Kansas > Secretary Of State > Business Entities > Charitable Organization
Registration Statement For Solicitations SC - Kansas
| Registration Statement For Solicitations Form. This is a Kansas form and can be used in Charitable Organization Business Entities Secretary Of State . |
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Contact Information Kansas Secretary of State Memorial Hall, 1st Floor 120 S.W. 10th Avenue Topeka, KS 66612-1594 (785) 296-4564 kssos@sos.ks.gov www.sos.ks.gov Registration Statement for Solicitations All information must be completed or this document will not be accepted for filing. Initial registration Renewal/update KANSAS SECRETARY OF STATE SC 53-10 This registration statement covers tax year end ___________________ Month Day Year 1.a. Name of organization: ____________________________________________________ b. Name/names under which it will solicit: ____________________________________________________ 2.a. Principal street address of the organization: Address City State Zip Do not write in this space b. Principal mailing address (if different) of the organization: Address City State Zip 3.a. Principal street address of any offices the organization has in Kansas: Address City State Zip b. Principal mailing address (if different) of any offices the organization has in Kansas: Address City State Zip 4.a. Purpose for which the organization was organized: ____________________________________________________________________________________ b. Purpose for which the organization intends to solicit contributions (if different): ____________________________________________________________________________________ 5. Names and mailing addresses of any subsidiary or subordinate chapters, branches or affiliates in Kansas: Name Address City State Zip 6. Date of organization ___________________ State of organization ____________________ 1/4 American LegalNet, Inc. www.FormsWorkFlow.com 7. Form of organization (trust, corporation, etc.): ______________________________________________ Yes No 8. Has the organization applied for or been granted IRS tax exempt status? If yes, date of application ____________________ or date of determination letter ____________________ If granted, exempt under 501(c) ____ Are contributions to the organization tax deductible? Yes No 9. Names and addresses (street and mailing) of the following (attach additional pages if necessary): Officers: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Directors: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Trustees: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Principal salaried employees: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 10. Name and address (street and mailing) of person having custody of the organization's financial records: _______________________________________________________________________________________________________ 11. Names of the individuals or officers of the organization who will have responsibility for custody of contributions: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 2/4 American LegalNet, Inc. www.FormsWorkFlow.com 12. Names of the individuals or officers of the organization who will have responsibility for the distribution of the contributions: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 13. Names of the individuals or officers of the organization who will have responsibility for the conduct of solicitation activities: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Yes No Yes No 14. Does the organization intend to solicit contributions directly? 15. Does the organization intend to have such solicitation done on such organization's behalf by others? If yes, name the professional fund raiser(s) the organization intends to use: _______________________________________________________________________________________________________ 16. Methods of solicitation used: Personal contact Volunteers Mail Internet Telephone Vendors Radio TV Specify Other ________________________________ Yes No 17. Is this organization authorized by any other states or governmental authorities to solicit contributions? If yes, give state or jurisdiction: ___________________________________________________________________________ 18. Is this organization, or has it ever been, enjoined by any court from soliciting contributions? Yes No If yes, explain in detail: __________________________________________________________________________________ __________________________________________________________________________________ 19. Report all fund raising costs below. Also report total fund raising costs as a percentage of contributions received. If this is an initial registration statement, report anticipated costs. For fiscal year: ___________ ______ _______ Month to Day Year List all fund raising costs - describe below: ___________ ______ _______ Month Day Year Total fund raising costs: Total costs as a percent of contributions received: (Attach additional pages, if necessary) American
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