New Jersey > Statewide > Office Of The Attorney General > Division Of Consumer Affairs
Long Form Initial Registration Statement CRI-150I - New Jersey
| Long Form Initial Registration Statement Form. This is a New Jersey form and can be used in Division Of Consumer Affairs Office Of The Attorney General Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
New Jersey Office of the Attorney General Division of Consumer Affairs Office of Consumer Protection Charities Registration Section 153 Halsey Street, 7th Floor, P.O. Box 45021 Newark, NJ 07101 (973) 504-6215 Form CRI-150-I Long-Form Initial Registration/Verification Statement (Revised April 2008) All of the questions must be answered. 1. 2. 3. 4. This statement contains the facts and financial information for the fiscal year ending: Federal ID Number (EIN) __________________ _____/ _____/ ________ month day year (Leave blank ONLY if this is an initial registration.) 2a. N.J. Charities Registration Number: CH- _________________________ Full legal name of the registering organization: ______________________________________________________________ In care of: (if necessary, otherwise leave this line blank) __________________________________________________________ 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. 6. The principal street address of the registering organization________________________________________________________ Street Address City State ZIP Code £ Same as Mailing Address Does the organization have any offices in New Jersey in addition to the one listed above? If "Yes," attach a list giving the street address and telephone number of each office in New Jersey. £ Yes £ No 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. _______________________________________________________________________________________________________ ________________________________ Telephone number (include area code) Contact person Street address City State ZIP Code ________________________________ Fax number (include area code) 7. Organization's contact information: ________________________________ ________________________________ E-mail address Telephone number (include area code) ________________________________ ________________________________ Web site Fax number (include area code) 8. Type of organization (check one): £ Nonprofit corporation £ Partnership £ Foundation £ Trust £ Individual £ Association £ Society £ Other (Specify) ____________________________________ 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 instrument of organization (that is, the organization's charter, articles of incorporation or organization, agreement of association, instrument of trust, or constitution). -1American LegalNet, Inc. www.FormsWorkflow.com 10. Does the organization solicit funds under any name or names other than as indicated on line 2 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 502(c)? £ Yes a. If "Yes," attach a photocopy of the Federal Tax Exemption determination letter issued by the I.R.S. b. If "No," has an application been filed which is still p
|
|||||||
