Form CHAR 410 Registration Statement for Charitable Organizations - New York

Form CHAR410 is a New York State Attorney General form also known as the "Registration Statement For Charitable Organizations". The latest edition of the form was released in January 1, 2018 and is available for digital filing.

Download an up-to-date Form CHAR410 in PDF-format down below or look it up on the New York State Attorney General Forms website.

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Registration Statement for Charitable Organizations
CHAR410
Form
New York State Department of Law (Office of the Attorney General)
Open to Public
Charities Bureau - Registration Section
28 Liberty Street
Inspection
For new registrants only
New York, NY 10005
(Amending use CHAR410-A,
Re-registering use CHAR410-R)
www.charitiesnys.com/
Part A - Identification of Registrant
1. Full name of organization (exactly as it appears in your organizing document)
5. Fed. employer ID no. (EIN)
__ __ - __ __ __ __ __ __ __
2. c/o Name (if applicable)
6. Organization’s website
Room/suite
3. Mailing address (Number and street)
7. Primary contact
City or town, state or country and ZIP+4
Title
4. Principal NYS address (Number and street)
Room/suite
Phone
Fax
City or town, state or country and ZIP+4
Email
Part B - Certification - Two Signatures Required
We certify under penalties for perjury that we reviewed this Registration Statement, including all schedules and attachments, and to the best of our
knowledge and belief, they are true, correct and complete in accordance with the laws of the State of New York applicable to this statement.
1. President or Authorized Officer/Trustee
Signature
Printed Name
Title
Date
2. Chief Financial Officer or Treasurer
Signature
Printed Name
Title
Date
Part C - Fee Submitted
If registering to solicit contributions, fee is $25.
-9
Submit check or money order,
Check
if you are submitting $25 fee to
If not registering to solicit contributions, no fee is owed.
payable to “NYS Department of Law.”
register to solicit contributions.
Part D - Attachments - All Documents Required
Attach all of the following documents to this Registration Statement, even if you are claiming an exemption from registration:
Certificate of incorporation, trust agreement or other organizing document, and any amendments; and
Bylaws or other organizational rules, and any amendments; and
IRS Form 1023 or 1024 Application for Recognition of Exemption (if applicable); and
IRS tax exemption determination letter (if applicable)
Part E - Request for Registration Exemption
G
G
Is the organization requesting exemption from registration under either or both Article 7-A or the EPTL? . . . . . . . . . . . . . . . . . . . . . . . . .
Yes*
No
* If “Yes”, complete Schedule E.
Page 1 of 3
Form CHAR410 (2018)
Registration Statement for Charitable Organizations
CHAR410
Form
New York State Department of Law (Office of the Attorney General)
Open to Public
Charities Bureau - Registration Section
28 Liberty Street
Inspection
For new registrants only
New York, NY 10005
(Amending use CHAR410-A,
Re-registering use CHAR410-R)
www.charitiesnys.com/
Part A - Identification of Registrant
1. Full name of organization (exactly as it appears in your organizing document)
5. Fed. employer ID no. (EIN)
__ __ - __ __ __ __ __ __ __
2. c/o Name (if applicable)
6. Organization’s website
Room/suite
3. Mailing address (Number and street)
7. Primary contact
City or town, state or country and ZIP+4
Title
4. Principal NYS address (Number and street)
Room/suite
Phone
Fax
City or town, state or country and ZIP+4
Email
Part B - Certification - Two Signatures Required
We certify under penalties for perjury that we reviewed this Registration Statement, including all schedules and attachments, and to the best of our
knowledge and belief, they are true, correct and complete in accordance with the laws of the State of New York applicable to this statement.
1. President or Authorized Officer/Trustee
Signature
Printed Name
Title
Date
2. Chief Financial Officer or Treasurer
Signature
Printed Name
Title
Date
Part C - Fee Submitted
If registering to solicit contributions, fee is $25.
-9
Submit check or money order,
Check
if you are submitting $25 fee to
If not registering to solicit contributions, no fee is owed.
payable to “NYS Department of Law.”
register to solicit contributions.
Part D - Attachments - All Documents Required
Attach all of the following documents to this Registration Statement, even if you are claiming an exemption from registration:
Certificate of incorporation, trust agreement or other organizing document, and any amendments; and
Bylaws or other organizational rules, and any amendments; and
IRS Form 1023 or 1024 Application for Recognition of Exemption (if applicable); and
IRS tax exemption determination letter (if applicable)
Part E - Request for Registration Exemption
G
G
Is the organization requesting exemption from registration under either or both Article 7-A or the EPTL? . . . . . . . . . . . . . . . . . . . . . . . . .
Yes*
No
* If “Yes”, complete Schedule E.
Page 1 of 3
Form CHAR410 (2018)
Part F - Organization Structure
1. Incorporation / formation
a. Type of organization:
b. Type of corporation if New York not-for-profit corporation
G
Corporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
G
G
G
G
A
B
C
D
G
Limited liability company (LLC) . . . . . . . . . . . . . . . . . . . . . . . . .
G
Partnership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Date incorporated if a corporation or formed if other than a corporation
G
Sole proprietorship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
__ __ / __ __ / __ __ __ __
G
Trust . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
G
Unincorporated association . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. State in which incorporated or formed
G
Other * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
* If Other, describe:
2. List all chapters, branches and affiliates of your organization (attach additional sheets if necessary)
Mailing address (number and street, room/suite,
Name
Relationship
City or town, state or country and zip+4)
3. List all officers, directors, trustees and key employees
Mailing address (number and street, room/suite,
End of term
Name
Title
city or town, state or country and zip+4)
(if applicable)
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
4. Other Names and Registration Numbers
a. List all other names used by your organization, including any prior names
b. List all prior New York State charities registration numbers for the organization, including those from the New York State Attorney General’s
Charities Bureau or the New York State Department of State’s Office of Charities Registration
Page 2 of 3
Form CHAR410 (2018)
Part G - Organization Activities
1. Month the annual accounting period ends (01-12)
2. NTEE code
3. Date organization began doing each of following in New York State:
a. conducting activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __ __ / __ __ / __ __ __ __
b. maintaining assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __ __ / __ __ / __ __ __ __
c. soliciting contributions (including from residents, foundations, corporations, government agencies, etc.) . . . . . . . . . __ __ / __ __ / __ __ __ __
4. Describe the purposes of your organization
5. Has your organization or any of your officers, directors, trustees or key employees been:
G
G
a. enjoined or otherwise prohibited by a government agency or court from soliciting contributions? . . . . . . . . . . . . . . . . . . . . . . . . .
Yes*
No
* If “Yes”, describe:
G
G
b. found to have engaged in unlawful practices in connection with the solicitation or administration of charitable assets? . . . . . . . .
Yes*
No
* If “Yes”, describe:
G
G
6. Has your organization’s registration or license been suspended by any government agency? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes*
No
* If “Yes”, describe:
7. Does your organization solicit or intend to solicit contributions (including from residents, foundations, corporations, government
G
G
agencies, etc.) in New York State? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes*
No
* If “Yes”, describe the purposes for which contributions are or will be solicited:
8. List all fund raising professionals (FRP) that your organization has engaged for fund raising activity in NY State (attach additional sheets if
necessary)
Mailing address (number and street, room/suite,
Type of FRP
Name
city or town, state or country and zip+4)
Dates of contract
(see instructions for definitions)
Start date:
_ _ / _ _ / _ _ _ _
PFR . . . . . . . . . . . . . . . . G
FRC . . . . . . . . . . . . . . . . G
End date:
_ _ / _ _ / _ _ _ _
CCV . . . . . . . . . . . . . . . . G
Start date:
_ _ / _ _ / _ _ _ _
PFR . . . . . . . . . . . . . . . . G
FRC . . . . . . . . . . . . . . . . G
End date:
_ _ / _ _ / _ _ _ _
CCV . . . . . . . . . . . . . . . . G
Start date:
_ _ / _ _ / _ _ _ _
PFR . . . . . . . . . . . . . . . . G
FRC . . . . . . . . . . . . . . . . G
End date:
_ _ / _ _ / _ _ _ _
CCV . . . . . . . . . . . . . . . . G
Part H - Federal Tax Exempt Status
1. If applicable, list the date your organization:
a. applied for tax exempt status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __ __ / __ __ / __ __ __ __
b. was granted tax exempt status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __ __ / __ __ / __ __ __ __
c. was denied tax exempt status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __ __ / __ __ / __ __ __ __
d. had its tax exempt status revoked . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __ __ / __ __ / __ __ __ __
2. Provide Internal Revenue Code provision:
501(c)( ___ )
Page 3 of 3
Form CHAR410 (2018)

Download Form CHAR 410 Registration Statement for Charitable Organizations - New York

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