Mail completed form to: 
                                                                                         NH Attorney General’s Office 
                                                                                         Attn: Charitable Trusts Unit 
                                                                                         33 Capitol Street 
                                                                                         Concord, NH 03301-6397 

 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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