South Carolina > Secretary Of State > Non-Profit Corporation
Application For Exemption - South Carolina
| Application For Exemption Form. This is a South Carolina form and can be used in Non-Profit Corporation Secretary Of State . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
State of South Carolina Office of the Secretary of State Mark Hammond Public Charities Division APPLICATION FOR EXEMPTION www.scsos.com charities@scsos.com Post Office Box 11350 Columbia, SC 29211 Phone: (803) 734-1790 Fax: (803) 734-1604 Check one: [ ] Initial Registration [ ] Renewal Registration Number: _________ Employer's Identification Number: ___ ___ -- ___ ___ ___ ___ ___ ___ ____ 1. Organization's Legal Name __________________________________________________________________________ Other Names Used ________________________________________________________________________________ 2. Contact Person's Name ___________________________________ Title _____________________________________ Contact Person's Mailing Address ____________________________________________________________________ City __________________________________ County ______________________ State _______ Zip _____________ Day Phone ( _____ )______________ Evening Phone ( ______ ) ________________ Fax ( ____ ) ________________ Contact Person's E-mail: __________________________________ Organization's Web Site: _____________________ 3. Organization's Street Address ________________________________________________________________________ ________________________________________________________________________________________________ City __________________________________ County _______________________ State _______ Zip _____________ 4. General purpose of the organization: __________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 5. Basis for exemption according to the Solicitation of Charitable Funds Act of 1994, check ONE of the following: _____ (1) Educational Institution (Schools, colleges, universities, and the foundations of South Carolina colleges and universities) _____ (2) Solicitation for the relief of a specified individual _____ (3)(a) Organizations which raise less than $5,000 in a calendar year if all of their functions including fund-raising activities are carried on by persons who are paid no more than $500 annually for their services. _____ (3)(b) Organizations which raise less than $20,000 in a calendar year and have a letter of tax exemption from the IRS, if all of their functions including fund-raising activities are carried on by persons who are paid no more than $500 annually for their services. (Please attach IRS tax letter if you have not already submitted one.) _____ (4) Organization solicits within its own membership, including utility cooperatives _____ (5) Veterans organization with congressional charter _____ (6) the State, its political subdivisions, and any agencies or departments thereof which are subject to the disclosure provisions of the Freedom of Information Act. OVER X:\Forms\External\Exemption Application.doc Rev. 2/10/05 Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com 6. Organization's Category Enter NTEE Codes (up to three) here: ____ ____ ____ ____ , ____ ____ ____ ____ , ____ ____ ____ ____ OR check up to three boxes below that best describe your organization: A. Arts, Culture, Humanities (inc. historical) B. Educational Institutions (inc. literacy) C. Environment, Beautification (inc. gardening, outdoor education) D. Animal-Related (inc. wildlife sanctuaries) E. Health-General, Rehabilitative (inc. nursing, family planning) F. Mental Health, Crisis Intervention (inc. alcoholism, services for rape and abuse victims) G. Disease, Disorders, Medical Disciplines H. Medical Research I. Crime, Legal-Related (inc. prevention of abuse, delinquency) J. Employment, Job-Related (inc. voc. rehabilitation, unions) K. Agriculture, Food, Nutrition (inc. livestock breeding) L. Housing, Shelter (inc. senior citizen housing) M. Public Safety, Disaster Preparedness and Relief (inc. rescue squads, auto safety) N. Recreation, Sports, Leisure, Athletics (inc. social clubs, Special Olympics) O. Youth Development P. Human Services (inc. thrift stores, YMCAs and YWCAs, hearing- or sight-impaired orgs.) Q. International, Foreign Affairs, National Security (inc. cultural exchange) R. Civil Rights, Social Action, Advocacy (inc. right to life and right to die, reproductive rights) S. Community Improvement, Capacity Building (inc. neighborhood associations, service clubs, bus. development) T. Philanthropy, Volunteerism, Grant-making (inc. foundations) U. Science and Technology Research Institutes W. Public Affairs, Society Benefit (inc. Citizen participation, consumer protection, veterans' orgs, leadership development) X. Religion, Spiritual Development Y. Mutual / Membership Benefit (inc. fraternal organizations, cemeteries) Z. Unknown, Other Please Specify: ___________________________ CERTIFICATION I certify that the information furnished in this application and all attached supplementary information is true and correct to the best of my knowledge, information and belief. I understand the giving of false or incorrect information may constitute a misdemeanor carrying a penalty upon conviction, for a first offense of not more than one thousand dollars or imprisonment for not more than thirty days, and for a second or any subsequent offense a fine of not more than five thousand dollars or imprisonment for not more than one year, or both. Chief Executive Officer: Chief Financial Officer: (Signature) (Signature) (Print Name) (Print Name) (Date) (Date) X:\Forms\External\Exemption Application.doc Rev. 2/10/05 Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com
|
|||||||
