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 45021th
Newark, NJ 07101
(973) 504-6215
Form CRI-150-I
Long-Form Initial Registration/Verification Statement
(Revised April 2008)
All questions must be answered.
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- _________________________
(leave blank)
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. 8. Type of OrganizationType (check(checkofone) one)Organization
8. Type of organization (check one):
NonprofitNonprofit corporation corporation Foundation Foundation
£ Nonprofit corporation £ Foundation Individual £ £ Association £ Society
£ Partnership £ Trust £ Other (Specify) ____________________________________ 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). Trust T rust Other (Specify)Other (Specify)
Form CRI-150-I Page 1 of 7