PART 400 SOLICITATION FOR CHARITY ACT : Sections Listing

TITLE 14: COMMERCE
SUBTITLE B: CONSUMER PROTECTION
CHAPTER II: ATTORNEY GENERAL
PART 400 SOLICITATION FOR CHARITY ACT

AUTHORITY: Implementing and authorized by the Solicitation for Charity Act [225 ILCS 460].

SOURCE: Adopted and effective November 5, 1975; amended at 2 Ill. Reg. 37, p. 185, effective September 30, 1978; amended at 6 Ill. Reg. 9616, effective August 1, 1982; codified at 7 Ill. Reg. 879; amended at 24 Ill. Reg. 14684, effective September 21, 2000; amended at 29 Ill. Reg. 11775, effective July 15, 2005.

 

Section 400.10  General

 

The Charitable Trusts Bureau of the Attorney General's Office (hereafter Bureau) will maintain a file of all charitable organizations, professional fund raisers, professional fundraising consultants and professional solicitors registered under the Illinois Solicitation for Charity Act at its Chicago office.

 

(Source:  Amended at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.20  Definitions

 

The words used in this Part are used with the same meaning assigned to them by statute unless clarified below.

 

"Charitable purposes" means any charitable, benevolent, philanthropic, patriotic, or eleemosynary purpose and includes the conduct described in Section 480.20(e) of Charitable Trust Act (14 Ill. Adm. Code 480).

 

"Contributions" means the gross amount of money raised and not merely the portion which after expenses is devoted to the charity.

 

(Source:  Amended at 2 Ill. Reg. 37, p. 185, effective September 30, 1978)

 

Section 400.30  Registration

 

a)         Charitable Organization

 

1)         Any charitable organization which solicits in Illinois must first register with the Attorney General unless it is exempt under the provisions of Section 3(b) of the Act.

 

2)         To register, a charitable organization must file a completed registration statement in the forms set forth in Appendix A, Illustrations A and B of this Part, all appropriate attachments, including a schedule of assets and investments, and all required statutory fees.  All registrations must be accompanied by a copy of the instrument under which the property is administered (for example, trust documents, articles of incorporation, constitution, by-laws) and a financial statement.  If the organization employs a professional fund raiser, a copy of its contract with the professional fund raiser must accompany the registration statement.

 

3)         If the organization has been in operation prior to registering, it must file, in addition to its registration statement, financial statements for each of the past three years and executed copies of annual reports or returns filed with the Internal Revenue Service for each of the past three years, must pay all filing fees and all late fees as provided by Sections 2 and 4 of the Act, and is subject to accounting for all past years of operation prior to registration.

 

4)         When a registration is canceled, to return to compliance, a re-registration must be made.  Re-registration requires the submission of all of the above registration documents as applicable, including the re-registration penalty fees as provided by Section 2 of the Act.

 

5)         Registration by an organization under Section 2 of the Act may upon request also satisfy the organization's registration requirements under the Charitable Trust Act [760 ILCS 55/5].

 

6)         The Attorney General may by pre-approval accept registration forms used by other states which contain the information required in Appendix A, Illustration A.

 

b)         Professional Fund Raiser

 

1)         No professional fund raiser may be employed by a charitable organization in Illinois without prior registration with the Attorney General.

 

2)         To register, a professional fund raiser must file a completed registration statement in the forms set forth in Appendix B, Illustrations A and B of this Part, all required statutory fees, copies of all Illinois charitable fundraising contracts and a professional fund raiser's bond when a bond is required, as described in subsection (b)(3).

 

3)         If the applicant is a professional fund raiser that will control or possess charitable funds, a bond in the amount of $10,000, expiring upon the next June 30, issued with the professional fund raiser as a principal and a corporate surety licensed to do business in Illinois as surety, must accompany the registration.  The bond must be in the form provided by the Bureau as set forth in Appendix B, Illustration C of this Part.

 

c)         Professional Solicitor

 

1)         No professional solicitor may solicit in Illinois without prior registration with the Attorney General.  No person may register as a professional solicitor unless he is employed by a registered professional fund raiser.

 

2)         To register, a professional solicitor must file a completed registration statement in the form set forth in Appendix C, Illustration A of this Part.

 

d)         Professional Fundraising Consultant

 

1)         No person or entity may act as a professional fundraising consultant without prior registration with the Attorney General.

 

2)         To register, a professional fundraising consultant must file a completed registration statement in the form set forth in Appendix D, Illustration A of this Part, copies of all Illinois charitable fundraising consultant contracts and an affidavit stating that the professional fundraising consultant has not or will not at any time have custody or control of contributions.

 

e)         A registrant shall notify the Attorney General of any changes in registration information within ten days after the change.

 

(Source:  Amended at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.40  Religious Exemption

 

a)         Religious organizations are subject to the Act and must register under the Act. If the Attorney General has issued a religious exemption to an organization pursuant to the provisions of Section 3(a) of the Act, that organization is exempt from filing annual reports.

 

b)         To obtain a religious exemption, an organization must file a completed registration statement, request an exemption and submit a religious exemption questionnaire in the form set forth in Appendix A, Illustration C of this Part.

 

c)         The Attorney General may require the organization to supply supplemental information as is necessary to determine its religious character.

 

d)         The Attorney General may issue either a blanket or an individual religious exemption.

 

e)         An individual religious exemption covers a single named religious group.

 

f)         A blanket religious exemption is issued to and upon the request of the central body of a church or denomination and covers the church and all of the affiliated agencies listed in the exemption request.

 

g)         Any religious organization with multiple subdivisions may request a blanket exemption.

 

h)         An application for a blanket religious exemption must be filed by the central governing authority of the church and shall contain the information required by Section 400.40(b) and also a list of the affiliated organizations and agencies which are directed and controlled by the central church.

 

i)          If, upon the filing of an application for religious exemption, the Attorney General determines that the organization is religious within the definition of Section 3(a) of the Act and that its purposes are actual and genuine, a religious exemption will be issued.

 

j)          Organizations receiving blanket exemptions shall periodically supply the Attorney General with current lists of their affiliates.

 

(Source:  Amended at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.50  Not Subject Organizations (Repealed)

 

(Source:  Repealed at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.60  Annual Reports for Charitable Organizations

 

a)         To complete a proper annual report filing, all annual reports required under the Act must be filed on the form set forth in Appendix A, Illustration D of this Part and with the attachments prescribed by the form and this Section, signed by both the president of the organization or other authorized officer, and the chief fiscal officer, and with all required statutory fees paid prior to the due date.

 

b)         Each annual financial report is due within six months after the close of the organization's fiscal year.  An organization may request a 60 day extension of the due date pursuant to Section 4(f) of the Act.

 

c)         Failure to file a complete annual report including all required attachments, along with payment of fees due prior to the due date, shall result in the organization being classified delinquent, and shall subject the organization to the payment of a late filing fee.

 

d)         On each annual report an organization must report separately all program costs associated with a joint cost fundraising appeal to the extent such was allocated to charitable program service expense and included on the annual report as charitable program service expense.  The organization must maintain written records showing how the allocation was determined and the reasoning behind it.

 

e)         The form and attachments required for an organization's annual report is determined by the amount of its revenue and assets during the reporting fiscal period or whether it has used the services of a paid professional fund raiser as follows:

 

1)         Any organization which received contributions of more than $150,000 in any reporting fiscal year or any organization which employed professional fund raisers during any part of the fiscal year who raised contributions totaling more than $25,000 during the organization's fiscal year must file:

 

A)        The Illinois Charitable Organization Annual Report form signed by the president and the treasurer and/or two trustees;

 

B)        A copy of the Federal Internal Revenue return and/or report as required by the Internal Revenue Codes and incorporated attachments for the same period;

 

C)        A financial report accompanied by financial statements and the certification of an independent certified public accountant.  Certification must be in the form of an unqualified opinion letter;

 

D)        All required statutory fees, including all late fees and re-registration fees; and

 

E)        If the organization employs a professional fund raiser, the Illinois Fundraising Campaign form for each professional fundraising campaign conducted during the fiscal period in the form set forth in Appendix A, Illustration E of this Part.

 

2)         Any organization with contributions more than $25,000 but not in excess of $150,000, or any organization which employed professional fund raisers who raised contributions of $25,000 or less during the organization's fiscal year, need not file an independent certified public accountant's opinion but must submit all of the other items required and listed in subsection (e)(1) above.

 

3)         Any organization which received contributions of more than $15,000 but not in excess of $25,000 during its fiscal year must file an annual report, but it may make a simplified filing by submitting:

 

A)        A financial statement using the Illinois Charitable Organization Annual Report form disclosing total receipts, total disbursements and assets on hand at the fiscal year end, accompanied by an attestation to the truth of the financial statement; and

 

B)        All required statutory fees.

 

4)         Certain organizations registered under the Act that are not required to file an annual report for a specific fiscal year under the Act, may be required to file under the Charitable Trust Act [760 ILCS 55].

 

f)         Charitable organizations which have made a consolidated registration pursuant to Section 2(g) of the Act shall include in their annual report such additional detailed financial information as will fairly represent the financial position of each of the affiliated groups.

 

g)         The Attorney General shall, upon written request, extend for 60 days the time for filing the annual financial report.

 

h)         If an organization is entitled to an additional extension for good cause by the Internal Revenue Service, which would extend its federal tax return or report due date to a date later than the Attorney General's due date, the organization may obtain an additional extension from the Attorney General coinciding with the same Internal Revenue Service due date.  Extension requirements are:

 

1)         This extension request must be made prior to the due date for the Attorney General's annual financial reports and must include:

 

A)        A written request for such additional extension;

 

B)        A completed and signed Illinois Charitable Organization Annual Report form;

 

C)        Financial statements, including a balance sheet and report of income and expenses for the subject period in final or interim form;

 

D)        All required statutory fees; and

 

E)        A copy of the application for extension of time filed with the Internal Revenue Service.

 

2)         The filing of all required reports must be done on or before the Internal Revenue Service extended filing date and shall include:

 

A)        A copy of the approved Internal Revenue Service application for extension;

 

B)        A copy of the Federal tax return or report; and

 

C)        Audited financial statements if required by the Attorney General and not previously filed.

 

i)          Failure to file a timely and complete financial report will result in penalty fees and/or a fine and subjects the organization's registration to cancellation.

 

j)          Upon cancellation the organization must cease operations.

 

(Source:  Amended at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.65  Mid-Year and Annual Reports for Professional Fund Raisers

 

a)         Mid-Year Reports:

 

1)         Every registered professional fund raiser who takes possession or control of charitable funds directly, indirectly, by an agent, or as an escrowee shall file a full written accounting to the charitable organization of all funds it or its agents collected on behalf of the charitable organization during the six month period ending June 30 of each year, and file a copy of the accounting with the Attorney General by September 30 of each year.

 

2)         The accounting shall be in writing and signed under oath on forms prescribed by the Attorney General as set forth in Appendix B, Illustrations D through G of this Part.

 

b)         Annual Reports:

 

1)         Every registered professional fund raiser shall file a calendar year written financial report with the Attorney General.  The report shall contain such information as the Attorney General may require, and shall use forms prescribed by him as set forth in Appendix B, Illustrations D through G of this Part.  Separate financial reports for each  fundraising campaign conducted shall be filed, together with the statutory report filing fee.

 

2)         The required report shall be filed on or before April 30 of the following calendar year, signed and verified under penalty of perjury, together with the required statutory fees.  The Attorney General will grant a 30 day extension of the due date pursuant to Section 6(d) of the Act if such extension is requested in writing prior to the due date.

 

3)         The professional fund raiser shall provide a copy of the report to the charitable organization by the due date of the filing.

 

(Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.70  Professional Fund Raiser Renewal

 

a)         The registration of all professional fund raisers expires on the next June 30 following their registration.

 

b)         A registered professional fund raiser who wishes to continue to act as professional fund raiser in Illinois must apply for renewal of its registration during June of the year in which his registration expires.

 

c)         To renew, a professional fund raiser must file a new, completed registration statement, an annual financial report as provided by the Attorney General, professional fund raiser bond which meets the requirements of Section 400.30(b)(3) for the period beginning July 1 and ending June 30 of the next year, and copies of active contracts and all required statutory fees.

 

d)         All Illinois professional fund raisers must file a copy of each professional fundraising contract prior to conducting a fundraising campaign.

 

e)         All charitable organizations and professional fund raisers shall retain copies of their professional fundraising contracts for three years following the completion of the contract.

 

(Source:  Amended at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.80  Professional Solicitor Renewal

 

a)         The registration of all professional solicitors shall expire on the next June 30 following their registration.

 

b)         A registered professional solicitor who intends to continue to act as a professional solicitor in Illinois must apply for renewal of its registration during June of the year in which its registration expires.

 

c)         To renew, a professional solicitor must file a new, completed registration statement.

 

(Source:  Amended at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.85  Professional Fundraising Consultant Renewal

 

a)         The initial registration of all professional fundraising consultants shall expire on the June 30 following two years of registration.  Successive two year re-registration periods shall also expire on June 30.

 

b)         A registered professional fundraising consultant who intends to continue to act as a consultant in Illinois must apply for renewal of its registration during the month preceding expiration of the two year registration period.

 

(Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.90  Public Records

 

All registrations and reports filed with the Attorney General under the Act are public records and may be inspected in the office of the Attorney General during ordinary business hours.

 

(Source:  Amended at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.100  Registration Not an Endorsement

 

a)         Any representation made by a charitable organization, professional fund raiser, or professional solicitor in connection with its solicitation that it is registered or has otherwise complied with the Act, or that indicates the Attorney General endorses the organization, is unlawful, except as provided in Section 17 of the Solicitation for Charity Act [225 ILCS 460/17].

 

b)         The Attorney General may immediately cancel the registration of any person or organization violating Section 400.100(a).  An affidavit from a person to whom such an illegal representation was made shall be sufficient to warrant an immediate cancellation.

 

(Source:  Amended at 24 Ill. Reg. 14684, effective September 21, 2000)



  • Section 400.APPENDIX A Charitable Organization Forms

    • Section 400.APPENDIX B   Professional Fund Raiser Forms

     

    Section 400.ILLUSTRATION A   Registration Statement and Instructions

     

    Form PFR-01

    PROFESSONAL FUND RAISER

    REGISTRATION STATEMENT

    JIM RYAN

    ATTORNEY GENERAL

     

     

     

     

    For Fiscal Year July 1, ___Through June 30, ___

     

     

    1. □ A NEW REGISTATION   □  RE REGISTRATION   □  CHANGE   □  ADDITION AS OF

           /         /

    2. □ INDIVIDUAL □ PARTNERSHIP or □ CORPORATION Attach: Partnership Agreement or Articles of Incorporation

     

    NAME of REGISTRANT

    PFR NUMBER

    02-

    ADDRESS

    PHONE NUMBER

    (           )           -     

    CITY, STATE, ZIP CODE

    FEDERAL ID NUMBER

                -        

     

    3.  NAME OF CHIEF MANAGEMENT PERSON(S)

     

    TITLE

     

    (Attach Schedules as needed)

     

    TITLE

     

     

     

    4.  NAME & ADDRESS OF ILLINOIS REGISTERED AGENT: (Address must be a street address for service)

     

    Name:

     

    Address:

     

     

     

    5.  LIST ALL PRINCIPAL PARTIES, OFFICERS, DIRECTOR, EXECUTIVE PERSONNEL, AND OWNERS OF TEN PERCENT OR MORE OF THE CAPITAL STOCK (ATTACH SCHEDULE as needed INDICATING NAME, STREET ADDRESS, TITLE, % OF INTEREST, BIRTH DATE, DRIVERS LICENSE #, STATE OF ISSUE for each person listed).

     

    Name

    Title

    Name

    Title

    Address

    Address

    □ Officer □ Director □ Executive Employee

    □ Officer □ Director □ Executive Employee

    □ Owner ____%

    Birth Date

    /       /

     

    □ Owner ____%

    Birth Date

    /       /

     

    Drivers License #

     

    State

     

     

    Drivers License #

     

    State

     

     

     

     

     

     

    Name

    Title

    Name

    Title

    Address

    Address

    □ Of ricer □ Director □ Executive Employee

    □ Officer □ Director □ Executive Employee

    □ Owner ____%

    Birth Date

    /       /

     

    □ On nor ____%

    Birth Date

    /       /

     

    Drivers License #

     

    State

     

     

    Drivers License #

     

    State

     

     

     

     

     

     

     

    6.  WERE ALL PROFESSIONAL SOLICITORS FURNISHED A 1099 OR W2 LAST YEAR?          □ Yes □ No

    IF NO, EXPLAIN IN DETAIL.  COMPLETE AND ATTACH FORM PS-01.

     

    7.  HAVE ANY OF THE FIRM'S PRINCIPAL PARTIES, EMPLOYEES, OFFICERS, DIRECTORS, EXECUTIVE PERSONNEL, OWNERS OF TEN PERCENT OR MORE OF THE CAPITAL STOCK OR THEIR RELATIONS EVER BEEN CONVICTED OF A MISDEMEANOR INVOLVING THE MISAPPROPRIATION OR MISUSE OF MONEY OF ANOTHER, OR OF ANY FELONY?   □ Yes  □ No

     

    IF "YES", INDICATE WHO WAS CONVICTED, THE NATURE of OFFENSE, DATE of CONVICTION, and NAME and ADDRESS of COURT.

     

     

     

    8.  LIST THE INTEREST OF ALL PRINCIPAL PARTIES, OFFICERS, DIRECTORS, EXECUTIVE PERSONNEL, OWNERS OF REGISTRANT AND THEIR FAMILY MEMBERS IN ANY OTHER FIRMS PROVIDING GOODS OR SERVICES USED IN FUND RAISING.

     

    NATURE OF BUSINESS

    NAME OF PARTY

    %  INTEREST

    NAME & STREET ADDRESS OF BUSINESS

     

     

     

    9.  COMPLETE & ATTACH FORM PFR-06 FOR ALL CHARITIES HAVING CONTRACTS WITH PFR.

     

    ATTACH THE FOLLOWING AS A PART OF REGISTRATION AND INDICATE BY AN "X" THOSE ATTACHED:

     

    □            Partnership Agreement or Articles of Incorporation of professional Fund Raiser (PFR).

    □            Certificate of Authority to Transact Business in Illinois (Out of state PFRs only).

    □            Form CS-6 (PFR Bond).

    □            Form PFR-06 (List of Charities for whom fund Raising services are to be provided.).

    □            Form PS-01 (For all Solicitors employed by PFR).

    □            List all business locations, other than above, used for fundraising. (attach a schedule indicating street address, city, state).

    □            All schedules and explanations for any of the above questions.

    □            Copies of all Fund Raising Contracts with Charities including Amendments, and Extensions.

     

    NOTE: VERIFICATION MUST BE BY THE CORPORATE PRESIDENT, A GENERAL PARTNER OR THE SOLE PROPRIETOR

     

    STATE OF

     

    )

    SS

    AFFIDAVIT

    COUNTY OF

     

    )

    I,

     

    under penalty of perjury and being sworn on oath state that I am

    (strike out) the CORPORATE PRESIDENT, a GENERAL PARTNER or the SOLE PROPRIETOR of the registrant professional fund raiser.

     

    I have read the forgoing registration statement and personally know the contents thereof to be true, and each and every attachment, attached form and attached schedule, the content thereof as stated by me and filed by me with the Illinois Attorney General for the purpose of having the people of the State of Illinois rely thereupon. I herebv further authorize and agree to submit myself and the registrant hereby to the jurisdiction of the State of Illinois.

     

    Subscribed and sworn to before me.

    This

     

    day of

     

    , 19

     

     

     

     

    (Signature)

     

     

     

    Notary Public

     

    (Print Name & Title)

    Attach as many copies of this form and all schedules needed to complete your registration.

    Send completed registration to:

    Attorney General's Office, Charitable Trust Bureau, 100 West Randolph, 3rd Floor, Chicago, Illinois 60601

     

     

    DOCUMENTS A PROFESSIONAL FUND RAISER MUST SUBMIT TO REGISTER

    WITH THE ILLINOIS ATTORNEY GENERAL'S OFFICE

     

    ALL PROFESSIONAL FUND RAISERS MUST SUBMIT:

     

    1.       $100.00 Registration Fee. Check or Money Order payable to "Illinois Charity Bureau Fund" attached to Form PFR-01.

     

    2.       "Professional Fund Raiser Registration Statement" (Form PFR-01).

     

    3.       "Professional Fund Raiser (PFR) List of Charities & Contracts" (Form PFR-06).

     

    4.       A copy of all contracts listed on Form PFR-06 along with the $25.00 Annual Filing Fee for Each Contract Filed or on File.  Check or Money Order payable to the "Illinois Charity Bureau Fund" attached to Form PFR-06.

     

    5.       "Professional Fund Raisers Bond" (Form CS-6)  This Form must be filed by all Professional Fund Raisers that have access to or control of funds raised.

     

    6.       "Professional Solicitor Registration Statement" (Form PS-01)  This Form must be filed for each Solicitor employed by the PFR.

     

    7.       Partnership Agreement or Articles of Incorporation of Professional Fund Raiser.

     

    8.       Certificate of Authority to Transact Business in Illinois.  This must be filed by out of state corporations only.

     

    9.       List of all business locations used for fund raising. (Attach a schedule indicating street address, city, state).

     

    Direct the above registration materials, including all required fees payable to the "Illinois Charity Bureau Fund" to:

     

    Office of the Attorney General

    Charitable Compliance Section

    100 West Randolph Street, 3rd Floor

    Chicago, Illinois  60601

    (312) 814-2595

     

    Note:  Registrations and contracts not filed timely must by law pay a late filing fee of $1,000.00 for each contract that is not on file with this office.

     

    (Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

    Section 400.APPENDIX B   Professional Fund Raiser Forms

     

    Section 400.ILLUSTRATION B   List of Charities and Contracts

     

    FORM PFR-06

    PROFESSIONAL FUND RAISER (PFR)

    JIM RYAN

     

    LIST OF CHARITIES & CONTRACTS

    ATTORNEY GENERAL

    Attachment

    For Whom Fund Raising Services Are to be Provided

     

     

     

     

    PFR NAME __________________________________________________________PFR # 02-________________

    MANAGEMENT PERSON(S) WHO PREPARE THIS FORM. _________________________________________

     

    SUBMIT A COPY OF EACH CONTRACT WITH REGISTRATION.

    LIST CHARITIES FOR WHOM FUNDRAISTNG SERVICES ARE TO BE PROVIDED.

    PROVIDE the following BANK ACCOUNT INFORMATION FOR ALL ACCOUNTS USED TO DEPOSIT FUNDS SOLICITED FOR OR ON BEHALF OF EACH CHARITY LISTED:

     

    Contract Info:

    Charity Name, City, State:

    Contract

    Contract Date:   ___/___/___

    CO#

     

    Terms:

    Beginning:         ___/___/___

    01- ________ _________

     

     

    Ending:             ___/___/___

    Bank Account

    Name of Bank:

    Signatory Control of Bank Acct:

    Information:

    Address of Bank:

     PFR  Charity  Escrow/Caging

     

    Acct. #

     Other describe:__________________

    Contract Info:

    Charity Name, City, State:

    Contract

    Contract Date:   ___/___/___

    CO#

     

    Terms

    Beginning:         ___/___/___

    01-________ _________

     

     

    Ending:             ___/___/___

    Bank Account

    Name of Bank:

    Signatory Control of Bank Acct:

    Information:

    Address of Bank:

     PFR  Charity  Escrow/Caging

     

    Acct. #

     Other Describe:_________________

    Contract Info:

    Charity Name, City, State:

    Contract

    Contract Date:    ___/___/___

    CO#

     

    Terms:

    Beginning:         ___/___/___

    01-________ _________

     

     

    Ending:             ___/___/___

    Bank Account

    Name of Bank:

    Signatory Control of Bank Acct:

    Information:

    Address of Bank:

     PFR  Charity  Escrow/Caging

     

    Acct. #

     Other Describe:_________________

    Contract Info:

    Charity Name, City, State:

    Contract

    Contract Date:   ___/___/___

    CO#

     

    Terms:

    Beginning:         ___/___/___

    01-________ _________

     

     

    Ending:             ___/___/___

    Bank Account

    Name of Bank:

    Signatory Control of Bank Acct:

    Information:

    Address of Bank:

     PFR  Charity  Escrow/Caging

     

    Acct. #

     Other Describe:_________________

    Contract Info:

    Charity Name, City, State:

    Contract

    Contract Date:    ___/___/___

    CO#

     

    Terms:

    Beginning          ___/___/___

    01-________ _________

     

     

    Ending:             ___/___/___ 

    Bank Account

    Name of Bank:

    Signatory Control of Bank Acct:

    Information:

    Address of Bank:

     PFR  Charity  Escrow/Caging

     

    Acct. #

     Other Describe:_________________

     

     

     

    COMPLETE AS MANY COPIES OF FORM PFR-06 AS NEEDED TO LIST ALL CHARITIES FOR WHICH FUND RAISING SERVICES ARE TO BE PROVIDED. A COMPLETED COPY OF THIS FORM MUST BE SUBMITTED WITH EACH NEW CONTRACT FILED.

     

     

    Contract Info:

    Charity Name, City, State:

    Contract

    Contract Date:    ___/___/___

    CO#

     

    Terms:

    Beginning:         ___/___/___

    01-________ _________

     

     

    Ending:              ___/___/___

    Bank Account:

    Name of Bank:

    Signatory Control of Bank Acct:

    Information:

    Address of Bank:

     PFR  Charity  Escrow/Caging

     

    Acct #

     Other Describe:

    Contract Info:

    Charity Name, City, State:

    Contract

    Contract Date:    ___/___/___

    CO#

     

    Terms:

    Beginning:         ___/___/___

    01-________ _________

     

     

    Ending:              ___/___/___

    Bank Account:

    Name of Bank:

    Signatory Control of Bank Acct:

    Information:

    Address of Bank:

     PFR  Charity  Escrow/Caging

     

    Acct #

     Other Describe:

    Contract Info:

    Charity Name, City, State:

    Contract

    Contract Date:    ___/___/___

    CO#

     

    Terms:

    Beginning:         ___/___/___

    01-________ _________

     

     

    Ending:              ___/___/___

    Bank Account

    Name of Bank:

    Signatory Control of Bank Acct:

    Information:

    Address of Bank:

     PFR  Charity  Escrow/Caging

     

    Acct #

     Other Describe:

    Contract Info:

    Charity Name, City, State:

    Contract

    Contract Date:    ___/___/___

    CO#

     

    Terms:

    Beginning:          ___/___/___

    01-________ _________

     

     

    Ending:              ___/___/___

    Bank Account

    Name of Bank:

    Signatory Control of Bank Acct:

    Information:

    Address of Bank:

     PFR  Charity  Escrow/Caging

     

    Acct #

     Other Describe:

    Contract Info:

    Charity Name, City, State:

    Contract

    Contract Date:    ___/___/___

    CO#

     

    Terms:

    Beginning:         ___/___/___

    01-________ _________

     

     

    Ending:              ___/___/___

    Bank Account

    Name of Bank:

    Signatory Control of Bank Acct:

    Information:

    Address of Bank:

     PFR  Charity  Escrow/Caging

     

    Acct #

     Other Describe:

    Contract Info:

    Charity Name, City, State:

    Contract

    Contract Date:    ___/___/___

    CO#

     

    Terms:

    Beginning:         ___/___/___

    01-________ _________

     

     

    Ending:              ___/___/___

    Bank Account

    Name of Bank:

    Signatory Control of Bank Acct:

    Information:

    Address of Bank:

     PFR  Charity  Escrow/Caging

     

    Acct #

     Other Describe:

    Contract Info:

    Charity Name, City, State:

    Contract

    Contract Date:    ___/___/___

    CO#

     

    Terms:

    Beginning:         ___/___/___

    01-________ _________

     

     

    Ending:              ___/___/___

    Bank Account

    Name of Bank:

    Signatory Control of Bank Acct:

    Information:

    Address of Bank:

     PFR  Charity  Escrow/Caging

     

    Acct #

     Other Describe:

     

    (Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

    Section 400.APPENDIX B   Professional Fund Raiser Forms

     

    Section 400.ILLUSTRATION C   Bond

     

    Form CS-6

    JIM RYAN

    ATTORNEY GENERAL

    Professional Fund Raiser's Bond

    PLEASE TYPE or PRINT IN INK

    KNOW ALL MEN BY THESE PRESENTS

    That we,

     

     

    of

     

     

    as Principal and

     

     

    as surety, are held and firmly bound unto the Attorney General of the State of Illinois, for the use of the State of Illinois, and to any person who may have a cause of action against the Principal for any malfeasance or misfeasance in the conduct of solicitation by the Principal as a Professional Fund Raiser, in the sum of TEN THOUSAND DOLLARS ($10,000), lawful money of the United States of America to be paid to the Attorney General of the State of Illinois for the use of the State of Illinois, and for charitable purposes, and to any persons who may have a cause of action against the Principal for any malfeasance or  misfeasance in the conduct of solicitation by the Principal as a Professional Fund Raiser, as their interests may appear, not exceeding in the aggregate and said sum of TEN THOUSAND DOLLARS ($10,000), for  which payment well and truly to be made we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally by these presents.

     

    WHEREAS, the above bounden Principal has applied to the Attorney General of the State of Illinois for registration as a Professional Fund Raiser for the purpose of acting as a Professional Fund Raiser for a charitable organization required to register with the Attorney General of the State of Illinois pursuant to Section 6 of "An Act to Regulate Solicitation and Collection of Funds for Charitable Purposes" of the Sate of Illinois and the acts amendatory thereof and supplemental thereto.

     

    NOW, the condition of this obligation is such,

     

    That if the Attorney General of the State of Illinois does register the above bounden Principal as such Professional Fund Raiser and said Principal faithfully and honestly acts as such Professional Fund Raiser in accordance with law, and fully complies with the provisions of "An Act to Regulate Solicitation and Collection of Funds for Charitable Purposes" of the Sate of Illinois and the acts amendatory thereof and supplemental thereto, and the Principal shall fully indemnify and save harmless from loss of the State of Illinois and any person who may have a cause of action against the Principal for any malfeasance or misfeasance in the conduct of solicitation as such Professional Fund Raiser, then this obligation to be void, otherwise to remain in full force and virtue.

     

     

     

     

    This bond shall not become void upon the first recovery thereon but may be sued upon from time to time until the full amount shall have been exhausted.

     

    THIS BOND IS A SEPARATE BOND AND NOT A CONTINUATION OF A PREVIOUSLY ISSUED BOND.

     

     

    This bond is to cover all claims arising on account of the solicitation activities of the Principal and his acting as such Professional Fund Raiser

    for the full term here beginning on

     

    ,  19

     

    and expiring on the 30th day of the next June.

    In Witness Whereof we have hereunto set our hands and seals this

     

    day of

     

     ,  19

     

     

     

    (SEAL)

    Principal

     

    Surety

    BY:

     

     

    ACKNOWLEDGMENT OF INDIVIDUAL

     

    STATE OF

     

    )

    SS

    COUNTY OF

     

    )

    On this

     

    day of

     

    ,      19

     

    before me personally came

     

    ,  to me known and known to me to be the individual described in

    and who executed the foregoing instrument, and he acknowledged to me that he executed the same.

     

     

     

    Notary

     

    ACKNOWLEDGEMENT OF PARTNERSHIP

     

    STATE OF

     

    )

    SS

    COUNTY OF

     

    )

    On this

     

    day of

     

    ,     19

     

    before me personally came

     

    , to me known and known to me to be a partner in the partnership of

     

    and the person described in and who executed the foregoing instrument in the

    partnership name of

     

    , and he duly acknowledged to me that

    he executed the same as and for  the act and deed of said partnership.

     

     

     

    Notary

     

    ACKNOWLEDGEMENT OF CORPORATON

     

    STATE OF

     

    )

    SS

    COUNTY OF

     

    )

    On this

     

    day of

     

    , 19

     

    before me personally came

     

    , to me known, who being by me duly sworn, did depose and say that

    he resides in

     

    , that he is the

     

    of the corporation:

    that seal affixed of said instrument  in such corporate seal; that it was affixed  by order of the Board of Directors of said corporation

    and that he signed his name thereto by like order.

     

     

     

    Notary

    NOTE:  If acknowledgment is made outside the State of Illinois, a certificate of the County Clerk or other proper official, showing authority of the notary public or other official before whom acknowledgment is made, should be attached.

     

    (Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

    Section 400.APPENDIX B   Professional Fund Raiser Forms

     

    Section 400.ILLUSTRATION D   Annual Financial Report

     

    Form PFR-02

    PROFESSIONAL FUND RAISER ANNUAL FINANCIAL REPORT

    JIM RYAN

    ATTORNEY GENERAL

     

    THIS MUST BE FILED BY

     

     

    FILE AT:  Office of the Attorney General, Charitable Trust and Solicitations Bureau, 100 West Randolph Street, Chicago, Illinois 60601

    GENERAL INSTRUCTIONS (FURTHER INSTRUCTIONS AT END OF FORM)

    PLEASE TYPE OR PRINT IN BLACK INK

    A.

    RESPOND TO ALL ITEMS ON THIS FORM.

    B.

    CHANGES OF OR ADDITIONS TO THE INFORMATION IN THIS STATEMENT MUST BE SUBMITTED IN THIS FORMAT.

    C.

    ANNUAL REPORT (CHECK ONE):

     

     

    PREPARED ON ACCRUAL BASIS 

    PREPARED ON A CASH BASIS 

    OR PREPARED BY ANOTHER METHOD 

     

    IF PREPARED BY ANOTHER METHOD EXPLAIN:

     

     

     

    LEGAL NAME

     

    REGISTERED FOR FISCAL YEAR

    MAIL ADDRESS

     

    ENDED JUNE 30,

     

    AS

    CITY

     

    PFR# 02-

     

     

    STATE, ZIP CODE

     

    FEDERAL ID NUMBER

     

    PHONE NUMBER

    (             )

     

     

     

     

     

     

     

    REPORT IS FOR PERIOD BEGINNING JANUARY 1,

     

    AND ENDING

     

     

    CHARITIES FOR WHOM FUNDS WERE RAISED

    (A)

    AMOUNT TO

    CHARITY

    (B)

    SOLICITATION

    EXPENSES

    (C))

    TOTAL AMOUNT RAISED

    (D)

    % = A/C

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    TOTAL FOR ALL CHARITABLE FUNDRAISING BY PFR:

     

     

     

     

    TOTAL NUMBER OF CHARITIES BEING REPORTED

     

     

     

    Note:  Verification must be by the Corporate President, a General Partner or the Sole Proprietor

    STATE OF

     

    }

    SS

    AFFIDAVIT

    COUNTY OF

     

     

    I,

     

    , under penalty of perjury and being sworn on oath that I am (circle one) the

    corporate president, a general partner or the sole proprietor of the registered professional fundraiser.

    (Name of PFR)________________________________

    , have read this annual report including all attachments and personally

    know the contents thereof to be true, and such is stated herein and filed with the Illinois Attorney General for the purpose of having the people of the State of Illinois rely thereupon.  I hereby further authorize and agree to submit myself and the registrant hereby to be jurisdiction of the State of Illinois.

    Subscribed and sworn to

    before me, this

     

     

     

     

    (Signature)

    day of

     

    19

     

    .

     

     

    NOTARY PUBLIC

     

     

     

    (Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

    Section 400.APPENDIX B   Professional Fund Raiser Forms

     

    Section 400.ILLUSTRATION E   Report of Individual Fundraising Campaign

     

    Form IFC

    REPORT OF INDIVIDUAL

    JIM RYAN

     

    FUNDRAISING CAMPAIGN

    ATTORNEY GENERAL

    CHARITY:

    Name

    Campaign Beginning

    and Ending

    Mailing Address

     

    CO# 01-

     

    City, State, Zip Code

     

    Phone #

    Contact Person

     

    Title

    Phone #

    PROFESSIONAL FUND RAISER (PFR):

     

     

    Name

     

    PFR #02-

    NATURE OF FUNDRAISING ACTIVTY:

     

     

     

     

     

    A.

    Amount received by the charitable organization .......................................................... A.

    $

     

     

     

    PAID BY:

     

    B.

    Expenses:

    PFR

    Charity

     

     

    1.

    Professional Fundraiser Fee................. 1.

     

     

     

     

    2.

    Solicitor Compensation....................... 2.

     

     

     

     

    3.

    Salaries.............................................. 3.

     

     

     

     

    4.

    Printing.............................................. 4.

     

     

     

     

    5.

    Postage.............................................. 5.

     

     

     

     

    6.

    Telephone.......................................... 6.

     

     

     

     

    7.

    Rent & Utilities.................................. 7.

     

     

     

     

    8.

    Supplies............................................. 8.

     

     

     

     

    9.

    Travel................................................ 9.

     

     

     

     

    10.

     

    10.

     

     

     

     

    11.

     

    11.

     

     

     

     

    12.

     

    12.

     

     

     

     

    13.

    TOTAL EXPENSES (PFR + Charity)............. 13.

     

     

             B.

    $

    C.

    Total Amount Raised.................................................................................................. C.

    $

    D.

    Percentage of funds received by charity (Line A divided by Line C)................................ D.

    %

    E.

    Bank and account number where funds are deposited?

     

    F.

    Who (charity or PFR) has signature control of the account(s) listed above?

     

    F.

    Attach a schedule explaining, in detail, how expenses are allocated between fundraising campaigns.

    We, the undersigned, declare and certify under perjury that we have examined this report, including all the schedules, and statements, and the facts therein stated are true and complete and filed with the Illinois Attorney General for the purpose of having the people of the State of Illinois rely thereupon.

    PFR CAMPGAIN

    MANAGER (Print Name)

    TITLE

    SIGNATURE

    DATE

    OFFICER, DIRECTOR

    OF CHARITY (Print Name)

    TITLE

    SIGNATURE

     

    DATE

     

     

    (Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

    Section 400.APPENDIX B   Professional Fund Raiser Forms

     

    Section 400.ILLUSTRATION F   Professional Solicitor Compensation Report

     

    Form PFR-04

    PROFESSIONAL SOLICITOR

    JIM RYAN

     

     

    COMPENSATION REPORT

     

    ATTORNEY GENERAL

     

     

     

     

     

     

    FOR THE PERIOD ENDING

     

     

    PFR NAME:

     

     

     

    PFR #02-

     

     

    CHANGES OF OR ADDITIONS TO THE INFORMATION IN THIS STATEMENT MUST BE SUBMITTED IN THIS FORMAT.

    1.

    LIST ALL SOLICITORS EMPLOYED BY YOU DURING THE PERIOD COVERED BY YOUR ANNUAL FINANCIAL REPORT:

    PROFESSIONAL SOLICITOR NAME  & ADDRESS

    SOCIAL SECURITY #

    AREA CODE/

    TELEPHONE #

    AMOUNT PAID

    HOURS

    WORKED

    ADDRESS:

     

     

     

     

     

     

     

     

     

     

     

    ADDRESS

     

     

     

     

     

     

     

     

     

     

     

    ADDRESS

     

     

     

     

     

     

     

     

     

     

     

    ADDRESS

     

     

     

     

     

     

     

     

     

     

     

    ADDRESS

     

     

     

     

     

     

     

     

     

     

     

    ADDRESS

     

     

     

     

     

     

     

     

     

     

     

    ADDRESS

     

     

     

     

     

     

     

     

     

     

     

    ADDRESS

     

     

     

     

     

     

     

     

     

     

     

    ADDRESS

     

     

     

     

     

    2.

    TOTAL NUMBER OF SOLICITORS EMPLOYED:

     

     

    3.

    TOTAL AMOUNT PAID TO ALL SOLICITORS EMPLOYED DURING THIS PERIOD:

    $

     

     

    4.

    TOTAL NUMBER OF MAN HOURS WORKED BY PROFESSIONAL SOLICITORS DURING THIS PERIOD:

     

     

    5.    DESCRIBE IN DETAIL HOW SOLICITORS ARE PAID. PROVIDE INFORMATION DESCRIBING THE SALARY STRUCTURE OF ALL PROFESSIONAL SOLICITORS EMPLOYED BY YOU DURING THIS PERIOD (I.E. HOURLY RATE, COMMISSION, SALARY, OTHER):

     

     

     

     

     

     

     

     

     

     

     

    6.    WERE ALL PROFESSIONAL SOLICITORS FURNISHED A 1099 OR A W2 LAST YEAR?  YES     NO

    IF NO, EXPLAIN IN DETAIL:

     

     

     

    7.    WERE ALL PROFESSIONAL SOLICITORS EMPLOYED BY YOU REGISTERED WITH THE ILLINOIS ATTORNEY GENERAL:

     

    YES 

    NO 

    IF NO, EXPLAIN:

     

     

     

     

    PAGE _____ OF _____ PAGES

     

    (Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

    Section 400.APPENDIX B   Professional Fund Raiser Forms

     

    Section 400.ILLUSTRATION G   Explanation of Professional Fundraising Fees

     

    Form PFR-05

    EXPLANATION OF

    JIM RYAN

     

    PROFESSIONAL FUNDRAISING FEES

    ATTORNEY GENERAL

     

    FOR THE PERIOD ENDING

     

     

    PFR NAME:

    PFR #02

     

    1.             GIVE DETAILED DESCRIPTION OF THE SERVICES RENDERED FOR CAMPAIGN, DRIVE, OR EVENT HELD OR ORGANIZED BY YOUR ORGANIZATION FOR THE PURPOSE OF RAISING FUNDS FOR A CHARITABLE ORGANZATION:

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    2.             GIVE A DETAILED DESCRIPTION OF THE BASIS USED TO DETERMINE YOUR OWN ORGANIZATION'S COMPENSATION FOR SERVICES RENDERED ON EACH FUNDRAISING CAMPAIGN HELD OR ORGANIZED BY YOUR ORGANIZATION (I.E. PERCENTAGE OF FUNDS RAISED, TIME SPENT, RESOURCES USED, ETC.) (SEE CONTRACT IS NOT ACCEPTABLE):

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    (Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

    Section 400.APPENDIX C   Professional Solicitor Forms

     

    Section 400.ILLUSTRATION A   Registration Statement

     

    Form PS-01

    PROFESSIONAL  SOLICITOR

    -REGISTRATION  STATEMENT-

    JIM RYAN

    ATTORNEY GENERAL

    PLEASE TYPE OR PRINT IN BLACK INK.  Respond to all items. If unable to answer in space provided attach a schedule in the same format.  Changes of or additions to the information in this statement are to be submitted in this format.  Due to the  large volume of reports and registrations handled by this division, we will not consider a partial registration.  This form must be complete and accompanied by any supporting documents.  A copy of this form must be retained by the Professional Fund Raiser who intends to employ this party.  One copy of this Registration Statement and attachments are to be filed with the Attorney General's Office, Charitable Trust and Solicitations Bureau,  100 West Randolph Street, Chicago, Illinois 60601.

    1.

    THIS IS A (CHECK ONE and DATE):

     

     

    NEW REGISTRATION    REREGISTRATION    CHANGE    ADDITION , AS OF

              /       /             

     

    2.

    LEGAL NAME

    REGISTRATION/REREGISTRATION

     

     

    For Fiscal Year Ending June 30,  ______

    3.

    MAIL ADDRESS

    PFR NUMBER

     

     

    02-

     

    CITY, STATE, ZIP CODE

    PHONE NUMBER

    SOCIAL SECURITY NUMBER

     

     

     

    4.

    This PROFESSIONAL SOLICITOR intends to be employed by (PFR)

     

     

     

    (NAME OF PFR)

    5.

    A STREET ADDRESS (if different than above)

     

     

     

     

    6.

    BIRTH DATE

          /        /      

    DRIVER'S LICENSE NO.

     

    STATE OF ISSUE

     

    7.

    IF THE ADDRESS ABOVE IS NOT IN ILLINOIS, LIST PRINCIPAL ILLINOIS ADDRESS, IF ANY, A STREET ADDRESS ONLY (NOT A P.O. BOX)

     

     

    8.

    LIST NAME AND DAYTIME TELEPHONE NUMBER OF A FAMILY MEMBER OR ANOTHER PERSON WHO CAN CONTACT YOU IN THE EVENT YOU ARE NO LONGER AT THE ABOVE ADDRESS.

     

     

    RELATIONSHIP

     

     

    9.

    LIST ALL PAST, PRESENT AND ANTICIPATED EMPLOYMENT AS A PROFESSIONAL SOLICITOR.  THROUGH THE END OF THE FISCAL YEAR INDICATE ALL TERMS OF COMPENSATION. BE SPECIFIC: INDICATE ACTUAL RATE PER HOUR, % OF FUNDS or OTHER ARRANGEMENT.

     

    NAME and ADDRESS of PROFESSIONAL FUND RAISER

    TERMS of COMPENSATION

    FROM and To Dates (Month/Day/Year)

     

     

     

     

     

     

    10.

    ARE YOU LICENSED, REGISTERED OR HAVE A PERMIT FROM ANY OTHER STATE OR GOVERNMENTAL BODY FOR SOLICITING

     

    FUNDS FOR CHARITABLE ORGANIZATIONS?   YES    NO  IF "YES" COMPLETE THE FOLLOWING:

     

    NAME and ADDRESS of STATE or GOVERNMENT

    DATE of AUTHORIZATION

     

     

    11.

    ARE YOU TO RECEIVE, FOR TAX PURPOSES, A W-2 OR 1099 FROM PFR?    YES    NO 

    12.

    HAS ANY LICENSE OR PERMIT BEEN DENIED, CANCELED OR REVOKED, OR HAS ANY ACTION BEEN TAKEN

     

    AGAINST YOU IN CONNECTION WITH SOLICITATION OF FUNDS FOR CHARITABLE PURPOSES?    YES    NO

     

    IF "YES"  COMPLETE THE FOLLOWING:

     

    NAME and ADDRESS of GOVERNMENTAL AGENCY

    NATURE and DATE of ACTION

     

     

    13

    ARE YOU AN EMPLOYEE OF OR INDEPENDENT CONTRACTOR WITH THE PER?

     

    14.

    HAVE YOU EVER BEEN CONVICTED OF A CRIME INVOLVING THE MISUSE OR THEFT OF MONEY?    YES    NO

     

    AFFIDAVIT OF INDIVIDUAL

     

    STATE OF

     

    )

    SS

     

    COUNTY OF

     

    )

     

     

     

    , BEING DULY SWORN

    DEPOSES AND SAYS THAT S/HE IS THE INDIVIDUAL WHO HAS MADE THE FOREGOING PROFESSIONAL SOLICITOR'S REGISTRATION STATEMENT, AS REQUIRED BY SECTION 8 OF "AN ACT TO REGULATE THE SOLICITATION AND COLLECTION OF FUNDS FOR CHARITABLE PURPOSES"; THAT S/HE HAS READ THE FOREGOING REGISTRATION STATEMENT AND KNOWS THE CONTENTS THEREOF; THAT S/HE IS AUTHORIZED TO VERIFY THIS REGISTRATION STATEMENT; THAT THE SAME IS TRUE TO HER/HIS OWN KNOWLEDGE; AND THAT THE STATEMENT WAS MADE FOR THE PURPOSE OF COMPLYING WITH THE REQUIREMENTS OF SECTION 8 OF SAID ACT.

     

    Subscribed and sworn to before me,

    this

     

    day of

     

    , 19

     

     

     

     

     

     

    (Signature)

    NOTARY PUBLIC

     

     

    NOTE:

    If sworn to outside the State of Illinois, a certificate of the County Clerk or other proper official, showing authority of the notary public or other official before whom the oath is administered, shall be attached.

     

     

     

     

    AFFIDAVIT BY PROFESSIONAL FUND RAISER

     

    STATE OF

     

    )

    SS

    COUNTY OF

     

    )

     

     

     

    , BEING DULY SWORN

    DEPOSES AND SAYS THAT S/HE IS THE (Title of Office)

     

    OF THE (Name of Corporation)

     

    OR MEMBER OF THE FIRMS OF (Partner or Association)

     

    OR THE INDIVIDUAL WHO OR WHICH HAS or INTENDS TO EMPLOY THE FOREGOING PROFESSIONAL SOLICITATOR WHO IS REGISTERING, AS REQUIRED BY SECTION 8 OF "AN ACT TO REGULATE THE SOLICITATION AND COLLECTION OF FUNDS FOR CHARITABLE PURPOSES"; THAT S/HE HAS READ THE FOREGOING REGISTRATION STATEMENT AND KNOWS THE CONTENTS THEREOF; THAT S/HE IS AUTHORIZED TO VERIFY INFORMATION IN THIS REGISTRATION STATEMENT IS THE SAME AS IN THE EMPLOYMENT RECORDS OF THE PROFESSIONAL FUND RAISER; AND THAT THE STATEMENT WAS MADE FOR THE PURPOSE OF COMPLYING WITH THE REQUIREMENTS OF SECTION 8 OF SAID ACT.

     

    Subscribed and sworn to before me,

    this

     

    day of

     

    , 19

     

     

     

     

     

    (Signature)

    NOTARY PUBLIC

     

    NOTE:

    If sworn to outside the State of Illinois, a certificate of the County Clerk or other proper official, showing authority of the notary public or other official before whom the oath is administered, shall be attached.

     

     

     

    (Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

    Section 400.APPENDIX D   Professional Fund Raising Consultant Forms

     

    Section 400.ILLUSTRATION A   Registration Statement

     

     

    Form PFC-01

    PROFESSIONAL FUNDRAISING CONSULTANT

    – REGISTRATION STATEMENT –

    Jim Ryan

    Attorney General

     

    PLEASE TYPE OR PRINT IN BLACK INK.  Respond to all items. If unable to answer in space provided attach a schedule in the same format.  Changes of or additions to the information in this statement are to be submitted in this format. All consultants must attach an affidavit attesting that the professional fund raising consultant has not or will not at any time have custody or control of charitable contributions.  Copies of all fund raising contracts must be submitted to this Office within ten (10) days of signing. If any of the information in this statement changes, this Office must be notified in writing within 10 days of the changes. All contracts between professional fund raising consultants and charitable organizations must be in writing and filed by the PFR with the Attorney General within ten (10) days of execution. Contracts shall contain the charity's legal name, their registration number, a street address, a contact party and that party's daytime telephone number. Changes or additions to the information in this statement must be submitted on this form.  One copy of this Registration Statement and attachments are to be filed with the Office of the Attorney General, Charitable Trust and Solicitations Bureau, 100 West Randolph Street, Chicago, Illinois 60601.

     

    1.

    THIS IS A (CHECK ONE and DATE):

     

     

     

    NEW REGISTRATION (  )  REREGISTRATION (  )  CHANGE (  ) ADDITON (  ) AS OF  

          /        /     

     

    2.

    LEGAL NAME

    REGISTRATION/REREGISTRATION

    For Two (2) Years Upon Filing with the Attorney General

     

     

     

    3.

    MAIL ADDRESS

    PFR NUMBER

    11-

     

     

     

     

     

    CITY, STATE, ZIP CODE

    PHONE NUMBER

    FEDERAL ID NUMBER

     

     

     

     

     

     

     

     

    4.

    TYPE OF FIRM (Individual, Partnership or Corporation)

     

     

     

    5.

    WHERE and WHEN ORGANIZED (Corporations must ATTACH Charter & Articles)

     

     

     

     

    6.

    NAME OF MANAGEMENT PERSON & PRESIDENT

     

    TITLE

     

     

     

    7.

    A STREET ADDRESS (if different than above)

     

     

     

    8.

    NAME OF ILLINOIS REGISTERED AGENT

     

     

     

    9.

    AGENT'S MAIL ADDRESS (if P.O. BOX also a street address)

     

     

     

     

    10.

    GIVE PRINCIPAL ILLINOIS ADDRESS, IF ANY, AT WHICH RECORDS ARE KEPT AND NAME OF CUSTODIAN (NOT A P.O. BOX)

     

     

     

     

    11.

    LIST ALL BUSINESS LOCATIONS, OTHER THAN ABOVE, USED FOR FUNDRAISING.  (ATTACH SCHEDULE INDICATING ACTIVITY DESCRIPTION, STREET ADDRESS, CITY, STATE and if temporary location BEGINNING and ENDING USE DATES.)

     

     

     

     

    12.

    IF NAME IN ABOVE IS NOT THE CORPORATE or ONLY NAME USED BY THE REGISTRANT ATTACH SCHEDULE AND DOCUMENTS TO SUPPORT LEGAL USE OF OTHER NAMES (e.g., REGISTRATION UNDER THE ASSUMED NAME ACT)

     

     

     

     

    13.

    ILLINOIS SECRETARY OF STATE'S CORPORATE FILE NO.

     

     

     

    IF A FOREIGN CORPORATION ATTACH A COPY OF AUTHORIZATION.

     

     

    14.

    LIST ALL PRINCIPAL PARTIES, OFFICERS, DIRECTORS, EXECUTIVE PERSONNEL, AND OWNERS OF TEN PERCENT OR MORE OF THE CAPITAL STOCK.  (ATTACH SCHEDULE IF NECESSARY)

     

     

     

    NAME     STREET ADDRESS      TITLE     % OF INTEREST     BIRTH DATE     DRIVERS LICENSE #     STATE OF ISSUE

     

     

     

     

     

     

     

     

     

     

    15.

    LIST THE INTEREST OF ALL PRINCIPAL PARTIES, OFFICERS, DIRECTORS, EXECUTIVE PERSONNEL, OWNERS OF REGISTRANT AND THEIR FAMILY MEMBERS HAVING ANY OWNERSHIP INTEREST IN ANY OTHER FIRMS PROVIDING GOODS OR SERVICES USED IN FUNDRAISING

     

     

     

    NATURE OF BUSINESS

    NAME of PARTY

    % INTEREST

    NAME and STREET ADDRESS OF BUSINESS

     

     

     

     

     

     

     

     

     

     

     

     

    16.

    LIST THE INFORMATION REQUESTED BELOW FOR ALL CHARITABLE ORGANIZATIONS HAVING CONTRACTS WITH THIS FIRM FOR THE PERIOD OF THIS REGISTRATION OR CURRENTLY IN EFFECT INVOLVING THE RAISING OF FUNDS IN ILLINOIS AND ATTACH COPIES OF THE CONTRACTS.

     

     

     

     

     

    ILLINOIS CO #

    LEGAL NAME and STREET ADDRESS of CHARITABLE ORGANIZATION

    FROM and TO DATES (Month/Day/Year)

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    17.

    IS THE REGISTRANT LICENSED BY, REGISTERED WITH OR HAVE A PERMIT FROM ANY OTHER GOVERNMENTAL AGENCY FOR THE PURPOSE OF PROVIDING FUNDRAISING COUNSEL FOR CHARITABLE ORGANIZATIONS          YES         NO

     

    IF "YES" LIST THE FOLLOWING INFORMATION:

     

    NAME and ADDRESS of GOVERNMENTAL AGENCY

    DATE of AUTHORIZATION (Month/Day/Year)

     

     

     

     

     

     

    18.

    HAS THE REGISTRANT EVER HAD ANY LICENSE, REGISTRATION OR PERMIT DENIED, CANCELED OR REVOKED, OR IS ANY SUCH ACTION PENDING?       YES       NO  IF "YES" ATTACH A SCHEDULE INDICATING NAME and ADDRESS of GOVERNMENTAL AGENCY, NATURE of ACTION, DATE of ACTION

     

     

     

    19.

    HAS ANY GOVERNMENTAL ACTION, OTHER THAN LISTED IN 20 ABOVE, BEEN TAKEN AGAINST THE BUSINESS OR ANY OF ITS PRINCIPAL PARTIES, EMPLOYEES, OFFICERS, DIRECTORS, EXECUTIVE PERSONNEL, OWNERS OF TEN PERCENT OR MORE OF THE CAPITAL STOCK OR THEIR RELATIONS IN CONNECTION WITH ANY FUNDRAISING ACTIVITY?        YES         NO

     

    IF "YES" ATTACH A SCHEDULE INDICATING NAME and ADDRESS of GOVERNMENTAL AGENCY, AGAINST WHOM ACTION WAS TAKEN, NATURE of ACTION, DATE of ACTION.

     

     

     

     

    20.

    HAS ANY OF THE FIRM'S PRINCIPAL PARTIES, EMPLOYEES, OFFICERS, DIRECTORS, EXECUTIVE PERSONNEL, OWNERS OF TEN PERCENT OR MORE OF THE CAPITAL STOCK OR THEIR RELATIONS EVER BEEN CONVICTED OF A MISDEMEANOR INVOLVING THE MISAPPROPRIATION OR MISUSE OF MONEY OF ANOTHER, OR OF ANY FELONY?        YES        NO

     

    IF "YES" ATTACH A SCHEDULE INDICATING NAME and ADDRESS of COURT, WHO WAS CONVICTED, NATURE of OFFENSE, DATE of CONVICTION.

     

    NOTE:  VERIFICATION MUST BE BY THE CORPORATE PRESIDENT, A GENERAL PARTNER OR THE SOLE PROPRIETOR.

     

     

    STATE OF

     

    )

    SS

    AFFIDAVIT

     

    COUNTY OF

     

    )

     

     

     

    I,

     

    , under penalty of perjury and being sworn on oath state

    that I am (strike out) the CORPORATE PRESIDENT, a GENERAL PARTNER or the SOLE PROPRIETOR of the registrant professional fund raiser.

     

     

    (Name of PFC)

     

    , that I have read the foregoing registration statement and personally

    know the contents thereof to be true, and such is stated and filed with the Illinois Attorney General for the purpose of having the people of the State of Illinois rely thereupon.  I hereby further authorize and agree to submit myself and the registrant hereby to the jurisdiction of the State of Illinois.

     

     

    Subscribed and sworn to before me

     

     

    this

     

    day of

     

    ,

    19

     

     

     

     

     

     

     

     

     

     

     

     

    (Signature)

     

     

     

     

     

    NOTARY PUBLIC

     

     

     

    (Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)