STATE OF TENNESSEE

DEPARTMENT OF SECRETARY OF STATE

CHARITABLE ORGANIZATION REGISTRATION INSTRUCTIONS

AND SUPPLEMENTAL REGISTRATION FORM

Read instructions carefully.� Complete all questions and provide all requested information.��� A copy of the �Summary of Financial Activities (SFA) Form and the organization�s filed IRS Form 990 (and any other forms required to be filed with the IRS) must be submitted with the registration application.� Organizations with gross revenue in excess of� $250,000 must also submit an audit report.

Registrations expire each year on the organization�s anniversary date.� The last day of the sixth month following the month in which the fiscal year ends is the organization�s anniversary date.� Applications received after the expiration of the current registration period shall be assessed a late fee of twenty-five dollars ($25.00) for each month, or portion thereof, that the report is late filed.� Registration applications will not be approved until late fee assessments are paid.

INSTRUCTIONS

1.� Complete the Unified Registration Statement (URS).

2.� Submit the required filing fee.

3.�������� In addition to the information supplied in the URS, you must provide the � following information:

A.������� Title and birth date of each officer, director, and executive of the organization.� Attach a ten year employment history, beginning with their most recent employment.

B.������� Is your organization currently authorized by any Tennessee authority to solicit contributions?���� Yes __���� No __���
If the answer is �Yes�, list the municipal authorities.

FOR OFFICE USE ONLY

Date Received:

State Registration No. ������������������������������� �� Fee Payment Received $��������������������������

Receipt No. ������������������������������������������������

© 2014 MULTI-STATE FILER PROJECT