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Professional Solicitor Registration Statement PS-01 - Illinois

Professional Solicitor Registration Statement Form. This is a Illinois form and can be used in Charitable Trusts Office Of The Attorney General Statewide .
 Fillable pdf Last Modified 5/3/2005
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Form PS-01 PROFESSIONAL SOLICITOR LISA MADIGANRevised 03/2005 ATTORNEY GENERAL REGISTRATION STATEMENT PLEASE TYPE OR PRINT IN BLACK INK. Respond to all items. This form must be completed in full. A copy of this form must be retained by the Professional Fund Raiser who intento employ ds this party. Regstration iexpires on June 30 each year. You must submit a new registration form for each fiscal year ended June 30. File this Registration Statement with the Attorney Generals Office, Charit abTrluest Bureau, 11th Floor, 100 West Randolph Street, Chicago, Illinois 60601. REGISTRATION SUPPLEMENTAL REGISTRATION RE-REGISTRATION 1. THIS REGISTRATION IS FOR THE PERIOD BEGINNING _________________ AND ENDING JUNE 30, _____ 2. LEGAL NAME HOME PHONE NUMBER 3. MAIL ADDRESS WORK PHONE NUMBER CITY, STATE, ZIPCODE BIRTHDATE 4. NAME OF PFR PFR # 5. LIST ALL CHARITABLE ORGANIZATIONS FOR WHICH YOU WILL BE SOLICTING DURING THE PERIOD OF THIS REGISTRATION. YOU MUST SUPPLEMENT THIS REGISTRATION AND ADD ANY NE W OR ADDITIONAL CHARITIES BY FILING A SUPPLEMENTAL REGISTRATION BEFORE YOU START SOLICITI NG FOR NEW OR ADDITIONAL CHARITIES. CO # CHARITABLE ORGANIZATION / NAME, CITY, STATE 6. DESCRIBE THE METHOD BY WHICH YOU WILL BE PAID COMPENSA TION. (i.e.Amount Per Hour, Percentage to be paid; be precise) 7. HAS ANY LICENSE OR PERMIT BEEN DENIED, CANC ELED OR REVOKED, OR HAS ANY ACTION BEEN TAKEN AGAINST YOU IN CONNECTION WITH SOLICITATION OF FUNDS FOR CHARITABLE PURPOSES? YES NO 8. ARE YOU AN EMPLOYEE OF OR INDEPENDENT CONTRACTOR WITH THE PER? 9. HAVE YOU EVER BEEN CONVICTED OF A CRIME INVOLVING THE MISU SE OR THEFT OF MONEY? YES NO 10. HAVE YOU EVER BEEN CONVICTED OF A CRIME OF DISHONESTY, THEFT, BURGLARY, DECEPTION OR FRAUD? YES NO UNDER PENATIES OF PERJURY, I DECLARE THAT I HAVE EXAMIN ED THIS STATEMENT, AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, IT IS TRUE CORRECT AND COMPLETE. Solicitor: SIGNATURE DATE Professional Fund Raiser: SIGNATURE DATE American LegalNet, Inc. www.USCourtForms.com
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