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                                                            New Jersey Office of the Attorney General
                                                                                          Division of Consumer Affairs
                                                                                          Office of Consumer Protection
                                                                                          Charities Registration Section                                                                 
                                                             124 Halsey Street, 7  Floor, P.O. Box 45021 th
                                                                                                        Newark, NJ  07101
                                                                                                         (973) 504-6215

                                                                                                        Form CRI-300R
                       Long-Form Renewal Registration/Verification Statement
                                                                                                        (Revised April 2008)
                                                              All questions must be answered.

Pursuant to the New Jersey Charitable Registration and Investigation Act (also known as “the C.R.I. Act” (N.J.S.A. 45:17A-18 et seq.), 
and prior to operating or commencing solicitation activity in the State, a charitable organization unless exempted from registration 
requirements (or qualified to file a Short-Form Registration Statement, CRI-200) shall file a Long-Form Initial Registration Statement, 
CRI-150-I. Charities submitting their annual long-form renewal registration must use Form CRI-300R.  Please see the checklist at the 
end of this form for a discussion of fees, financial statements, documents to be attached, and other requirements for registration.   

  1.   This statement contains the facts and financial information for the fiscal year ending:     _____/ _____/ ________   
                                                                                                                                                        month           day                   year
  2.   Federal ID Number (EIN) __________________     2a. N.J. Charities Registration Number: CH- _________________________
                                                                                                                                                                                                                                             
  3.      Full legal name of the registering organization:  ______________________________________________________________
          In care of: (if necessary, otherwise leave this line blank) __________________________________________________________ 
 
  4.   Mailing Address: ____________________________________________________________________  £  Change of Address
                                                            Street Address                                                               City                                      State                                      ZIP Code 
 NOTE: If “ in care of,” a postal, private or rural delivery mail box number is used, the street address of the charity must be given below.  

 5.  The principal street address of the registering organization________________________________________________________
          £ Same as Mailing Address                                                                                                          Street Address                              City                            State                     ZIP Code  

 6.       Does the organization have any offices in New Jersey in addition to the one listed above?                                                                                                                                                   £  Yes      £No       
          If “Yes,”  attach a list giving the street address and telephone number of each office in New Jersey.  

 6a.  If the street address listed above is not where the organization’s official records are kept, or if the organization does not maintain an 
          office in New Jersey, indicate the name, full address, phone and fax number of the person having custody of the of the organization’s  
          records, and to whom correspondence should be addressed.

          _______________________________________________________________________________________________________
                         Contact person                                                                  Street address                                        City                                                                      State                           ZIP Code
          ________________________________         ________________________________
                     Telephone number (include area code)                                                                Fax number (include area code) 

 7.       Organization’s contact information:
        
           ________________________________         ________________________________
                     Telephone number (include area code)                                                            Fax number (include area code) 
           ________________________________         ________________________________
                            E-mail address                                                                                           Web site

 8.       Type of organization (check one):                                                                                                                                                                         
 
          £  Nonprofit corporation                          £  Foundation                                   £   Individual                                      £  Association                                                                        £    Society                             
          £  Partnership                                    £    Trust                                      £   Other   (Specify) ____________________________________

                                                             Form CRI-300R                  Page 1 of 7

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8. 8. TypeTypeofofOrganizationOrganization (check(check one) one)
NonprofitNonprofit corporationcorporation Foundation Foundation

Individual Individual AssociationAssociation

9. Where and when was the organization legally established? Date: ____________________ State: _____________________

As required by the C.R.I. Act (N.J.S.A. 45:17A-24c(1)), attach to this registration a copy of the organization’s bylaws and Society Society PartnershipPartnership

instrument of organization (that is, the organization’s charter, articles of incorporation or organization, agreement of association,
instrument of trust, or constitution) only if the document has been issued or amended during the fiscal year being reported. Trust T rust Other Other (Specify)(Specify)

10. Does the organization solicit funds under any name or names other than as indicated on line 3 of this form? Yes No
If “Yes,” indicate all of the other names used: _________________________________________________________________

11. Does the organization intend to solicit contributions from the general public? Yes No

12. Is the organization authorized by any other state or jurisdiction to solicit contributions? Yes No
If “Yes,” please provide a list of those states or jurisdictions, below or on a separate sheet of paper.
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________

13. Does the organization have affiliates which share the contributions or other revenue it raised in New Jersey? Yes No
If “Yes,” provide a separate listing of those affiliates indicating the name, street address and telephone number for each one.

14. What is the charitable purpose or purposes for which the organization was formed? If necessary, attach a separate statement to this
registration.

_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________

14a. What are the specific programs and charitable purposes for which contributions are used? For each program, state whether it
already exists or is planned. Only major program categories need be listed. If necessary, attach a separate statement to this
registration.
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________

15. Does the organization use an independent paid fund-raiser or fund-raising counsel? Yes No
If “Yes,” please attach to this registration a list of paid fund-raiser(s) or fund-raising counsel(s), including their full address, telephone
number, fax number, registration number in New Jersey, and a contact person’s name.

15a. Does the independent paid fund-raiser or fund-raising counsel have custody, control or access to the organization’s funds?
Yes No
If “Yes,” please describe the situation.
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________

16. Has the organization permitted a charitable sales promotion to be conducted on its behalf by a commercial co-venturer during the
fiscal year-end being reported? Yes No
If “Yes,” please explain: ___________________________________________________________________________________
_______________________________________________________________________________________________________

17. Has the Internal Revenue Service (I.R.S.) determined that the organization is tax exempt under code 501(c)(3)? Yes No
a. If “No,” has an application been filed which is still pending? If so, please attach a copy of the
I.R.S. 1023 form filed. Yes No
b. Has a tax exemption been granted under another I.R.S. code? Yes No
If “Yes,” advise which one: ____________________________
c. Has an I.R.S. tax exemption been refused, changed or revoked? Yes No
If an exemption has been refused, changed or revoked, attach to this registration a copy of the I.R.S. determination letter of
notification and provide a detailed explanation of the circumstances on a separate sheet of paper.

Form CRI-300R Page 2 of 7

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 18.  Has the organization ever had its authority to conduct charitable activities denied, suspended, or revoked in any jurisdiction or has the  
      organization ever entered into any voluntary agreement of discontinuance with any governmental entity?                  Yes       No 
      If “Yes,” attach to this registration a copy of the denial, suspension, revocation or voluntary agreement of discontinuance. If the  
      document does not explain the reasons for the denial, suspension or revocation, attach to this registration an explanation on a  
      separate sheet of paper. 

 19.    Has the organization voluntarily entered into an assurance of voluntary compliance or similar order or agreement (including, but  
      not limited to, a settlement of an administrative investigation or proceeding, with or without an admission of liability) with any  
      jurisdiction, state or federal agency or officer?                                                                       Yes       No  
      If “Yes,” please attach to this registration the relevant document.
                                                                                                                                                                                                              
 20.  Has the organization or any of its present officers, directors, executive personnel or trustees ever been found to have engaged in  
      unlawful practices in the solicitation of contributions or administration of charitable assets or been enjoined from soliciting  
      contributions, or are such proceedings pending in this or any other jurisdiction?                                       Yes       No     
      If “Yes,” attach to this registration photocopies of any and all written documentation (such as a court order, administrative order, 
      judgment, formal notice, written assurance  or other document) which show the final disposition of the matter. 

 21.  Has the organization or any of its present officers, directors, trustees or principal salaried executive staff employees ever been  
      convicted of any criminal offense committed in connection with the performance of activities regulated under this act or any  
      criminal or civil offense involving untruthfulness or dishonesty or any criminal offense relating adversely to the registrant’s  
      fitness  to  perform  activities  regulated  by  this  Act?  A  plea  of  guilty,  non  vult,  nolo  contendere  or  any  similar  disposition  
      of alleged criminal activity shall be deemed a conviction.                                                              Yes       No   

 22.  Has the organization or any of its officers, directors, trustees or principal salaried executive staff employees been adjudged liable                                                                    
      in any administrative or civil action involving theft, fraud, or deceptive business practices?  For purposes of this question a judgment 
      of liability in an administrative or civil action shall include, but is not limited to, any finding or admission that the individual engaged 
      in an unlawful practice in relation to the solicitation of contributions or the administration of charitable assets.    Yes       No
      If  “Yes,” identify the individual(s) below  and attach to this registration a copy of any order, judgment or other documents indicating  
      the final disposition of the matter.  
      _______________________________________________________________________________________________________
      _______________________________________________________________________________________________________

 23.  Provide  the  following  information  for  each  officer,  director,  trustee  and  the  five  most-highly  compensated  executive  staff  
      employees:
   
                     Name                                  Business address    Telephone number             Title                       Salary
                                                                                 (include area code)                               
       
      _______________________________________________________________________________________________________ 
      _______________________________________________________________________________________________________ 
      _______________________________________________________________________________________________________ 
      _______________________________________________________________________________________________________ 
      _______________________________________________________________________________________________________ 
      _______________________________________________________________________________________________________
      ______________________________________________________________________________________________________ 
      _______________________________________________________________________________________________________ 
      _______________________________________________________________________________________________________ 
      _______________________________________________________________________________________________________ 
      _______________________________________________________________________________________________________

                                            Form CRI-300R                  Page 3 of 7

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           CRI-300R Long-Form Registration Renewal Financial Statement

	                         Note:  If the financial value of a line item = 0, place a zero in the space provided.
                                                        Please report all figures as GROSS, not NET.

	   Full	legal	name	and	street	address	of	the	organization		

    Full legal name:__________________________________________________________________________________________   

    Fiscal year-end being reported:  _____/_____/_____      Federal ID Number (EIN) __________________  
                                                          month           day            year
    Mailing  address:  
    _______________________________________________________________________________________________________
              Mailing Address                           P.O. Box Number or Suite                                            City                                                          State                                               ZIP code

    Street address of the registering organization: __________________________________________________________________ 
                                                                                                         Street Address                  City                                          State                          ZIP Code
    New Jersey Charities Registration number:  CH _______________ -00         Telephone number: _________________________
                                                                                                                                                       (include area code)
    Attach to this registration the most recent Internal Revenue Service Form 990 and Schedule A (990), if the organization has filed those  
    forms. Attach a copy if the organization’s annual financial report included an audited financial statement, or if the organization                                                                                                                 
    received  gross  revenue  in  excess  of  $500,000.                                      Note:  If  the  organization  received  gross  revenue  of  less  than  $                                             500,000,  
    the financial reports must be certified by the organization’s president or other authorized officer of the organization’s board.
    
	   £ In lieu of completing the CRI-300R Financial Statement pages, attached please find a copy of the I.R.S. 990 filing for the fiscal year-end 
      indicated above.   

    A.	Receipts		
        Line A1a.  Direct Public Support received from the following sources: 
                         (1)                           Direct mail ………………………………………....                                                    __________________
                         (2)                           Telephone solicitation……………………………....                                              __________________
                         (3)                           Commercial co-venture………………………….....                                               __________________
                         (4)                           Gross receipts from fund-raising events……………                                       __________________
                         (5)                           Canisters, counter cards, door to door etc………….                                    __________________
                         (6)                           Corporations and other businesses………………….                                          __________________                                                                     
                         (7)                           Foundations and trusts……………………………...                                               __________________
                         (8)                           Donated land, buildings, property, equipment and
                                                       materials…………………………………………….                                                        __________________                                                                                           
                         (9)                           Legacies and bequests………………………………                                                  __________________
                         (10)                          Membership dues solely resulting from 
                                                       solicitations………………………………................                                          __________________
                         (11)                          Other support (specify)…………………………......                                            __________________
      
       Line A1b.  Total Direct Public Support (add lines A1a(1) through A1a(11)  ...…                                                     __________________
      
       Line A1c.  Indirect Public Support received from the following sources:   
                         (1)                           Federated fund-raising organization………………..                                        __________________
                         (2)                           From an affiliated organization……………………..                                          __________________
                         (3)                           From another fund-raising organization…………....                                     __________________
      
           Line A1d.  Total Indirect Public Support  (add lines Alc(1) thru A1c(3))…........                                             __________________

          Line	A1e. Total	Gross	Contributions              (add lines A1b and  A1d) ………...……                                              __________________

                                                        Form CRI-300R                  Page 4 of 7

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Line A2. Government grants including purchase of service contracts (specify agency)
a. …………………………………………………................ __________________
b. …………………………………………………................ __________________
c. …………………………………………………................ __________________
d. …………………………………………………................ __________________
Line A2e. Total Government Grants (add lines 2a thru 2d)..…………………..... __________________

Line A3. Other Support

a. Bona fide membership ………………………................... __________________
b. Program service revenue…………………….................... __________________
c. Professional services rendered by volunteers………......... __________________
d. Miscellaneous income (specify)………………................. __________________

Line A3e. Total Other Support (add the total of lines A3a thru A3d)…..…........ __________________

Line A4. Total Gross Revenue (add lines A1e, A2e and A3e) …………......... __________________

B. Expenses

Line B1. Program expenses…………………………………................... __________________
Line B2. Management and general expenses……………….................... __________________
Line B3. Fund-raising expenses…………………………….................... __________________
Line B4. Payments to state/national affiliates (if applicable).................... __________________
Line B5. Total Expenses (add the totals of line B1 thru B4)…..……...... __________________

C. Excess or Deficit
For the fiscal year-end (subtract line B5 from line A4)…………….................. __________________

D. Fund Balance

Line D1. Net assets or fund balances at beginning of year…………….... __________________
Line D2. Other changes in net assets or fund balances (attach explanation)….. __________________
Line D3. Net assets or fund balances at end of year (Combine line C, D1 and D2) ... __________________

Please Note: The amount of Gross Contributions ( line A1e on this form) determines the registration fee which must be paid and the
form which should be used. July 2006 revisions to the Charities Registration Act now require all charities to pay a registration fee,
including charities whose Gross Contributions are less than $10,000. Further information for charity registrants may be found on our
Web site: http://www.njconsumeraffairs.gov/ocp/charities.htm.

Form CRI-300R Page 5 of 7

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Long-Form Renewal Registration Statement
Form CRI-300RC
Confidential Information

Organization’s Name: _________________________________________________________________________________

N.J. Charities Registration Number: CH -__________ -00 Federal ID Number (EIN) ______________

Fiscal Year-End being reported: ____ / _____ / ____
month day year

24. Are any of the organization’s officers, directors, trustees or the five most-highly compensated employees related by blood,
marriage or adoption to:

a. each other? £ Yes £ No
b. any officers, agents or employees of any fund-raising counsel or independent paid fund-raiser under contract to the
organization? £ Yes £No
c. any chief executive, employee, any other employee of the organization with a direct financial interest in the transaction,
or any partner, proprietor, director, officer, trustee, or to any shareholder of the organization with more than two (2)
percent interest in any supplier or vendor providing goods or services to the organization? £ Yes £ No
d. If you answered “Yes,” to questions 24a, b, or c, please provide a statement explaining these relationships.

25. Do any of the organization’s officers, directors, trustees or the five most-highly compensated employees have a financial
interest in any activities engaged in by a fund-raising counsel or independent paid fund-raiser under contract to the organization,
or any supplier or vendor providing goods or services to the organization? £ Yes £ No
If “Yes,” please detail these relationships below or on a separate sheet of paper, and provide the name, business address and
telephone number of all interested parties.

We understand that this registration is being issued at the discretion of the Division of Consumer Affairs and agree that employees
of the Division may inspect the records in the possession of this organization in order to ascertain compliance with the statute and all
pertinent regulations. We also understand that we may be required to provide additional information if requested.

We hereby certify that the above information and the attached financial schedule(s) and statement(s) are true. We are aware that if any
of the above statements are willfully false, we are subject to punishment.

Signature____________________________ Name______________________________ Title ______________ Date ____________

This form must be signed by two (2) authorized officers of the organization, including the chief financial officer.

Note: Form CRI-300RC must be filed with Form CRI-300R.

Form CRI-300R Page 6 of 7

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Renewal registrants who are required to file the
Long-Form Renewal Registration/Verification Statement CRI-300R/RC
must submit the following:

(1) A fully completed Long-Form Renewal Statement CRI-300R along with the CRI-300R Financial Statement, the CRI-300RC
Confidential Information Statement (with signatures), and all lists, statements and attachments as may be required by
answers to the form’s questions.

(2) All charity registrants in New Jersey must pay a registration fee based on gross contributions. Please visit our Web site at
www.njconsumeraffairs.gov for a complete schedule of registration fees due. A check or money order for the registration
fee due, made payable to the New Jersey Division of Consumer Affairs, must accompany the registration form. Cash or
credit card payments cannot be accepted. Initial registrations must be submitted prior to soliciting in the State of New
Jersey. Registrations must be renewed annually, and are due within six months of the fiscal year-end. Extensions of time to
file cannot be granted on initial (first-time) registrations.

(3) Charity registrants with total gross revenue in excess of $500,000 annually are required to submit a certified audit (including
any management letters) which has been prepared by a certified public accountant.

(4) Please write the organization’s charities registration number on all checks, forms, and copies of documents submitted.

(5) If the charity was required by the Internal Revenue Service to file an IRS-990 form for the organization’s fiscal year-end
being reported, a copy, including Schedule A, must be submitted with the registration form.

(6) Photocopies of any orders, judgments, agreements or other documents which show the final disposition of any civil or
criminal actions brought against the organization or its board members, must be marked with the related question number
and the charities registration number.

(7) Only initial registrants must submit photocopies of the organization’s bylaws, the certificate of incorporation and the I.R.S.
determination letter. However, copies of these documents must be resubmitted each time they are amended.

(8) Mail the completed registration, enclosures and any attachments to the:

New Jersey Division of Consumer Affairs
Charities Registration & Investigation Section
P.O. Box 45021
Newark, NJ 07101

Should you have questions regarding charities registration in New Jersey, please visit our Web site at
http://www.njconsumeraffairs.gov/ocp/charities.htm where registration information, instructions, forms and a fee schedule
may be viewed and/or downloaded. After reading through all of the information on our Web site, if you have further questions,
please contact the Charities Registration Section at our hotline number (973)-504-6215 during regular business hours.

Form CRI-300R Page 7 of 7

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