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Charitable Organization Registration Statement - Ohio
| Charitable Organization Registration Statement Form. This is a Ohio form and can be used in Business Services Attorney General Office Statewide . |
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Charitable Law Section Office 614.466.3181 Fax 614.466.9788 150 East Gay Street, 23rd Floor Columbus, Ohio 43215-3130 www.OhioAttorneyGeneral.gov FOR OFFICIAL USE REG# _________________ YEAR __________________ EXP. __________________ A.C. ___________________ CHARITABLE ORGANIZATION REGISTRATION STATEMENT For Charitable Solicitation in the State of Ohio (Section 1716.02, Ohio Revised Code) This registration statement is to be completed by every charitable organization, except those exempted under section 1716.03 of the Revised Code, that intends to solicit contributions in this state by any means or have contributions solicited in this state on its behalf by any other person, charitable organization, commercial co-venturer or professional solicitor, prior to engaging in any of these activities and annually thereafter. Please answer all questions on the registration form and do not reference a federal tax return or any other attachment. Failure to complete this form in its entirety will delay the registration process. This registration statement shall be re-filed on or before the fifteenth day of the fifth calendar month after the close of each fiscal year in which the charitable organization solicited in this state, or by the date of any applicable extension of the federal filing date, whichever is later. Initial Registration ______ Renewal Registration ______ This registration is for tax year beginning ______________, 2 _ _ _ , and ending _______________, 2 _ _ _ If applicable, Ohio Bingo License Number _______________ Employer Identification Number ________________________ 1. 2. ______________________________________________________________________________ (Full official name of charitable organization) Does the charitable organization intend to solicit funds under any other name or names other than the name listed on item 1 above (i.e., dba names)? ____ Yes ____ No If yes, please list each name. Attach additional pages, if necessary. ______________________________________________________________________________ ______________________________________________________________________________ 3. ______________________________________________________________________________ (Address of principal place of business) ______________________________________________________________________________ (City) (State) (Zip) (Telephone No.) 4. E-mail address ________________________ Web address _______________________________ American LegalNet, Inc. www.FormsWorkFlow.com 5. ______________________________________________________________________________ (Address of primary office, chapter, branch, or affiliate located in Ohio, if the above address is not in Ohio) ______________________________________________________________________ (City) (State) (Zip) (Telephone No.) 6. Indicate the form of the charitable organization (corporation, partnership, association or individual). ______________________________________________________________________________ 7. Does this organization file a group federal tax return on behalf of other chapters and/or affiliates? _____ Yes _____ No. If yes, please list the address, telephone number and EIN of every office, chapter, branch, or affiliate of this organization which is located in this state. Attach additional pages, if necessary. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 8. If the charitable organization does not maintain an office in this state, complete the following information for the person that has custody of its financial records: ______________________________________________________________________________ (Name of person with custody of financial records) ______________________________________________________________________________ (Address) ______________________________________________________________________________ (City) (State) (Zip) (Daytime Telephone No.) 9. With the initial registration only, state the place where and the date when the charitable organization, if other than an individual, was legally established: ______________________________________________________________________________ 10. With the initial registration only, please attach a copy of the charitable organization's current charter, articles of incorporation, agreement of association, instrument of trust, constitution, or other organizational instrument and a copy of its regulations or bylaws. With the renewal registration, attach a copy of any amendment to these documents. Is the charitable organization exempt from federal taxation? ___Yes ___No 10a. 11. If yes, under what section of the Internal Revenue Code? _________________________________ 12. With the initial registration only, please attach a copy of the charitable organization's federal tax exemption determination letter. Revised: 2/24/2011 2 of 7 American LegalNet, Inc. www.FormsWorkFlow.com 13. Give the date of the fiscal year end for the organization: ______________________________________________________________________________ 14. Please attach a copy of the annual financial report on the form prescribed by the Attorney General or a copy of the federal tax form as filed with the Internal Revenue Service for the immediately preceding fiscal year as required under section 1716.04, Revised Code. Provide the names and addresses of all officers, directors, trustees, and executive personnel of the charitable organization. Attach additional pages, if necessary: Name Address Title/Position 15. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 16. Give the general purposes for which the organization was created: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 17. 18. Please attach a schedule of the activities carried on by
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