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Volunteer Legal Handbook
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C. Charitable Organization Registration Form
STATE OF ALASKACHARITABLE ORGANIZATION REGISTRATION FORM
FOR THE PERIOD OF SEPTEMBER 2, 1997 THROUGH SEPTEMBER 1, 1998
(Pursuant to AS 45.68.010)
Return to: Attn: Rose Grant
Alaska Department of Law
Attorney General's Office
1031 W. 4th Avenue, Suite 200
Anchorage, Alaska 99501-19941. Organization name _________________________________________________
2. Mailing address ___________________________________________________
___________________________________________________
City State Zip3. Street address (if different) _____________________________________
___________________________________________________
City State Zip4. Daytime phone (_____) _____-__________
5. Is the organization a corporation? Yes [ ] No [ ]
Year incorporated: __________ Year founded __________________
(if different)
6. Purpose of organization:
[ ] School college and other training
[ ] Cultural and historical
[ ] Health and other services to individuals
[ ] Youth activities
[ ] Business, professional, employee & fraternal
[ ] Sports, athletic, recreational and social
[ ] Conservation & environmental
[ ] Public opinion advocacy & legal aid
[ ] Other, describe ________________________________________
____________________________________________________________
____________________________________________________________
7. Summarize the organization programs and activities which support the stated purposes.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
8. Describe how a citizen would verify or observe these activities.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
9. Under what names (other than the name above) will contributions be solicited?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
10. Names and titles of three officers or employees receiving the greatest compensation from the organization:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
11. Attach a list of names, addresses and telephone numbers of officers of the organization unless (check if applicable):
[ ] State nonprofit corporation registration is current
12. Number of solicitation campaigns conducted during the reporting year: ___________
13. Paid solicitors under contract to provide fund raising services during this reporting year:
(a) ____________________________________________________________
Name Address Phone____________________________________________________________
____________________________________________________________
____________________________________________________________
(b) Was there a written contract? [ ] Yes [ ] No
(c) How is the paid solicitor's compensation calculated under the contract? (describe formula or other method of calculating compensation): _________________________________
____________________________________________________________
14. Federal tax exempt status: [ ] applied for on _____/_____/_____
[ ] Exemption not requested [ ] 501(c)(3) granted
[ ] Exemption denied Federal employer ID no. ________________
15. Check the form number(s) of the return(s) filed with the Internal Revenue Service for the reporting period.
[ ] None [ ] 990/990/EZ [ ] Sched. A 990 [ ] 990-PF
[ ] 990-T [ ] 5227 [ ] 1041 [ ] 1041-A
[ ] 1041-B [ ] 4720 [ ] Other _______________________
16. (a) Did the organization file a Form 990 the preceding fiscal year?
[ ] Yes [ ] No
(b) Did the organization have an audited financial report prepared for the preceding fiscal year? [ ] Yes [ ] No
(c) If you checked either 16(a) or 16(b) "Yes", ATTACH the most recently completed Form 990 and/or audited financial report to this registration and skip to item 18. You MUST complete items 16(d)(1) through 16(d)(10) and 17, if you answered "No" on both 16(a) and 16(b).
(d) Financial Report for the accounting year ending:
(Date) _______________________
1. Gross revenue from all sources: _________________________
2. (Subtract) Cost of goods sold: __________________________
3. TOTAL REVENUE:................ __________________________
4. Gross fund raising expenses: ____________________________
5. (Subtract) Cost of goods sold: __________________________
6. Cost of solicitation: ___________________________________
7. Management & general expenses: __________________________
8. TOTAL AMOUNT APPLIED TO CHARITABLE PURPOSE: _____________
9. Total Expenses (Lines 6, 7, 8): _________________________
10. Surplus/(deficit): ________________________________
17. Did the organization pay for the fund raising services of any of the
following "Outside Entities"?
(a) [ ] No outside entity retained [ ] Contract employee
[ ] Paid solicitor (AS 45.68.900(4)) Name and address:
____________________________________________________________
____________________________________________________________
(b) Was part of the amount paid to "Outside Entities" included in Line 16(d)(8) of the financial report?
[ ] Yes [ ] No
(c) If Line 17(b) is yes, indicate both of the following:
Total amount paid to "Outside Entities" ____________________
Amount of line 16(d)(8) paid to "Outside Entities" _________
18. I certify, under unsworn falsification in violation of AS 11.56.210,that information contained in this Charitable Organization Registration Form is true and correct to the best of my knowledge.
DATED: ________________
_________________________________
Signature
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