if between $200,001 and 
$500,000; $300 if between with $500,001 and $1 million; $350 if between $1,000,001 and $9,999, 999; $400 if $10 million or more. Note: If 
$25,000 or less and no paid professional, the fee is $10. Check payable to: “Florida Department of Agriculture and Consumer Services.” Period 
covered: One Year. Due date: Anniversary date. Required signatures: One. Treasurer or Chief Fiscal Officer. Notarized signature required: Yes. 
Fundraiser contracts: Yes. Certificate/Articles of Incorporation: No. Bylaws: No. IRS Form 990: Yes. IRS Determination Letter: Yes. 
Resident/Registered Agent required: No. Audit: No. Mailing address: Florida Department of Agriculture & Consumer Services, 407 S. Calhoun, 
Tallahassee, FL 32399-0800. Information telephone and contact: 850-488-2221, Mary Stimmel.  Annual Reporting information: NO REPORTING 
APART FROM REGISTRATION.  Web: http://doacs.state.fl.us/onestop/cs/solicit.html 
 
Oklahoma 
Governing law: Title 18 O.S. § 552 et seq.  Exemptions: Religious organizations; educational institutions that have a faculty and regularly enrolled 
students when solicitations are limited to students and their families, alumni, faculty, and trustees; fraternal organizations, when soliciting from their 
own members, and patriotic and civic organizations, when solicitations are confined to membership and managed by membership without paid 
solicitors; organizations raising less than $10,000.  Fees: $15  Check payable to: "Secretary of State."  Period covered: One year.  Due date: 
Anniversary of initial registration.  Required signatures: One. An authorized officer.  Notarized signature required: No.  Fundraiser contracts: Yes.  
Certificate/Articles of Incorporation: No.  Bylaws: No.  IRS Form 990: Yes.  IRS Determination Letter: No.  Resident/Registered Agent required: 
No.  Audit: No.  Mailing address: Office of the Secretary of State, 2300 N. Lincoln, #101, Oklahoma City, OK  73105-4897  Info. telephone & 
contact: 405-521-3049; Darlene Adams.  Web: http://www.sos.state.ok.us/forms/FORMS.HTM#Charity

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NAAG/NASCO Standardized Reporting URS v. 4.0 2Appendix Pg 13

Information on Annual Financial Reporting

As noted throughout the URS, most states requiring registration also require annual financial reporting. Although MANY STATES DO NOT
ALLOW USE OF THE URS FOR THIS PURPOSE, basic information on annual financial reporting for the all URS cooperating states is presented
below.

Alabama: months will be granted upon written where the charity prepares an audited
Due Date: Within 90 days of Fiscal request before the expiration date by financial statement required by a
Year end. email to ctcharityhelp@po.state.ct.us. governmental authority or third party.
Fee: $25 Mailed and faxed requests will not be
IRS 990: No. granted. Illinois:
Financial Report: Yes, this Fee: $50 if received in the Public Due Date: Within 6 months of Fiscal
requirement may be met by submitting Charities Unit on or before the due Year end.
a copy of IRS Form 990. date or extended due date, $25 late fee Fee: $15 ($100 late fee if registration
Audit: No applies per month or part thereof if expires)
received after the due date or extended IRS 990: Yes.
Arizona due date. Financial Report: Yes. (state form)
Due Date: Within one year of filing. IRS 990: Yes. Audit: Yes, if gross revenue over
Fees: None. Financial Report: Yes. $150,000 or professional fundraiser
IRS 990: Yes Audit: Yes, if gross revenue exceeds used and contributions exceed
Financial Report: Yes, Form 990. $500,000 (excluding government $25,000.
Audit: No grants and fees, and trust revenues).
Kansas:
Arkansas: District of Columbia: Due Date: Within 6 months of Fiscal
Due Date: By May 15th. If Fiscal Due Date: September 1 Year end.
Year other than calendar year, may Fee: $80 Fee: $20
file within six months after Fiscal IRS 990: Yes. IRS 990: Yes.
Year end, upon request. Financial Report: Yes. Financial Report: Yes. May be
Fee: None. Audit: No. submitted instead of IRS Form 990.
IRS 990: Yes, if required to file with Audit: Yes, if contributions in excess
the IRS. Georgia: of $500,000.
Financial Report: Yes, if no Form 990 Due Date: Within two years of filing
to file and receive more than $10,000. anniversary date. Kentucky:
Audit: Yes, for organizations with Fee: $20 Due Date: Within 4 1/2 months of
gross revenue more than $500,000. IRS 990: Yes. Fiscal Year end.
Financial Report: Yes, Form 990. Fee: None.
California: Audit: Yes, if gross revenue over $1 IRS 990: Yes, unless Form 990 has
Due Date: Within 4 !months of million; CPA review for organizations not yet been filed with the IRS.
Fiscal Year end. between $500,000 and $1 million; and Financial Report: No.
Fee: $25 for organizations with assets below $500K, the organization’s own Audit: No.
or revenue exceeding $100,000 during financial statement consisting of a
Fiscal Year. Such organizations must balance sheet and income/expense Louisiana:
submit Form RRF-1 due Within 4 ! statement. Due Date: Anniversary of initial
months after the close of the registration.
organization’s fiscal or calendar Hawaii: Fee: $25
accounting period. Due Date: On or before the date the IRS 990: Yes.
IRS 990: Yes. (Note: Due within 4 ! organization’s Form 990 or 990EZ Financial Report: No
months of the close of the must be filed with the IRS (including Audit: No.
organization’s fiscal or calendar any extensions granted by the IRS).
accounting period. Extensions granted Fee: $10 if gross income is less than Maine:
by the IRS will be honored) $25,000; $25 if $25,000-$49,999; $50 IMPORTANT NOTE: Maine requires
Financial Report: Yes. if $50,000-$99,999; $100 if $100,000- a separate “Annual Fundraising
Audit: Yes, if gross revenue exceeds $249,999; $150 if $250,000-$499,999; Activity Report” that is due September
th
$2 million (exclusive of grants from, $200 if $500,000-$999,999; $300 if 30 of each year.
and contracts for services with, $1,000,000-$1,999,999; $500 if Due Date: November 30.
governmental entities for which the $2,000,000-$4,999,999; $750 if Fee: $25.
entity requires an accounting of the $5,000,000 or more. IRS 990: Yes.
funds received). IRS 990: Yes Financial Report: Yes.
Financial Report: Yes, either the Audit: Yes, if gross receipts are more
Connecticut: Form 990 or 990EZ. than $30,000. (State advises filers to
Due Date: Last day of the fifth month Audit: Yes, if organization’s gross contact the registration office if
following the close of the organiza- contributions (excluding government organization does not have an audit).
tion’s fiscal year. Extensions of 6 grants) are more than $500,000 or

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NAAG/NASCO Standardized Reporting                                                                 URS v. 4.0 2Appendix Pg 14 
 
Maryland:                                 IRS 990: Yes.  Accepted in lieu of       Audit: Yes, if revenue $100,000 and 
Due Date: Within 6 months of Fiscal       separate financial statement if it       over. 
Year end.                                 fulfills the requirements of Minnesota    
Fee: No fee if gross income from          Statutes section 309.53 (2008).          New Mexico: 
charitable contributions is less than     Audit: Yes, if revenue exceeds           Due Date: Within 6 months of Fiscal 
$25,000; $50 if $25,000-$50,000; $75      $750,000 (Audit must be prepared in      Year end.  
if $50,001-$75,000; $100 if $75,001-      accordance with GAAP).                   Fee: None. 
$100,000; $200 if $100,001 or more.                                                IRS 990: Yes. 
IRS 990: Yes.                             Mississippi:                             Financial Report: Yes.  
Financial Report: Yes, must be            All filers MUST USE THE URS and          Audit: Yes, if total revenue is in 
reviewed by an independent CPA if         can, with a single filing, both renew    excess of $500,000. 
revenue is between $100,000 and           registration and effect annual financial  
$200,000.                                 reporting                                 New York: 
Audit: Yes, if gross income equals or     Due Date: Anniversary of registration    Due Date: Within 4 1/2 months of 
exceeds $200,000.                         Fee: $50.                                Fiscal Year end. 
                                          IRS 990: Yes.                            Fee: $10 if revenue is below 
Massachusetts:                            Financial Report: Yes.                   $250,000. $25 if fee is $250,000 or 
Due Date: Within 4 1/2 months of          Audit: Yes, if the organization          more. 
Fiscal Year end.                          received contributions over $500,000     IRS 990: Yes. 
Fee: $35 if revenue under $100,000;       or engaged the services of a             Must use form New York Form 
$70 if $100,001-$250,000; $125 if         professional fundraiser.  If             CHAR500. 
$250,001-$500,000; $250 if over           contributions are $250,000 to            Financial Report: Yes. Must be 
$500,000.                                 $500,000 a review is required.  The      reviewed by CPA if revenue 
IRS 990: Yes.                             Secretary has statutory authority to     $100,000-$250,000. 
Financial Report: Yes (Mass. Form         request audits on a case-by-case basis   Audit: Yes, if revenue $250,000 and 
PC).                                      for registrants between $25,000 and      over.  CPA review if between 
Audit: Yes, if revenue exceeds            $250,000.                                $100,000 and $250,000.   
$500,000. If revenue over $200,000                                                  
and not more than $500,000, CPA           Missouri:                                North Carolina: 
review required.                          Due Date: Within 2  !months of           Due Date: Within 4 months and 15 
                                          Fiscal Year end.                         days after Fiscal Year end.  
Michigan:                                 Fee: $15                                 Fee: $50 if revenue is under $100,000. 
Due Date: 30 days prior to license        IRS 990: Yes.                            $100 if revenue $100,001-$200,000. 
expiration.                               Financial Report: Yes.                   $200 if revenue $200,001 or more.  
Fee: None.                                Audit: No.                               IRS 990: Yes.  
IRS 990: Yes.  “Michigan Supplement                                                Financial Report: Yes. May be 
to Form 990-EZ” required if gross         New Hampshire:                           submitted instead of 990.  
receipts are $100,000 or more.            Due Date: Within 4 1/2 months of         Audit: No. 
Financial Report: Yes.                    Fiscal Year end.                           
Audit: Yes, if public support $500,000    Fee: $75                                 North Dakota: 
or more. If between $250,000 and          IRS 990: Yes.                            Due Date: September 1. 
$500,000, reviewed financial              Financial Report: Yes.                   Fee: $10. 
statements required.  Audited financial   Audit: Yes, if revenue equals $1         IRS 990: Yes. 
statements must be prepared in            million or more.                         Financial Report: Yes. 
accordance with GAAP.                                                              Audit: No. 
                                          New Jersey:                                
Minnesota:                                Due Date: Within 6 months of Fiscal      Ohio: 
FILERS MAY USE the URS in lieu of         Year end.                                Due Date: Within 4 1/2 months of 
the state’s own annual report FORM if     Fee: No fee if short form filer and less Fiscal Year end. 
the filer fulfills the audit requirement, than $10,000; $30 if short form filer    Fee: $50 if revenue $5,000-
below (See the Minnesota entry on         and more than $10,000. $60 if long       $24,999.99; $100 if $25,000-
Page 4 of this Appendix for further       form filer and less than $100,000;       $49,999.99; $200 if $50,000 or more. 
information).                             $150 if long form filer and $100,000-    IRS 990: Yes or financial report. 
                                    th
Due Date: Due on or before the 15         $500,000; $250 if long form filer and    Financial Report: Yes (on Attorney 
day of the seventh month following        more than $500,000.  ($25 late fee if    General Form). 
the close of its fiscal year.  Attorney   submitted more than 30 days after due    Audit: No. 
General may extend the time for filing    date)                                     
the annual report for a period not to     IRS 990: Yes.                             Oregon: 
exceed four months.  File extension       Financial Report: Yes and certified by   Due Date: Within 4 1/2 months of 
request in writing prior to due date.     authorized officer of organization if    Fiscal Year end. 
Fee: $25 ($50 late fee)                   revenue under $100,000.                  Fee: The total fee is composed of 
                                                                                   two parts, one based upon revenues

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NAAG/NASCO Standardized Reporting                                                               URS v. 4.0 2Appendix Pg 15 
 
and one upon assets. For revenues, the   Tennessee:                              West Virginia: 
fee is $10 if $0-$25,000; $25 if         Due Date: Within 6 months of Fiscal     Due date: Anniversary of registration.   
$25,000-$50,000; $45 if $50,000-         Year end.                               Fees: $15 if gross revenue is less than 
$100,000; $75 if $100,000-$250,000;      Fee: $0-48,999.99: $100; $49,000-       $1 million; $50 if gross contributions 
$100 if $250,000-$500,000; $135 if       $99,999.99: $150; $100,000-             $1 million or more.  
$500,000-$750,000; $170 if $750,000-     $249,999.99: $200; $250,000-            IRS 990: Yes. 
$1 million; $200 if 1 million and over.  $499,999.99: $250; $500,000+: $300      Audit: Yes if contributions exceed 
Important Note: filers may compute       IRS 990: Yes, if revenue between        $50,000. 
this fee based upon revenues raised in   $25,000 and $100,000. Organizations       
Oregon if this can be computed or        with more than $100,000 in revenue      Wisconsin: 
reasonably estimated (filers must        must submit audited financial           Due date:   months9 after Fiscal Year 
show basis of any estimates).            statements.                             end. 
For assets, filers pay a fee of one-one  Financial Report: Yes, audited          Fee: $ 0
hundredth of a percent on the            statements required when revenue is     IRS 990: Yes, plus Wisconsin 
organization’s “fund balance” at the     more than $100,000.                     supplement, Form 1952, or may file 
close of its reporting period (assets    Audit: Yes if gross revenue exceeds     Wisconsin form #308 instead of IRS 
below $50K or above $10 million are      $300,000.                               Form 990. 
not subject to the fee).  Important                                              Financial Report: Yes. If 
note: assets located or held outside     Utah:                                   contributions exceed $5,000 
Oregon are NOT subject to this fee.      Due Date: Within 30 days of the end     organizations must file either 
IRS 990: Yes.                            of the year reported.                   Wisconsin form #308 or
Financial Report: Yes.                   Fee: None                               Wisconsin form #1952 and an
Audit: No.                               IRS 990: Yes.  Accepted in lieu of      IRS Form 990. If contributions are 
                                         separate financial statements.          $5,000 or less, organizations must 
Pennsylvania:                            Financial Report: Yes                   file form #1943.
Due Date: Within 4.5 months of           Audit: No.                              Audit: Yes, if charitable organizations 
Fiscal Year end.                         Virginia:                               receive contributions in excess of 
Fee: $15 if $25,000 or less; $100 if     Due Date: Within 4 1/2 months of        $400,000 .  If contributions are between   
$25,001-$100,000; $150 if $100,001-      Fiscal Year end.                        $200,000 and $400,000, a CPA review 
$500,000; $250 if $500,001 and over.     Fee: $30 if gross contributions less     is required. 
 IRS 990: Yes.                           than $25,000; $50 if contributions are 
Financial Report: Yes. Must be           from $25,000-$50,000; $100 if 
reviewed by CPA if contributions         $50,000-$100,000; $200 if $100,000-
$50,000-$125,000.                        $500,000; $250 if $500,000-$1 
Audit: Yes, if gross contributions are   million; $325 if more than $1 million. 
$125,000 or more.                        ($100 late filing fee) 
                                         IRS 990: Yes, or may submit audited 
Rhode Island:                            financial statement. Certified 
Due Date:  Anniversary of initial        treasurer’s report for proceeds less 
registration.                            than $25,000. 
Fee: $75                                 Financial Report: Yes. 
IRS 990:  Yes.                           Audit: Yes if revenue $25,000 or 
Financial Report: Yes                    more.  This requirement may be 
Audit: Yes, if annual gross budget       fulfilled by filing IRS Form 990. 
exceeds $500,000.                         
VERY IMPORTANT NOTE: Rhode               Washington: 
Island requires that all charitable      Due Date: Within four months and 
organization registration applications   fifteen days after Fiscal Year end 
and all associated documents be          (state provides an automatic 6  !
submitted on CD-ROM no later than        month extension).    
thirty days prior to the expiration date Fee: $10. 
of the organization’s registration.      IRS 990: Yes. 
Paper filings are NOT accepted.          Financial Report: Yes.  (WA also 
                                         requires the following state form:  
South Carolina:                          “Solicitation Report”)   
Due Date: Within 4 1/2 months of         Audit:  Yes, beginning with renewals 
Fiscal Year End.                         submitted after January 1, 2010, an 
Fee: None                                audit is required if over $3 million in 
IRS 990: Yes.                            annual gross revenue (based upon a 
Financial Report: Yes, may be            three-year average of annual gross 
submitted instead of 990.                revenue).  
Audit: No.

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  Help for Filers 

 * Checklist (1 pg) 

 * Changes to the URS (1 pg)

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NAAG/NASCO Standardized Reporting                                                                                                                 URS v. 4.0 2Help  Pg. 1  
                                                            Checklist for Initial Registrations© 
                                                           (URS v. 4.02) *denotes a state that does not accept paper applications 
                                                                         †denotes fees for annual reporting 
                                  Fee          State Forms IRS Det. Lttr Fund. Contrc               Bylaws     Cert/Arts Inc      Form 990      Audit     Notarized 
      Alabama                     $25                              !                                    !            !                                        ! 
       Alaska                     $40                                               !                                             !                            
      Arizona                                                      !                                                              !                           ! 
      Arkansas                                     !               !                !                   !            !            !             !             ! 
  California                  $0-$300              !               !                                    !            !            !             !              
  Connecticut                     $50                                                                                             !             !              
       D.C.                       $70              !               !                !                   !            !            !                           ! 
      Georgia                     $35              !               !                                                              !             !             ! 
  Hawaii*†                    $10-$750                                                                                            See Appendix            
       Illinois                   $15                              !                !                   !            !            !             !              
       Kansas                     $35                              !                                                 !            !             !              
  Kentucky                                                         !                                                              !                           ! 
  Louisiana                       $25                              !                !                   !            !                                         
       Maine                      $50              !               !                                                              !             !             ! 
  Maryland                    $0-200                               !                !                   !            !            !             !              
  Massachusetts                   $50                              !                !                   !            !                                         
  Michigan                                                         !                !                   !            !            !             !              
  Minnesota                       $25              !               !                !                                !            !             !              
  Mississippi                     $50              !               !                !                   !            !            !             !             ! 
      Missouri                    $15        See Appendix          !                !                                !            !                           ! 
  New Hampshire                   $25        See Appendix          !                                    !            !            !             !             ! 
  New Jersey                  $30-250                              !                !                   !            !            !             !              
  New Mexico*                                                      !                !                   !            !            !             !             ! 
  New York                    $10-25                               !                                    !            !            !             !         
  North Carolina              $50-200              !               !     See Appendix                                             !                           ! 
  North Dakota                    $25              !               !                !                                !            !                           ! 
       Ohio                   $0-200                               !                                    !            !            !                           ! 
       Oregon                                                      !                                    !            !            !                            
  Pennsylvania                $15-250                              !                                    !            !            !             !              
  Rhode Island*                   $90        See Appendix          !                !                                !            !             !             ! 
  South Carolina                  $50                              !                                                              !                            
  Tennessee                       $50              !               !                !                   !            !            !             !             ! 
       Utah                     $100               !               !                !                   !            !            !                           ! 
      Virginia                $100+                                !                !                   !            !            !             !              
  Washington                      $60              !               !                !                                             !             !              
  West Virginia               $15-50               !               !                !                                             !             !             ! 
  Wisconsin                       $15                !             !                 X                    !           !           !             !             !          
© 201 4M U L T I - S T A T E  F I L E R  P R O J E C T

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NAAG/NASCO Standardized Reporting URS v. 4.0 2Help Pg. 2

Changes to the URS
A Cumulative Listing of Changes Since v. 2.00 of the Unified Registration Statement
[Version 2.00 of the URS was released in November 1998. It replaced v. 1.0, which was released in March, 1997. Version 2.00 was a
wholesale revision, adding 11 cooperating states, adding or amending questions on the form itself, and enhancing instructions for
users of the URS kit.]

April 1999 (v. 2.10)
• Wisconsin became a “cooperating state” and is added to the list of states accepting the URS (bringing the total of
participating states to 33 of 39 jurisdictions requiring registration). Conforming changes were made throughout the
URS kit.
• The exemption section in the Appendix has been updated to include the title of the required state form (where a
specific form is required) for use by organizations claiming an exemption.
• Address and contact information was updated for several of the URS distribution sites.

October 1999 (v.2.11)
• Changes in the state listings for Arkansas, Maryland, and Rhode Island were made in the Appendix.
• Address and contact information was updated for several of the state charity regulator sites.

September 2000 (v.2.20)
• Address and contact information was updated for several of the state charity regulator offices.
• Revisions were made throughout the Appendix. With this version, the Appendix reflects the terminology used within
each state for articulating the need to submit an audit, as appropriate.
• New Mexico enacted new legislation and its state listing in the Appendix reflects new requirements.
• West Virginia became a “cooperating state” and was added to the list of states accepting the URS. Conforming
changes were made throughout the URS kit, including the addition of a supplemental form required in addition to the
URS for registration.

October 2001 (v.2.21)
• Address and contact information was updated for several states. Minor formatting changes were made.
• North Carolina became a “cooperating state” and was added to the list of states accepting the URS.

September 2002 (v.2.30)
• Address and contact information was updated for several of the state charity regulator offices.
• Utah became a “cooperating state” and was added to the list of states accepting the URS.

July 2003 (v.2.31)
• URS becomes available in a fill-in PDF format.
• Conforming changes were made throughout the URS kit.

September 2004 (v. 3.00)
• Editorial changes were made to Item #22 in the URS form and the instructions were amended accordingly.
• Arizona became a “cooperating state” and was added to the list of states accepting the URS.
• Oklahoma was removed from the list of cooperating states.

November 2005 (v. 3.01)
• Utah and Washington add supplemental forms required in addition to the URS for registration.
• Address and contact information were updated for several state offices and web sites.

July 2006 (v. 3.02)
• Fees, filing date, address and contact information, and various other items were updated for a number of states.

October 2007 (v. 3.10)
• Alaska became a “cooperating state” and was added to the list of states accepting the URS.
• Various items were updated for Virginia and several other states.

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NAAG/NASCO Standardized Reporting                                                       URS v. 4.0  2  Help  Pg.  3 

September 2008 (v. 3.20) 
•    Hawaii became a “cooperating state” and was added to the list of states accepting the URS. 
•    Various items were updated for Arkansas, California, Colorado, Florida, Georgia, Kentucky, Maine, Mississippi, 
Missouri, North Carolina, North Dakota, South Carolina, Rhode Island, and Washington. 
•    Mississippi and Maine added supplemental forms required in addition to the URS for registration. 
 
February 2010 (v. 4.00) 
•    Instructions were updated to include cross references to the revised IRS form 990. 
•    Hawaii became a nominal “cooperating state” and was added to the list of states accepting the URS. 
•    Various items were updated for Arkansas, California, Colorado, Florida, Georgia, Kentucky, Maine, Massachusetts, 
Mississippi, Missouri, North Carolina, North Dakota, South Carolina, Rhode Island, and Washington. 
•    Maine and Mississippi added supplemental forms required in addition to the URS for registration. 
 
May 2010 (v. 4.01) 
•    Utah added supplementary forms for states filing the 990-EZ, PF, N, or those not filing a 990. 
•    Fee structure was updated for Washington. 
 
 February 2014 (v.4.02) 
 -   Wisconsin supplementary forms and information updated to reflect transfer of regulatory duties from DSPS to DFI.

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