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Charitable Organization Registration Statement BCO-10 - Pennsylvania

Charitable Organization Registration Statement Form. This is a Pennsylvania form and can be used in Bureau Of Charitable Organizations Department Of State .
 Fillable pdf Last Modified 9/12/2011
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For Official Use Only Bureau of Charitable Organizations 207 North Office Building Harrisburg, Pennsylvania 17120 Commonwealth of Pennsylvania Department of State Website: www.dos.state.pa.us/charities Approved: ____________ RF: ____________ AF: ____________ LF: ____________ Fee Received: ____________ Telephone: (717) 783-1720 (800) 732-0999 (within PA only) Fax: (717) 783-6014 Charitable Organization Registration Statement ­ Form BCO-10 (See note under "important information") Check if registering voluntarily Certificate Number: ____________ (Renewals Only) Fiscal Year Ended: _____ / _____ / _____ Employer Identification Number (EIN): ___________________ 1. Legal name of organization: ___________________________________________________ Check if name change Previous name: _________________________________ 2. All other names used to solicit contributions: ___________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 3. Contact person: ______________________________________________________________ Contact's E-mail: _____________________________________________________________ Physical address of organization: (Required) Mailing address: (If different than physical) __________________________________ __________________________________ City: _____________________________ State: ______ Zip code: __________ County: __________________________ Phone number: ___________________ ___________________________________ ___________________________________ City: ______________________________ State: ______ Zip code: ___________ 800 number: ______________________ Fax number: ______________________ E-mail (If different that Contact's E-mail): ___________________________________________ Website: _____________________________________________________________________ 4. Names, addresses, and telephone numbers of all offices, chapters, branches, auxiliaries, affiliates, or other subordinate units located in Pennsylvania: (Attach _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Form BCO-10 Revised (7/2009) Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com separate sheet if necessary) 5. For Organizations described in Section 162.7(a) of the Act, check section that describes organization: (See footnote #2 of instructions. Volunteer registrants do not respond.) 162.7(a)(1) 162.7(a)(3) 162.7(a)(2) 162.7(a)(4) Not Applicable 6. List type of organization (e.g. corporation, association, etc.): _________________________ Where established: ______________________ Date established:** __________________ **(Initial registrants must submit copies of organizational documents such as charter, articles of incorporation, constitution, or other organizational instrument, and by-laws.) 7. Is any person compensated, or do you intend to compensate any person, for soliciting contributions in Pennsylvania, including employees of the organization and professional solicitors? Yes No (Do not check "Yes" if you only use or intend to only use a professional fundraising counsel.) If "Yes", give date person or entity started or will start soliciting contributions from Pennsylvania residents. ____/____/____ Items 8 and 9 are required to be completed by initial registrants only 8. Date organization first solicited contributions from Pennsylvania residents: ___/___/____ 9. If organization solicited Pennsylvania residents and received gross* contributions totaling more than $25,000 during the fiscal year covered by this registration statement, or during its current fiscal year, give date contributions first totaled more than $25,000. ____/____/____ *Includes contributions received both within and outside Pennsylvania 10. Has organization been granted IRS tax-exempt status? Yes please submit copy of IRS exemption letter if not previously submitted.) No (If "Yes", A. If "Yes", under which IRS code section: ___________________________________ B. Has organization's tax-exempt status ever been denied, revoked, or (If "Yes" attach copy of denial, revocation, or modification.) modified? Yes No 11. Was the organization required to file an IRS 990 return and applicable schedules for its most recently completed fiscal year? Yes No (If "No", attach explanation of why organization is exempt from filing an IRS 990 return. An organization that is not required to file an IRS 990 return must file a Pennsylvania public disclosure form BCO-23. This includes an organization that files a 990N, 990EZ, or 990PF.) 12. A clear description of the specific programs for which contributions will be used, and a statement whether such programs are planned or in existence: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Page 2 of 6 Form BCO-10 Revised (7/2009) American LegalNet, Inc. www.FormsWorkFlow.com 13. Manner in which contributions are solicited (e.g. direct mail, telephone, internet, etc.): __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 14. Is organization registered to solicit contributions in any other state or municipality? Yes No (If "Yes", list all states and municipalities. Attach separate sheet if necessary.) __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 15. Names, addresses, and telephone numbers of all professional solicitors you use or intend to use to solicit contributions from Pennsylvania resid
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