§480.EXHIBIT A. Registration Statement and Instructions

Form CO-1	CHARITABLE ORGANIZATION			JIM RYAN
		— REGISTRATION STATEMENT —	ATTORNEY GENERAL
PLEASE TYPE OR PRINT IN INK.  This registration statement is required by the Illinois Charitable Trust Act and "An Act to Regulate Solicitation and Collection of Funds for Charitable Purposes."  Please answer all items which are applicable to your organization.  If you are unable to answer any question fully in the space provided, please attach a sheet containing the remainder of your answer. No further registration statement is required, provided that every registered organization shall notify the Attorney General within 10 days of any change in the information submitted herein.  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 registration under

Illinois Charitable Trust Act

An Act to Regulate Solicitation and Collection of Funds for Charitable Purposes

Both Acts

2

Name of Organization

Telephone Number

Federal Employer ID #

Street and Number

City

County

State

Zip Code

3

Type of legal entity (Corporation, Trust, Unincorporated Association or other) and date, method and place organization legally

established

If a foreign corporation, when was it authorized to do business in Illinois?

If a corporation, Illinois Secretary of State's File No.

* A copy of the Articles of Incorporation or Certificate of Authority issued by the Secretary of State must be attached.

4

Name, address and telephone number of Illinois registered agent

5

Address of all offices in the State of Illinois

6

Date on which the annual accounting period of the organization ends

Month

Day

7

State the purposes of the organization and purposes for which contributions are to be used (Be specific)

8

If the name under which the organization intends to solicits funds differs from the name listed in No. 2 provide name(s) under

which contributions will be solicited, and the reason for the use of such other name(s)

9

If organization has previously been registered with the Attorney General under either Act, give name under which registered

(if different than that shown in No. 2), last registration number, and date registered

10

Has the organization been registered with any other governmental authority to solicit contributions?

Yes

No

Name of authority and date of authorization)

Is such registration current?

Yes

No

11

Has the organization or any of its officers, directors or trustees ever been enjoined or prohibited by any court or other

governmental agency from soliciting contributions, or is such action pending?

Yes

No

If "Yes", attach an explanation.

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.

 

	UNDER PENALTY OF PERJURY, THE UNDERSIGNED DECLARE AND CERTIFY THAT THE INFORMATION CONTAINED IN THIS STATEMENT AND ALL ATTACHED SHEETS IS TRUE AND CORRECT TO THE BEST OF OUR KNOWLEDGE.
	Signature	Title	Date
	Signature	Title	Date

 

(Source:  Added at 24 Ill. Reg. 14665, effective September 21, 2000)