12
|
Do you intend to use the services of a professional fund raiser
as defined by "An Act to Regulate Solicitation and Collection
|
|
|
of Funds for Charitable Purposes?"
|
Yes
|
No
|
|
If "Yes", answer a, b, and comply with c below.
|
|
|
a. Name and address of professional fund raiser(s):
|
|
|
|
|
|
|
b. Has the professional fund
raiser registered and filed a bond with the Office of the Attorney General as
|
|
|
|
required?
|
Yes
|
No
|
|
|
c. Attach copies of all contracts with professional fund
raiser(s).
|
|
13
|
Have any of organization's officers, directors, executive
personnel, or have any of the organization's employees who have
|
|
|
access to funds, ever been charged with or convicted of a
misdemeanor involving the misapplication or misuse of money of
|
|
|
another, or any felony?
|
Yes
|
No
|
If "Yes", give the following information:
|
|
NAME AND ADDRESS OF COURT
|
NATURE OF
OFFENSE
|
DATE OF CONVICTION (Mo./Yr.)
|
|
|
|
|
|
14
|
State the board, group or individual having final discretion as
to the distribution and use of contributions received
|
|
|
|
|
15
|
Will you use any of the following methods of solicitation?
|
Unordered Merchandise
|
Distribution or Sale
of Seals
|
|
|
Telephone
Appeals
|
Coin
Collection Containers
|
Special
Events
|
Ad Books
|
Direct
Mail
|
|
|
Other – If
other, attach an explanation.
|
|
16
|
List name, mailing address and title of the chief executive or
staff officer of the organization.
|
|
|
|
|
|
17
|
Attach a list of names, mailing addresses, and daytime phone
numbers of all officers and directors, or trustees of the
|
|
|
organization.
|
|
|
|
18
|
Has the United States Internal Revenue Service determined that
this organization is tax exempt?
|
Yes
|
No
|
|
|
If "Yes", attach a copy of the determination letter.
Is application pending?
|
Yes
|
No
|
|
|
*All organizations with tax exempt status or an application
pending must attach a copy of Federal Form 1023
|
|
|
"Application for Recognition of Exemption" or an
exemption letter.
|
|
19
|
Has organization's tax exempt status ever been questioned,
audited, denied or cancelled at any time by any governmental
|
|
|
agency?
|
Yes
|
No
|
If
"Yes", attach the facts.
|
|
20
|
Organizations which have been in operation for over one (1) year
must attach a copy of the Federal return, or AG990IL if no Federal return was
filed for each year the organization was in existence, completed in detail.
Organizations which have been in operation less than one (1) year must attach
a completed Financial Information Form CO-2, notarized. Please note
charitable organization's are required to maintain accurate and detailed
accounting records.
|
|
21
|
Approximate amount of contributions solicited or income received
from persons in this State during the organization's last
|
|
|
annual accounting period $
|
|
|
|
22
|
EVERY REGISTERING ORGANIZATION MUST ATTACH THE FOLLOWING
APPLIABLE DOCUMENTS:
|
|
|
Corporation......................................
|
The Article of Incorporation, or
Certificate of Authority, Amendments and By-Laws
|
|
|
Unincorporated Association.............
|
Constitution and By-Laws
|
|
|
Testamentary Trust..........................
|
Will, Probate Number and Decree
of Distribution
|
|
|
Inter Vivos Trust...............................
|
Instrument Creating Trust
|
|
|
NOTE: The President and the Chief Financial Officer or
authorized officer both are required to sign. This must be two different
individuals. If entity is a trust, all trustees must sign.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Source: Added
at 24 Ill. Reg. 14665, effective September 21, 2000)