Mail completed form to: 
                                                                                    NH Attorney General’s Office 
                                                                                    Attn: Charitable Trusts Unit 
                                                                                    One Granite Place South
                                                                                    Concord, NH 03301

FORM NHCT-15
CHARITABLE GIFT  NNUITY A           ERTIFICATIONC  

ENTITY INFORMATION                  
Legal Name 
NH Charitable Trusts Unit Registration Number (if applicable) 

Mailing Address                                                       check here if this is a new address
                                                                     □
City                                                                 State                               Zip 
Website Address 

CONTACT INFORMATION
Contact Name                                                  Title 
Telephone Number                                              Email Address 

NHCT-15 Certification/Recertification for Charitable Gift Annuities 

1. The person signing the NHCT-15 on behalf of this entity certifies that the entity has entered into one or more
 charitable gift annuity agreements in New Hampshire and that each such agreement is and shall be a qualified
 charitable gift annuity, as defined in NH RSA 403-E:1, V, in that on the date of the annuity agreement, it (check
 each of the following to certify):

     □ Has a minimum of $300,000 in unrestricted cash, cash equivalents, or publicly-traded securities, exclusive of the
     assets funding the annuity agreement;

     □ Has been in continuous operation for at least 3 years or is a successor or affiliate of a charitable organization that
     has been in continuous operation for at least 3 years;

     □ Issues charitable gift annuities with payout ratios no greater than recommended by American Council on Gift
     Annuities at the time of issuance;

     □ Retains 100 percent of the contribution made in exchange for each charitable gift annuity, increased by earnings
     on the contribution and decreased by annuity payments and expenses properly allocated to the annuity, until the
     annuity is terminated; and

     □ Invests contributions made in exchange for charitable gift annuities solely in conformance with article 9 of RSA
     564-B, general standards of prudent investment.

2. Check the applicable box:
     □ Initial notification
     □ Annual recertification
     NHCT-15 (September 2022)                     www.doj.nh.gov/charitable-trusts/ charitabletrustsunit@doj.nh.gov 
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                             CERTIFICATION 
  
   I hereby certify that the information above is true and correct to the best of my knowledge and 
 belief subject to the penalty of making unsworn false statements under RSA 641:3 and RSA 641:8. 
  
 ____________________________________________                      __________________________ 
 Signature of President or Chief Executive Officer (CEO)           Date 
  
 ____________________________________________                      __________________________ 
 Print Name                                                        Title 
 
  NHCT-15 (September 2022)   www.doj.nh.gov/charitable-trusts/           charitabletrustsunit@doj.nh.gov 
                                                                                                    
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